Pathophysiology of Ureteropelvic Junction Obstruction: Experimental and Clinical Observations

Koff, Stephen A.; Hayden, Lawrence J.; Cirulli, Christopher; Shore, Richard M.

doi:10.1016/s0022-5347(17)44859-2

Cited by 94 publications

(50 citation statements)

References 4 publications

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“…A partial unilateral ureteral stenosis was obtained using the procedure of Koff et al (7). A ligature was placed onto the proximal (5 right, 5 left) and distal (6 right, 4 left) ureter of 20 animals.…”

Section: Methodsmentioning

confidence: 99%

Diuretic Renography in Hydronephrosis: Delayed Tissue Tracer Transit Accompanies Both Functional Decline and Tissue Reorganization

Schlotmann¹,

Clorius²,

Rohrschneider³

et al. 2008

J Nucl Med

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The significance of delayed tissue tracer transit (TTT) of 99m Tcmercaptoacetyltriglycine ( 99m Tc-MAG3) has not been systematically evaluated in hydronephrosis. We sought to demonstrate that delayed TTT accompanies both functional decline and histomorphologic restructuring. Methods: Twenty 2-to 3-mo-old piglets with surgically induced partial unilateral ureteral stenosis were examined with magnetic resonance urography (MRU) to evaluate morphology and with 99m Tc-MAG3 diuretic renography (DR) to determine single-kidney function (SKF), evaluate the response to furosemide stimulation (RFS), and assess TTT. All animals had DR and MRU before and after surgery and a third DR after surgery. Piglets were sacrificed after the final DR for renal histology. A total histologic score (THS) was generated. Results: Preoperative DR demonstrated nonobstructive RFS, timely TTT, and balanced SKF in all 20 kidneys. After ureteral ligature, MRU demonstrated pelvic dilatation in all piglets. The postoperative DRs revealed 12 kidneys with delayed TTT in one or both followups. In these 12 kidneys, the SKF declined from 51% 6 4% to 18% 6 14%, and the THS was 9.0 6 4.0. Three kidneys always had timely TTT, balanced SKF, and a THS of 1.8 6 0.3. The contralateral, nonoperated kidneys had timely TTT and a THS of 1.2 6 0.9. Postoperative scintigrams showed that 3 of 8 kidneys (38%) with an obstructive RFS had timely TTT, which demonstrates that TTT and RFS are not equivalent. Conclusion: In hydronephrosis, a delayed TTT of 99m Tc-MAG3 accompanies both functional decline and histomorphologic restructuring in obstruction. According to the literature, a delayed TTT is determined by the filtration fraction of the kidneys and appears to identify an obstruction-mediated upregulated renin-angiotensin system.

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Section: Methodsmentioning

confidence: 99%

Diuretic Renography in Hydronephrosis: Delayed Tissue Tracer Transit Accompanies Both Functional Decline and Tissue Reorganization

Schlotmann¹,

Clorius²,

Rohrschneider³

et al. 2008

J Nucl Med

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“…Crossing vessels, which are thought to cause from 40% to over 50% of the extrinsic UPJ obstructions in adults [4,5], are located ventral more often than dorsal to the UPJ. These are usually normal vessels of the lower pole segment [4,[6][7][8][9], which can be divided into additional renal arteries arising from the aorta, and accessoric renal arteries arising from branches of the aorta [10,11]. The primary surgical therapy of choice is endoscopic endopyelotomy [12].…”

mentioning

confidence: 99%

Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract: a 64-slice multidetector CT study in 1072 patients with 2132 kidneys

Glodny

Rapf²,

Unterholzner³

et al. 2011

BJR

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Objective: The aim of this study was to find out on an unselected patient group whether crossing vessels have an influence on the width of the renal pelvis and what independent predictors of these target variables exist. Methods: In this cross-sectional study, 1072 patients with arterially contrasted CT scans were included. The 2132 kidneys were supplied by 2736 arteries. Results: On the right side, there were 293 additional and accessory arteries in 286 patients, and on the left side there were 304 in 271 patients. 154 renal pelves were more than 15 mm wide. The greatest independent factor for hydronephrosis on one side was hydronephrosis on the contralateral side (p,0.0001 each). Independent predictors for the width of the renal pelvis on the right side were the width of the renal pelvis on the left, female gender, increasing age and height; for the left side, predictors were the width of the renal pelvis on the right, concrements, parapelvic cysts and great rotation of the upper pole of the kidney to dorsal. Crossing vessels had no influence on the development of hydronephrosis. Only anterior crossing vessels on the right side are associated with widening of the renal pelvis by 1 mm, without making it possible to identify the vessel as an independent factor in multivariate regression models. Conclusion: The width of the renal pelvis on the contralateral side is the strongest independent predictor for hydronephrosis and the width of the renal pelvis. There is no link between crossing vessels and the width of the renal pelvis.

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“…The one used by us concerns newborn rats, the kidneys of which are still fetal, corresponding approximately to the 20-30th gestational week in the human [11]. The Ulm and Miller procedure [9] creates an obstruction that is partial, moderate though long-term significant, and shaped as a 'high insertion' [8] which is more harmful than a simple stenosis [12]. Furthermore, the obtained obstruction is not automatically aggravating over time, as no artificial material is included which would implicate a successively increasing mismatch between the static device and the rapidly growing ureter.…”

Section: Discussionmentioning

confidence: 99%

Experimental Partial Ureteric Obstruction in Newborn Rats

Josephson

Jacobsson²,

Larsson

1998

Urol Int

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Partial obstruction of the left ureter was created in newborn rats. Unobstruction was performed after 2 or 7 days. The investigations were carried out at 9 weeks of age – under slight hydropenia to institute an element of stress. Unobstruction was successful. On the unobstructed side, there were nevertheless impairments as compared to controls: urine osmolality (–32%), free water reabsorption (–44%), potassium excretion (–34%), renal blood flow (–36%) and glomerular filtration (–36%). On the intact contralateral side, tubular changes were the only signs of an attempt to compensate. Thus, consistent renal damage remained despite a very early unobstruction. Furthermore, the changes were similar to those we observed during long-term permanent obstruction. The injury seems to be established within a very short time and imitates the probable development seen in the affected fetus: after start of production, the urine is confronted by the preformed obstruction at the pyeloureteral junction. A high-pressure-prone system is built up and is not reversed, until the pelvis has become dilated and thus capable to buffer urinary flow peaks. Thereafter, no further deterioration occurs except in specific conditions. If clinically applicable, these observations implicate that there is no advantage with surgical intervention, even when performed early in fetal life, and there is no need for swift intervention, as the damage does not progress after its establishment. Most of the cases probably do not require surgery at all, unless pain, obvious functional impairment or urinary tract infection supervene.

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Pathophysiology of Ureteropelvic Junction Obstruction: Experimental and Clinical Observations

Cited by 94 publications

References 4 publications

Diuretic Renography in Hydronephrosis: Delayed Tissue Tracer Transit Accompanies Both Functional Decline and Tissue Reorganization

Diuretic Renography in Hydronephrosis: Delayed Tissue Tracer Transit Accompanies Both Functional Decline and Tissue Reorganization

Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract: a 64-slice multidetector CT study in 1072 patients with 2132 kidneys

Experimental Partial Ureteric Obstruction in Newborn Rats

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