Pathophysiology of Urinary Tract Obstruction

Strandhoy, Jack W.; Assimos, Dean G.

doi:10.1016/b978-1-4160-6911-9.00040-2

Cited by 38 publications

(98 citation statements)

References 426 publications

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“…These were all experimental animal studies. It is well-documented that the response of kidneys to UUO is species-specific and animal models may not adequately reflect the exact mechanism (6). For this reason, we tried to design a human Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…The response of the kidney to relief of UUO is species-specific and depends on age of the patient, duration and extent of obstruction, function of the contralateral kidney, and compliance of the ureter and renal pelvis (5). UUO demonstrates a triphasic pattern of RBF and ureteral pressure changes which is different from bilateral ureteral obstruction or UUO of a solitary kidney (6).…”

Section: Introductionmentioning

confidence: 99%

“…There are several studies demonstrating the effect of ureteral obstruction on renal function and the reversibility of some changes after the relief of obstruction (6). Indeed, most of the studies were on animal models and the human studies were generally retrospective studies (5,7,8).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Yazıcı¹,

Tavukçu²,

Tınay³

et al. 2016

jus

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What's known on the subject? and What does the study add? ÖZ AmaçÇalışmamızda akut/subakut tek taraflı komplet üreteral tıkanıklığa bağlı böbrek fonksiyonlarının nefrostomi ile tedavi sonrası değişimini göstermek amaçlanmıştır. gereç ve yöntemOtuz hasta prostpektif olarak çalışmaya dahil edilmiştir. Hepsinin üreter taşı olup 24'ünde (%80) üst üreter ve 6'sında (%20) orta üreter yerleşimliydi. Tüm hastaların ileri düzeyde hidronefrozu olduğu için perkütan nefrostomi takılması planlandı. Nefrostomi takıldıktan sonra 1. haftada etkilenen böbrek nefrostomiden ve diğer böbrek üretral kreatinin klirensi ölçümü ile değerlendirilmiştir. Değişikliği saptamak için de 1. ayda nefrostomi ve üretral kreatinin klirensleri hesaplanıp 1. haftadaki sonuçlar ile karşılaştırılmıştır. BulgularHastalarımızın ortalama yaşı 44,6'dır (36-54). Etkilenen böbreğin 1. haftadaki kreatinin klirensi 38,8±4,9 ml/dak iken 1. aydaki değer 42,5±5,4 ml/dk'ya yükselmiştir (p<0,001). Tüm hastaların kreatini klirens analizlerinde %2,3 ile %17,3 arasında artış saptanmıştır. SonuçÇalışma sonuçlarımıza göre tek taraflı komplet üreteral tıkanıklığa bağlı bozulan böbrek fonksiyonu nefrostomi takılması sonrası 1. ayda 1. haftaya göre anlamlı olarak düzelmektedir. Bu düzelme böbrek fonksiyonları sınırda olan tek taraflı tıkanıklığı olan hastalarda asıl tedaviye veya nefrektomi yapmaya karar vermede etkili olacaktır. Anahtar KelimelerKreatinin klirens, nefrostomi, obstrüktif üropati objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and MethodsThirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. ResultsThe mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8±4.9 ml/min in the first week of urinary diversion and increased to 42.5±5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5±4.7%. ConclusionAccording to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidney KeywordsCreatinine clearance, nephrostomy, obstructive uropathy This is first study that evaluated the renal function change after relief of unilateral ureteral obstruction because of ureteral stones.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Yazıcı¹,

Tavukçu²,

Tınay³

et al. 2016

jus

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“…16 Microscopic pathological changes reported in models of pig kidney occurs 5 to 6 weeks after the obstruction and chronic obstruction of the human kidney. Microscopic changes include collapse (atrophy) glomerular and tubular atrophy, interstitial fibrosis, and proliferation of connective tissue.…”

mentioning

confidence: 99%

“…The most widely used serum creatinine based formulas in adults for estimated GFR (eGFR) are the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease Study (MDRD). 12 Chronic kidney disease (CKD) is a characterized by progressive and irreversible loss of renal function. The increasing inability of the kidneys to properly clear the blood of waste products eventually results in the end-stage renal disease (ESRD) and requiring renal replacement therapy such as dialysis and transplantation to prevent azotemia, systemic organ damage and death.…”

mentioning

confidence: 99%

The Role of Glomerulosclerosis and Tubular Atrophy as Determining Factor for Reduced Kidney Function in Kidney Stone Disease

Oka

Widiana

2015

Bali Med J.

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Background: Kidney fibrosis including glomerulosclerosis (GS) and tubulointerstitial fibrosis (TIF) or tubular atrophy (TA) may be predictor of kidney dysfunction. Estimated glomerular filtration rate (eGFR) is a common laboratory examination to estimate the kidney function. The aim of this research is to determine relationship between histologic features namely glomerulosclerosis (GS) and tubular atrophy (TA), and estimated glomerular filtration rate (eGFR) in kidney stone disease. Methods: A cross-sectional study in a total of the 63 patients with kidney stone consisted of 25 (39.7 %) males and 38 (60.3 %) females, aged (51 ± 11 years), Blood urea nitrogen (BUN) 16 (8-62) mg/dl, serum creatinine 1.26 ( 0.47-6.76 ) mg/dl and eGFR 61.4 ± 32.1 ml/min. Histologic features showed GS index 6 (0-30) and TA index 892 ± 333. There was significant correlation between eGFR and GS index dan TA index(r -0,577; p=0.001 and 0,514;p = 0,001, consecutively). Multivariate regresion equations were eLFG = 67,21 -1.63 (GS index) and eLFG = 67,21 + 0,01 (TA index). Estimated GFR may be used as a marker of glomerulosclerosis and tubular atrophy in obstructive nephropathy of kidney stone patients.Keywords: kidney; fibrosis; filtration; glomerulosclerosis, tubular atrophy. INTRODUCTIONRenal fibrosis is a main feature of the microscopic anatomy of renal pathology, characterized by glomerulosclerosis (GS) and tubulointerstitial fibrosis or tubular atrophy (TA), with clinical manifestations of chronic kidney disease (CKD). This condition may progress to end-stage renal disease (ESRD) which required renal replacement therapy such as dialysis and kidney transplantation. The most common causes of CKD are glomerulonephritis, metabolic disease, obstructive nephropathy, interstitial nephritis and nephropathy diseases including cystic kidney disease.1 The incidence and prevalence of CKD in the world is on the rise, threatening to ESRD for the next decade, not all countries are able to overcome this problem. In the UK, the incidence and prevalence of ESRD approximately 10% and 60 %, in Europe an average 13 % and 70 %, and in the United States approximately 33 % and 140 %.

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Intestinal seromuscular tunneling: a novel method for ureteral replacement—an experimental design

et al. 2015

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Pathophysiology of Urinary Tract Obstruction

Cited by 38 publications

References 426 publications

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

The Role of Glomerulosclerosis and Tubular Atrophy as Determining Factor for Reduced Kidney Function in Kidney Stone Disease

Intestinal seromuscular tunneling: a novel method for ureteral replacement—an experimental design

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