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1
Carlström, Mattias. "Development of Salt-Sensitive Hypertension in Hydronephrosis". Doctoral thesis, Uppsala University, Department of Medical Cell Biology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8586.
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Hydronephrosis, due to ureteropelvic junction obstruction, is a common condition in infants with an incidence of approximately 0.5-1%. During the last decade, the surgical management of non-symptomatic hydronephrosis has become more conservative, and the long-term physiological consequences of this new policy are unclear. The overall aim of this thesis was to determine whether there is a link between hydronephrosis and the development of hypertension. Hydronephrosis was induced by partial ureteral obstruction in 3-week old rats or mice. In the adult animals, blood pressure was measured telemetrically during different sodium conditions and the renal function was evaluated. Both species developed salt-sensitive hypertension and histopathological changes (i.e. fibrosis, inflammation, glomerular and tubular changes) that correlated with the degree of hydronephrosis. An abnormal renal excretion pattern with increased diuresis and impaired urine concentrating ability was observed in hydronephrosis. The mechanisms were primarily located to the diseased kidney, as relief of the obstruction attenuated blood pressure and salt-sensitivity. Increased renin angiotensin system activity, due to ureteral obstruction, might be involved in the development but not necessary the maintenance of hypertension. Hydronephrotic animals displayed reduced nitric oxide availability, which might be due to increased oxidative stress in the diseased kidney. Renal nitric oxide deficiency and subsequent resetting of the tubuloglomerular feedback mechanism, appeared to have an important role in the development of hypertension. In conclusion, experimental hydronephrosis, induced by partial ureteral obstruction, provides a new model for studies of salt-sensitive hypertension. Furthermore, the new findings imply that the current conservative treatment strategy in hydronephrosis should be reconsidered in favour of treatment that is more active, in order to prevent the development of renal injury and hypertension in later life.
2
Samnakay, Naeem. "Antenatal bladder outflow obstruction : effects of morphology and apoptosis in the fetal kidney, and effects on fetal ACTH and cortisol levels in an ovine model". University of Western Australia. School of Women's and Infants' Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0151.
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Posterior urethral valves cause bladder outflow obstruction and damage to the developing fetal kidney. Posterior urethral valves affect 1 in 8000 new-born males. A third of these children develop end stage renal failure by adolescence, despite valve ablation in the early post-natal period, implying that majority of the damage to the kidneys occurs in utero. How does this damage occur, and should we intervene in utero? The answers to these questions require further research, and are the basis to this thesis. This thesis focused on the effect bladder outflow obstruction has on morphology and apoptosis in the fetal kidney in a fetal lamb model. It also looked at the effect of bladder outflow obstruction on fetal stress hormone levels. Bladder outflow obstruction was created surgically in fetal lambs at day 70 of gestation, and fetal kidneys were analysed at day 2, 5, 10, 20 and 30 after creation of obstruction. Controls undergoing sham surgery were used for comparison. Four aspects were investigated: - effects of bladder outflow obstruction on renal histology effects of bladder outflow obstruction on expression of pro-apoptosis gene Bax and anti-apoptosis gene Bcl-X - effects of bladder outflow obstruction on renal regional apoptosis effects of bladder outflow obstruction on serum fetal ACTH and cortisol levels. Bladder outflow obstruction resulted in sequential morphological change in the fetal kidney over time. By 2 days post-obstruction, cystic change was noted. In addition, patchy attenuation of the nephrogenic blastema was evident by 5 days post-obstruction, with more confluent blastemal attenuation as well as generalized renal architectural disorganization by 10 days post-obstruction. By 20 and 30 days post-obstruction, cystic renal dysplasia had developed. Bladder outflow obstruction resulted in an increase in the ratio of renal expression of pro-apoptosis gene Bax to anti-apoptosis gene Bcl-X. Regional apoptosis counts showed increased tubular apoptosis compared to controls at 2 days post-obstruction, and increased blastemal apoptosis compared to controls at 5 days post-obstruction. By 10 days post-obstruction, blastemal apoptosis counts were reduced compared to controls. There were no significant differences in fetal serum ACTH and cortisol levels between fetal lambs with bladder outflow obstruction and controls. In conclusion, the results of this thesis outline the spectrum of morphological change in the fetal kidney over 30 days of bladder outflow obstruction. They show that detectable changes in morphology occur within two days of bladder outflow obstruction. Likewise, detectable changes in gene expression occur within 2 days of bladder outflow obstruction. The increased ratio of expression of Bax to Bcl-X suggests a swing towards increased apoptosis in response to bladder outflow obstruction. Further research is required to ascertain if these changes are reversible. However, the early onset of these changes as shown in this thesis suggests that any fetal intervention to protect the fetal kidney from the effects of bladder outflow obstruction may need to be instituted very early in gestation
3
Pegolo, Patrícia Traballi de Carvalho 1978. "Aferição da pressão anterógrada do trato urinário alto em crianças com hidronefrose pós-operatória persistente = Antegrade pressure measurement of the upper urinary tract in children with postoperative persistent hydronephrosis". [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310692.
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Orientadores: Márcio Lopes Miranda, Joaquim Murray Bustorff SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A dilatação do trato urinário pode existir sem a presença de obstrução. Os métodos diagnósticos dependentes da função renal podem suscitar diagnósticos equivocados. Whitaker (1973) propôs a avaliação da pressão do trato urinário submetida a um fluxo constante. Outros investigadores propuseram a perfusão da pelve renal sob pressão controlada, tornando o método mais fisiológico e reprodutível. Este estudo tem o objetivo de avaliar os resultados da aferição da pressão anterógrada do trato urinário alto (APA) em crianças com hidronefrose persistente pós-operatória e com suspeita de obstrução. Pacientes e Métodos: No período de doze anos, 26 unidades renais com hidronefrose persistente pós-operatória (12 anomalias da junção pieloureteral-JUP e 14 anomalias da junção ureterovesical-JUV), foram submetidas à avaliação da pressão do trato urinário alto para a orientação da conduta. As cintilografias renais dinâmicas (CRD), urografias excretoras (UE) e ultrassonografias (US) prévias, foram consideradas como indeterminadas para obstrução em 10 ocasiões e obstrutivas em 16. A APA foi realizada por punção da pelve renal sob radioscopia ou via estoma confeccionado previamente. Procedeu-se a infusão de solução salina com azul de metileno mais contraste iodado, sob pressão constante de 40cm de água para preenchimento do sistema urinário, aferindo-se a pressão de abertura ureteral a partir da drenagem do sistema e estabilização da coluna d'água. Resultados: Dentre os dez testes com diagnósticos prévios indeterminados, dois foram considerados não obstrutivos após a APA e tratados conservadoramente. Oito foram considerados obstrutivos e reoperados. Dos dezesseis testes classificados como obstrutivos previamente, nove confirmaram obstrução e foram submetidos à cirurgia. Sete foram considerados não obstrutivos, tratados conservadoramente e mantiveram hidronefrose e DMSA estáveis. Conclusão: A APA evitou cirurgia desnecessária em um terço dos casos e orientou o procedimento em 100%. Acreditamos que este teste simplificado é uma opção diagnóstica, quando utilizada seletivamente e principalmente, na presença de déficit funcional
Abstract: Introduction: The dilation of the urinary tract can exist even without obstruction. The diagnostic methods that depend on renal function may give rise to misdiagnosis. Whitaker (1973) proposed the evaluation of the urinary tract pressure subjected to a steady flow. Other researchers have proposed the perfusion of the renal pelvis under controlled pressure, making the method most physiological and reproducible. The aim of this study is evaluate the results of antegrade pressure measurements of the upper urinary tract (APA) in children with persistent hydronephrosis with suspected postoperative obstruction. Patients and Methods: During twelve years, 26 renal units with persistent postoperative hydronephrosis (12 JUP and 14 JUV), underwent pressure evaluation of the urinary tract to guide the patient management. The previous scintigraphy (DTPA), intravenous pyelography and ultrasonography were considered indeterminate for obstruction on 10 times and obstructive in 16. The APA was performed by puncture of the renal pelvis under fluoroscopy or by stoma previously performed. After accessing the renal pelvis, infusion of a mix of saline, methylene blue and contrast medium was performed, under constant pressure of 40cm of water, filling the urinary tract. Measurements of the uretheral opening pressure were taken after the water column was stabilized. Results: Often cases that had a previous undetermined diagnostics, after APA test, two cases were considered non-obstructive and had a conservative treatment. Eight tests were considered obstructive and the patients had a re-do operation. Of sixteen cases previously classified as obstructive, nine units showed obstruction on APA test and these patients underwent to a new operation. The remaining 7 units were considered non-obstructive and treated conservatively, with stable hydronephrosis and DMSA in the follow up. Conclusion: The APA test guided all patient management and avoided unnecessary surgical intervention in one third of these cases. We believe that this simplified test is a diagnostic option when used selectively and mainly in the presence of poor renal function
Mestrado
Fisiopatologia Cirúrgica
Mestra em Ciências
4
MIYAKE, KOJI, HATSUKI HIBI i MASANORI YAMAMOTO. "A CASE OF UNILATERAL GIANT HYDRONEPHROSIS WITH RENAL INSUFFICIENCY". Nagoya University School of Medicine, 1995. http://hdl.handle.net/2237/16085.
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Kato, Kazuo, Chiemi Haneda i Mutsushi Matsuyama. "CONGENIC STRAIN DIFFERENCES OF RENAL MALFORMATIONS IN ACI/MNA RATS BY INTROGRESSION OF THE CHROMOSOMAL REGION OF BUF/MNA RATS CONTAINING PUR1". Nagoya University School of Medicine, 2013. http://hdl.handle.net/2237/18474.
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Bernardes, Lisandra Stein. "Análise da vascularização renal ao Power Doppler tridimensional em fetos com dilatação de vias urinárias: correlação com prognóstico renal pós-natal". Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-18022011-124911/.
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INTRODUÇÃO: Não há, até o momento, método ideal de avaliação da função renal em fetos com dilatação de vias urinárias. A ultrassonografia é utilizada como um método não invasivo e alguns parâmetros, como o índice de líquido amniótico, foram descritos na predição de insuficiência renal. Entretanto, a sensibilidade é baixa e a detecção de alterações, muitas vezes, ocorre tardiamente na gestação. A avaliação bioquímica da urina ou sangue fetais acrescenta risco à gestação e, apesar de melhorar a detecção de insuficiência renal, tem sensibilidade e especificidade baixas. O Power Doppler tridimensional é um método capaz de quantificar fluxo em órgãos parenquimatosos e tem sido utilizado na quantificação de fluxo sanguíneo de órgãos fetais e placenta. Como fetos com obstrução de vias urinárias e insuficiência renal apresentam diminuição no número de glomérulos, a quantificação do fluxo renal ao Power Doppler tridimensional poderia aprimorar a avaliação da função renal desses fetos. OBJETIVOS: quantificar o fluxo renal ao Power Doppler tridimensional em fetos com suspeita de obstrução de vias urinárias e naqueles com morfologia renal normal, avaliar a influência da profundidade nos índices vasculares e comparar os índices nos fetos que evoluíram com e sem insuficiência renal no período pós-natal. MÉTODOS: fetos com hidronefrose bilateral e/ou dilatação vesical foram prospectivamente comparados com fetos sem malformações em relação à quantificação do fluxo renal ao Power Doppler tridimensional. Os parâmetros avaliados foram IV, IVF, IF e a profundidade. Após o nascimento, as crianças foram seguidas por uma equipe de nefrologia e urologia e, de acordo com a função renal, foram classificadas em 2 grupos: insuficiência renal e função renal normal. A vascularização renal foi avaliada em cada grupo e comparada ao grupo controle. RESULTADOS: vinte e três fetos com dilatação de vias urinárias e setenta e três com morfologia renal normal foram considerados para a análise estatística. Cinco crianças (21,7%) apresentaram insuficiência renal após o nascimento. IV e IVF foram significativamente mais baixos nos casos que apresentaram insuficiência renal do que naqueles com função renal normal (p=0,009 e 0,036, respectivamente). Os três índices corrigidos pela profundidade (IVCP, IFCP e IVFCP) variaram com a idade gestacional e a variação inter-observador melhorou quando eles foram utilizados. A porcentagem do IVCP e do IVFCP em relação à controles de mesma idade gestacional foi menor nos casos que desenvolveram insuficiência renal do que naqueles que evoluíram com função renal normal. CONCLUSÕES: IV e IVF foram significativamente mais baixos em fetos que evoluíram com insuficiência renal pósnatal, porém a profundidade foi um fator interferente importante. Desta forma, IVCP e IVFCP são potencialmente melhores na avaliação de fetos com suspeita de obstrução de vias urinárias. Como os índices corrigidos pela profundidade variam de acordo com a idade gestacional, é necessária a construção de curvas de normalidade por idade gestacional para que os referidos índices possam ser avaliados na prática clínicaINTRODUCTION: There is no ideal method for prenatal evaluation of renal function whether there is a urinary tract dilatation in the fetus. Although ultrasound is a noninvasive method and some parameters have been described to evaluate fetal renal function, as amniotic fluid index, there is a lack of sensitivity to renal failure when ultrasound is used alone. Furthermore, ultrasound changes may appear late in pregnancy. Biochemical evaluation of fetal urine or blood may expose the fetus to some risk, and still lack sensitivity and specificity for renal failure. Threedimensional Power Doppler evaluation has been used to quantify blood flow in fetal organs and placenta. As urinary tract obstruction lead to decrease in renal glomeurli and consequently to a decrease in parenchymal renal flow, three-dimensional quantification of renal flow may improve the evaluation of fetal renal function in fetuses with renal dilatation. OBJECTIVES: To evaluate the ability of threedimensional evaluation of renal vascularization to predict postnatal renal prognosis in fetuses with suspicion of urinary obstruction and to analyze depth influence in vascular indexes. METHODS: Fetuses with bilateral hydronephrosis and/or bladder dilatation had renal vascularization evaluated by three-dimensional ultrasound and VOCAL and were prospectively compared to healthy fetuses. Parameters evaluated were VI, VFI, FI and the distance between the probe and the renal cortex. Follow up by urologists and nephrologists allowed us to allocate these fetuses in two groups: renal impairment and normal renal function. Renal vascularization was evaluated in each group and compared to controls. RESULTS: Twenty-three fetuses with urinary dilatation and seventy-three fetuses with normal renal morphology where considered for statistical analysis. Five fetuses (21,7%) developed renal impairment. VI and VFI where significantly lower in fetuses that developed renal impairment than in those with normal renal function (p=0.009 and 0.036 respectively). Depth-corrected indexes (VIDC, FIDC and VFIDC) varied with gestational age and inter-observer variability was improved when depth was taken into account. The percentage of VIDC and VFIDC of cases in relation to gestational aged matched controls were lower in fetuses that developed post-natal renal impairment than in fetuses with normal renal function. CONCLUSION: Although VI and VFI were significantly lower in fetuses that developed post-natal renal impairment, depth seemed to be an important confounding variable. Thus, VIDC and VFIDC were potentially useful in this context. However, since depth-corrected indexes are related to gestational age, nomograms are needed to further evaluate the role of these parameters in predicting renal impairment
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More, Stuart Setjhaba. "Renal Cortical Transit time as a predictor for pyeloplasty in paediatric patients with unilateral hydronephrosis at the Red Cross War Memorial Children's Hospital". Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30166.
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Background:
Majority of patients with unilateral hydronephrosis (HN) detected on ultrasound (US)
do not require pyeloplasty. Indications for pyeloplasty are in patients with symptomatic
obstruction (recurrent flank pain), complications such as urinary tract infection, a drop
in differential renal function (DRF) of more than 10% and a progressive increase in the
anterior posterior diameter (APD) in subsequent studies. Schlotmann et al, Piepsz et al
and Harper et al have demonstrated the measurement of the cortical transit time (CTT)
to predict the need for patient who may require pyeloplasty.
Objectives:
To assess if the CTT would have predicted a drop in DRF in patients with unilateral HN
on the affected side. In addition to assess whether the CTT would differ on the first
renogram between those patients who had a pyeloplasty and those who did not have a
pyeloplasty at the Red Cross War Memorial Children’s Hospital (RCWMCH).
Methods:
Sixty eight (68) patients with at least two renograms with unilateral HN with a normal
contralateral kidney were observed retrospectively between December 2000 and May
2015. The CTT was recorded for the upper, middle and lower third of each kidney and
the mean used as the CTT of the kidney. Each renogram was processed three times to
measure the DRF using the Rutland Patlak and Integral methods. The mean of the three
DRF measurements was used for analysis.
Results:
The mean CTT of the left and right hydronephrotic kidneys were 6.0minutes and
6.7minutes respectively. A significant relationship was demonstrated in the CTT and
DRF as well as CTT and APD in the first renogram of those patients who did not have a
pyeloplasty (p < 0.05). There was no difference between the DRF of the first and second
renograms in those patients who did not have a pyeloplasty.
In the 20 patients who had a pyeloplasty, there was a drop of more than 10% in the DRF
of 3 patients. No difference was seen in the DRF or in the CTT between the first and
second renogram. The CTT was shorter in the second renogram in 9 of the 20 patients
who had a pyeloplasty.
No significant difference was found in the CTT or DRF when comparing the group who
had surgery against the group who did not have surgery.
Conclusion:
The current study was unable to demonstrate in our series of patients that CTT can
predict those patients who would require pyeloplasty. This may be owing to the
retrospective nature of the study and the reliance on the clinical notes for the US data
and surgical notes. In future, a prospective study evaluating the relationship between
CTT and a drop in the DRF should be undertaken in this unit.
8
Bertti, Rodolfo Otávio Tomaz 1974. "Modelo experimental de obstrução ureteral em coelhos". [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310675.
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Orientadores: Marcelo Lopes de Lima, Carlos Arturo Levi D¿AnconaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A estenose da junção pieloureteral (JUP) é uma das anomalias congênitas mais frequentes. Clinicamente, pode se manifestar por infecção do trato urinário, por dor e pela perda da função renal. Portanto, o estudo desta doença é importante para se determinar a melhor forma tratamento. O objetivo deste trabalho foi criar um modelo experimental de estenose ureteral. Dez coelhas da raça New Zealand foram estudadas, com idade de três meses e peso aproximado de 3,5kg. Através de laparotomia e abordagem do retroperitôneo, um segmento do ureter esquerdo foi introduzido no músculo psoas ipsilateral de forma padronizada. O lado direto funcionou como controle. Um mês após a cirurgia, os animais foram submetidos a estudo renal cintilográfico com o ácido dietilenotriaminopentacético marcado com 99mTc (DTPA-99mTc). Em seguida, os animais foram submetidos à eutanásia e as peças (rins e ureteres) retiradas para análise histológica. O estudo cintilográfico demonstrou que sete unidades renais esquerdas apresentaram padrão de obstrução ureteral. A porcentagem de excreção após a administração de furosemida variou de 1 +/- 74% para DTPA-99mTc, apresentando uma diferença estatisticamente significante (p<0,05). No estudo anatomopatológico, concluiu-se que os rins e ureteres mantinham hidronefroses leves em dois e moderadas em sete animais, caracterizando diagnóstico de obstrução em nove coelhas (90%). Houve, também, discreto processo inflamatório e ausência de fibrose no segmento ureteral introduzido no músculo psoas. A técnica experimental de obstrução ureteral criou um modelo de hidronefrose em coelhos
Abstract: The stenosis of the ureteropelvic junction (UPJ) is one of the most frequent congenital anomalies and are clinically important to be treated not only for the quality of life that gets worse, pain and urinary tract infection, but also the loss of the kidney function (1,2,3). So, the study of UPJ model will be used for future treatment. The aim of this study was to create an experimental model of ureteral obstruction in rabbits. The sample of this project was composed by a number of ten female rabbits from New Zealand, three months old, weighing about 3.5kg. An intra-peritoneal medium laparatomy was made, pushing the abdominal organs in order to have a large access to the retroperitoneal. The studies consist of creating an experimental ureteral obstruction model through the introduction of its segment inside the psoas ipsilateral muscle in a standard way. The right side was used as the control. After one month, the rabbits were underwent the intravenous injection of 99mTc-DTPA. After the diuretic renogram analysis was realized, the animal was sacrificed end the removed parts, kidneys and ureters were submited histological analysis. The study showed that seven left kidneys presented obstruction. The excretion after furosemide injection was 1 ± 74% for 99mTc-DTPA, with a statistically significant difference between both renal (p<0.05). In the anatomopathological study, two animals were classified as light and seven as moderate obstruction, characterizing diagnosis of obstruction in nine rabbits (90%). The lack of an inflammatory process and fibrosis in the circumvolution location was observed. The experimental technique of ureteral obstruction created a model of hydronephrosis in rabbits
Mestrado
Cirurgia
Mestre em Cirurgia
9
Kostic, Dusan. "Biomarcadores para diagnóstico precoce de injúria renal em uropatias obstrutivas congênitas". Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-28092018-101314/.
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Introdução: Os estudos com proteômica especificamente relacionada à nefrologia e urologia pediátrica são limitados. O diagnóstico do comprometimento da função renal e da sua deterioração na presença de uropatias obstrutivas congênitas (UOC) representa o desafio na rotina da nefro-urologia pediátrica. Novos biomarcadores com o potencial para detecção precoce da lesão renal surgiram recentemente, permitindo a escolha da melhor opção terapêutica no tempo hábil, e assim minimizando ou prevenindo o dano renal definitivo. Objetivos: Avaliar o perfil de dois biomarcadores renais séricos: creatinina (CrS) e cistatina C (CyCs); e seis biomaracadores renais urinários: lipocalina associada à gelatinase neutrofílica (NGAL), proteína ligadora de retinol (RBP), molécula de injúria renal 1 (KIM-1), cistatina C na urina (CyCu), fator transformador de crescimento-beta 1 (TGF-beta1) e microalbuminúria (uALB) durante o primeiro ano de vida em lactentes saudáveis; em relação à detecção precoce da lesão renal em lactentes com UOC; em relação à sua capacidade de prever a necessidade de intervenção cirúrgica em lactentes com UOC. Metodologia: 37 lactentes com UOC foram divididos em três subgrupos: 14/37 casos com hidroureteronefrose unilateral (HU), 13/37 com hidroureteronefrose bilateral (HB) e 10/37 com obstrução de vias urinárias baixas (OTUB); e comparados com 24 lactentes saudáveis. No grupo dos pacientes, as amostras de sangue e urina foram obtidas ao nascer e entre o 3º e 7º dia, 1º, 2º, 3º, 6º, 9º e 12º mês de vida. Grupo de controle seguia o mesmo cronograma, com exceção da coleta de sangue que ocorria ao nascer, entre o 3º e 7º dia, no 6º e 12º mês de vida. Todas as amostras foram armazenadas sob - 70 ºC, e analisadas posteriormente através de imunoensaio enzimático quantitativo (ELISA). Resultados: No grupo-controle, CrS, CyCs, CyCu e RBP refletiram a maturação glomerular e tubular. O ritmo de filtração glomerular pela CyCs atingiu os níveis estáveis no 6º mês de vida (93 ± 22 mL/min/1,73 m2). KIM-1 e TGF-beta1 mantiveram os níveis absolutos próximos ao limite de detecção pelo método. Os valores do NGAL no sexo feminino foram significativamente maiores (p=0,005) ao longo do 1º ano, quando comparados aos do sexo masculino. Em comparação aos controles, a coorte dos pacientes apresentou valores mais elevados para todos os biomarcadores urinários no 1º mês de vida (p <= 0,009), sendo que NGAL (p=0,005), TGF-betsa1 (p < 0,001) e ?ALB (p < 0,001) mostraram-se elevados desde o nascimento, em comparação aos controles. O RBP apresentou o melhor desempenho no subgrupo com HB e OTUB (AUC=0,844, sensibilidade >=83,3%, especificidade 94,3%), assim como o KIM-1 no HU (AUC=0,768, sensibilidade 70,7%, especificidade 82,7%). RBP em combinação com TGF-ß1 ou KIM- 1 e NGAL com CyCs e CyCu, atingiram os melhores resultados para detecção da lesão renal (AUC=0,934, sensibilidade 89,4%, especificidade 92,8%; AUC=0,896, sensibilidade 86,8%, especificidade 81,1%; AUC=0,867, sensibilidade 92,4%, especificidade 79,5%, respectivamente). Nos pacientes operados, os níveis elevados de RBP (p <= 0,043), NGAL (p <= 0,043), KIM-1 (p <= 0,03) e TGF-beta1 (p <= 0,034) baixaram significativamente após a cirurgia, no subgrupo com HU e OTUB. NGAL, isolado ou em combinação, com CyCs e CyCu demonstrou o melhor desempenho para determinar a necessidade cirúrgica (AUC=0,801, sensibilidade 63,6%, especificidade 96,7%; AUC=0,881, sensibilidade 87,7%, especificidade 82,2%, respectivamente). A analise do perfil dos biomarcadores indicou a necessidade da intervenção cirúrgica em 55,4% (7/13) dos casos não-operados e antecipou a decisão cirúrgica no mínimo 3 meses, em 58% (14/24) de todos os pacientes operados, baseada nas diretrizes atuais. Conclusão: A evolução dos valores normais dos biomarcadores no primeiro ano de vida, pode servir como a base para os próximos estudos de detecção precoce de afecções uro-nefrologicas. RBP, NGAL, KIM-1, TGF-beta1 e CyC, individualmente ou em combinação, demonstraram um forte potencial para identificar a lesão renal e servir como uma ferramenta de diagnóstico não-invasivo para diferenciar pacientes que necessitam de intervenção cirúrgica precoce daqueles que se beneficiariam de uma conduta conservadoraIntroduction: The proteomics studies specifically related to pediatric nephrology and urology are limited. The diagnosis of renal function impairment and deterioration in congenital obstructive uropathies (COU) represents challenge in pediatric nephrourology routine. New renal biomarkers applied in this setting have potential for early renal injury detection, allowing reliable choice of optimal therapeutic options and thus preventing or minimizing definitive renal damage. Objectives: To analyze the first-year profiles of two serum renal biomarkers: Creatinine (CrS) and Cystatin C (CyCs); and six urinary renal biomarkers: Neutrophil Gelatinase-Associated Lipocalin (NGAL), Retinol- Binding Protein (RBP), Kidney Injury Molecule-1 (KIM-1), urine Cystatin C (CyCu), Transforming Growth Factor Beta 1 (TGF-beta1), and microalbuminuria (uALB) in a cohort of healthy infants; in relation to early detection of renal injury capability in a group of infants with COU; in relation to capability of predicting the need for surgery in a group of infants with COU. Methods: 37 infants with COU were divided in 3 subgroups: 14/37 cases with unilateral hydro(uretero)nephrosis (UH), 13/37 with bilateral hydro(uretero)nephrosis (BH) and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. In the patient group, blood and urine samples were collected at birth, between 3rd-7th day, at 1st, 2nd, 3rd, 6th, 9th and 12th month of age. In the control group urine sampling followed the same routine with exception that blood sampling was obtained between 3rd-7th day, at 6th and 12th month of age. The samples were stored at -70 ºC, and thereafter analyzed by quantitative enzymatic immunoassay (ELISA). Results: In the group of healthy controls, the values of CrS, CyCs, CyCu and RBP reflected glomerular and tubular maturation. The glomerular filtration rate by CyCs reached steady-state levels at 6th month of life (93 ± 22 mL/min/1,73 m2). KIM-1 and TGF-beta1maintained very low absolute levels, near to the limit of detection by the method. NGAL levels in females were significantly higher (p=0,005) throughout the first year of life, when compared to male gender. In the cohort of patients, all the urinary biomarkers showed significantly higher values at the first month of life (p <= 0,009), while NGAL (p=0,005), TGF-beta1(p < 0,001) e uALB (p < 0,001) were high since birth, compared to control group. The best single biomarker performance was achieved by RBP in BH and LUTO subgroups (AUC=0,844, sensitivity >= 83,3%, specificity 94,3%), and by KIM-1 in UH subgroup (AUC=0,768, sensitivity 70,7%, specificity 82,7%). The best biomarker combination results for all subgroups were obtained by matching RBP with TGF-beta1 or KIM-1 and NGAL with CyC (AUC=0,934, sensitivity 89,4%, specificity 92,8%; AUC=0,896, sensitivity 86,8%, specificity 81,1%; AUC=0,867, sensitivity 92,4%, specificity 79,5%, respectively). In the operated group of patients, the levels of RBP (p <= 0,043), NGAL (p <= 0,043), KIM-1 (p <= 0,03) e TGF-beta1 (p <= 0,034) dropped significantly after surgery, in UH and LUTO subgroups. NGAL alone or in combination with CyCs and CyCu, demonstrated the best performance to determine the need for surgery (AUC=0,801, sensitivity 63,6%, specificity 96,7%; AUC=0,881, sensitivity 87,7%, specificity 82,2%, respectively). Biomarkers\' profile analysis indicated the need for surgical intervention in 55,4% (7/13) of non-operated cases and anticipated clinically based surgical decision for at least 3 months, in 58% (14/24) of all operated patients. Conclusions: The presented biomarkers\' normal values evolution during the first year of life can be of use as a base for future studies that will involve early detection of uronephrological disorders in infants. RBP, NGAL, KIM-1, TGF-beta1 and CyC, alone or in combination, demonstrated strong capability to identify renal injury and serve as a noninvasive diagnostic tool for differentiating between infants that require early surgical intervention from those who would benefit from conservative approach
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Cordeiro, Mauricio Dener. "Fatores prognósticos em pacientes submetidos à desobstrução ureteral secundária a tumores urológicos ou extraurológicos". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-14082014-144337/.
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INTRODUÇÃO E OBJETIVOS: Há controvérsias em relação à indicação e ao momento ideal de realização de derivação urinária em pacientes com obstrução ureteral secundária a neoplasias malignas avançadas. O objetivo do presente estudo foi identificar fatores relacionados ao mau prognóstico de pacientes com nefropatia obstrutiva maligna e criar um modelo de estratificação de risco desses pacientes, a fim de fornecer evidências para uma melhor decisão terapêutica. MÉTODO: Realizou-se estudo prospectivo com pacientes portadores de insuficiência renal obstrutiva por neoplasias pélvicas, acompanhados por um tempo mínimo de seis meses, tratados entre janeiro de 2009 à novembro de 2011. De um total de 340 pacientes submetidos à procedimentos de descompressão ureteral por catéter ureteral (CUR) ou nefrostomia percutânea (NPC), 208 foram incluídos no estudo por serem maiores de 18 anos, apresentarem obstrução ureteral secundária à neoplasias malignas, confirmada por tomografia computadorizada (TC) ou ultrassom (USG) e por terem realizado derivação urinária por catéter ureteral ou nefrostomia percutânea em nossa Instituição. RESULTADOS: A sobrevida média global foi de 144 dias, com mortalidade ao final do estudo de 164 pacientes (78.8%), sendo 44 (21.2%) durante a internação hospitalar. Não houve diferença significativa na sobrevida global entre os dois tipos de derivação urinária realizada (p = 0.216). Após análise univariada, a presença de qualquer sintoma (p = 0.014), derrame pleural (p = 0.015), grau de hidronefrose 1 e 2 (p = 0.001), Índice de Charlson >= 6 (p = 0.003), linfonodos retroperitoneais metastáticos (p = 0.002), linfonodos pélvicos metastáticos (p = 0.024), número de sítios relacionados à disseminação da doença >= 4 (p < 0.001), niveis séricos iniciais de uréia >= 80mg/dl (p = 0.01), sódio <= 138 mEq/L (p = 0.018) e albumina < 3.0 mg/dl (p = 0.035), diálise peri-operatória (p = 0.05) e índice de ECOG PS (Eastern Cooperative Oncology Group Performance Status) >= 2 (p < 0.001), foram associados a menor sobrevida média. A análise multivariada de Cox revelou que apenas o número de sítios relacionados à disseminação maligna (quatro ou mais) e o índice de ECOG PS >= 2 foram significativamente associados à menor sobrevida. A fim de criar um modelo de estratificação de risco, os pacientes foram, posteriormente, divididos em três grupos: nenhum fator de risco - grupo I, um fator de risco - II e dois fatores de risco - III. As taxas de sobrevida mediana de 1,6 e 12 meses nesses grupos foram, respectivamente de 94.4%, 57.3% e 44.9% no grupo I, de 78.0%, 36.3% e 15.5% no grupo II e de 46.4%, 14.3% e 7.1% no grupo III, com diferenças significativas nos perfis de sobrevivência dos três grupos de risco (p < 0.001). CONCLUSÕES: Nosso modelo de estratificação de risco poderá representar uma ferramenta útil na decisão de se instituir procedimentos de desobstrução ureteral em pacientes com neoplasias abdominopélvicas malignas avançadas. Pacientes com mais de quatro sítios de metástases e com índice de performance (ECOG) igual ou superior a 2 apresentam pobre evolução após derivações urinárias realizadas para tratar nefropatia obstrutiva maligna. De acordo com o método de estratificação de risco de óbito por nós descrito, pacientes com um ou mais fatores de risco evoluem com sobrevida mais precária que os casos sem fatores de risco presentesINTRODUCTION AND OBJECTIVES: There is a controversy regarding the decision to perform diversion procedures in patients with ureteral obstruction secondary to advanced malignancies. The goal of this study was to identify poor prognosis factors and to create a model to stratify patients with malignant obstructive nephropathy in order to provide evidence-based information for better treatment decisions. METHODS: A prospective study was performed from January 2009 to November 2011, with patients followed at least for 6 months. From 340 patients initially submitted to ureteral decompression procedures by ureteral stents or percutaneous nephrostomy, 208 were elected for the study because they were 18 years old or more and presented ureteric obstruction secondary to any type of malignancy, confirmed by computadorized tomography (CT) or ultrasound (US) and were submitted to urinary diversion by ureteral stents or percutaneous nephrostomy at our institution.RESULTS: The median survival for all patients was 144 days, with mortality at the end of study seen in 164 patients (78.8%) including 44 (21.2%) during hospitalization. There was no significant difference in overall survival between the two types of urinary diversion (p = 0.216). After univariated analysis the presence of any symptoms (p = 0.014), pleural effusion (p = 0.015), degree of hydronephrosis 1 and 2 (p = 0.001), Charlson Index >= 6 (p = 0.003), metastatic retroperitoneal lymph nodes (p = 0.002), metastatic pelvic lymph nodes (p = 0.024), number of sites related to dissemination >= 4 (p < 0.001), preoperative serum level urea >= 80mg/dl (p = 0.01), sodium <= 138mEq/L (p = 0.018), albumin < 3.0 mg/dl (p = 0.035), perioperative dyalisis (p = 0.05) and ECOG PS index >= 2 (p < 0.001) were associated to shorter mean survival. The multivariate Cox proportional hazards regression model revelead that only the number of sites related to malignant dissemination (4 or more) and the index of performance status of Eastern Cooperative Oncology Group (ECOG PS >= 2) were significantly associated with short survival. To creat a risk stratification model, the patients were further divided into three risk groups: no risk factor - favorable group, one risk factor - intermediate and two risk factors - unfavorable, to creat a risk stratification model. The median survival rates at 1,6 and 12 months were respectively, 94.4%, 57.3% and 44.9% in the favorable group; 78.0%, 36.3% and 15.5% in the intermediate group and 46.4%, 14.3% and 7.1% in the unfavorable group. There were significant differences in the survival profiles of the three risk groups (p < 0.001). CONCLUSION: Our model of stratification may be a useful tool before deciding on ureteral desobstruction procedures in patients with advanced abdominopelvic malignancies. Patients with more than four sites of metastases and performance index (ECOG) equal to or greater than 2 have a poorer outcome after urinary diversion. According to the method of risk stratification for death from we described, patients with one or more risk factors have significant poorer outcome than cases with no risk factors
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Santarosa, Ingrith Aparecida Mazuhy. "Nefrostomia percutânea ecoguiada em cães". Universidade Federal de Santa Maria, 2006. http://repositorio.ufsm.br/handle/1/10154.
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The technological development of imaging equipment has allowed for the
improvement of pre-existing procedures and for the creation of new options in
treatment, mainly in the application of urinary treatment, by introducing minimally
invasive techniques. Hydronephrosis often originates from the partial or complete
obstruction of the urine flow and it can affect one or both kidneys, causing dilation
and progressive functional impairment. When renal function is evidenced by exams
such as the excretory urography or scintigraphy, it becomes vital to recover the
kidney with hydronephrosis, especially if the other damaged. Urinary drainage by
percutaneous nephrostomy promotes immediate relief of intrarenal pressure,
diverting the urine flow when its habitual trajectory is damaged. Furthermore,
temporary drainage can be utilized, providing time for an adequate diagnosis and
therapeutic planning or even avoiding or postponing a alternative of greater
dimension and higher risk. The aim of this study was to describe and adjust the
percutaneous nephrostomy technique, using ultrasound as a real-time guide to insert
a catheter into the dilated pelvis. The procedure was performed on eight dogs, of
both sexes, weighing between 10 and 17.5Kg, with unilateral hydronephrosis
produced experimentally. The Seldinger and direct insertion techniques were used
for the introduction of a pigtail catheter. The confirmation of the insertion of the
cateter into the kidney was carried out by the infusion of a 30 per cent diluted iodine
contrast medium according to the percutaneous antegrade pyelography. Washing
with sterile saline solution through the catheter impeded the interruption of the urine
flow by clots after the insertion. The technique demonstrated satisfactory results in
urinary drainage of hydronephrosis in dogs, proving to be a quick, efficient and safe
alternative.A expansão tecnológica dos equipamentos de imagem permitiu o aperfeiçoamento de procedimentos pré-existentes e o desenvolvimento de novas opções de tratamento, principalmente aplicados ao trato urinário, através da criação das técnicas minimamente invasivas. A hidronefrose decorre freqüentemente da obstrução parcial ou completa do fluxo de urina e pode afetar um ou ambos os rins, causando dilatação da pelve e comprometimento funcional progressivo. Quando um rim hidronefrótico demonstra alguma função em exames como a urografia excretora ou cintilografia, passa a ser vital a recuperação desse rim, particularmente se o outro estiver comprometido. A drenagem urinária por nefrostomia percutânea promove a diminuição imediata da pressão intra-renal, desviando a urina de seu trajeto habitual, quando o mesmo encontra-se prejudicado. Ademais, pode ser utilizada como drenagem temporária, fornecendo tempo para um adequado diagnóstico e planejamento terapêutico ou ainda evitando ou prorrogando alternativas cirúrgicas de maior porte, principalmente em pacientes de alto risco. O objetivo deste estudo foi descrever e adequar a técnica de nefrostomia percutânea para seu uso em cães, utilizando a ultra-sonografia como guia em tempo real para a inserção de um cateter na pelve renal dilatada. O procedimento foi realizado em oito cães de ambos os sexos, com peso variando de 10-17,5kg, submetidos à produção experimental de hidronefrose unilateral. As técnicas de Seldinger e de inserção direta foram utilizadas para a introdução de um cateter de modelo pigtail. A confirmação do cateter na pelve renal foi feita pela infusão de meio de contraste à base de iodo diluído a 30%, através do mesmo, conforme a técnica de pielografia percutânea anterógrada. Lavagens com solução salina estéril, através do cateter, impediram a interrupção do fluxo urinário por coágulos, após sua inserção. A Nefrostomia percutânea ecoguiada demonstrou resultados satisfatórios na drenagem urinária de hidronefrose em cães, provando ser uma alternativa rápida, eficiente e segura.
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Eckoldt, Felicitas. "Die Bedeutung der pränatalen Erkennbarkeit obstruktiver Harnwegsfehlbildungen für Diagnostik, Therapie und Prognose aus kinderchirurgischer Sicht". Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2004. http://dx.doi.org/10.18452/13950.
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Einleitung: Fehlbildungen der Nieren und ableitenden Harnwege gehören zu den häufigsten angeborenen Anomalien. Ihr Anteil an den pränatal diagnostizierten Fehlbildungen wird mit bis zu 50% angegeben. Die Behandlung urogenitaler Fehlbildungen hat sich nicht zuletzt unter dem Einfluss der Pränatalen Diagnostik erheblich gewandelt. Nach einer Phase der Übertherapie nach Einführung der pränatalen Diagnostik ergab sich nach modernen diagnostischen Kriterien und im Ergebnis von Langzeitstudien des natürlichen Ganges der Fehlbildungen eine wesentlich differenziertere Indikationsstellung für das aktive therapeutische Vorgehen Fragestellung: In der retro- und prospektiv angelegten Studie sollte untersucht werden, inwieweit die pränatale Diagnostik das postnatale Vorgehen beeinflusst. So sollte untersucht werden, aus welchen pränatalen Befunden welche pränatalen Verdachtsdiagnosen gestellt wurden und wie sich diese zu den definitiven postnatalen Diagnosen verhalten. Des weiteren sollte der Aussagewert einzelner pränataler Befunde herausgearbeitet werden. Besondere Beachtung sollte dabei die Frage finden, inwieweit aus den pränatalen Befunden eine Aussage über die postnatale Therapiebedürftigkeit und schließlich auch für die Prognose der Nierenfunktion möglich ist. Patienten und Methoden: Ausgangspunkt waren 21.616 in der Abteilung für pränatale Diagnostik und Therapie in der Zeit von 1984 bis 1996 untersuchte Schwangerschaften. Unter diesen fanden sich 1.574 Feten mit angeborenen Anomalien mit fraglich kinderchirurgischer Relevanz. 1077 Fälle konnten ausgewertet werden. Mit 990 Fällen dominierten die Fehlbildungen des Urogenitalsystems, von denen 693 in die komplette Analyse mit einbezogen werden konnten. Ergebnisse: Bei 7,28% aller untersuchten Feten fanden sich Organfehlbildungen außerhalb des Zentralnervensystems. Unter diesen dominierten Harntraktfehlbildungen mit 63%. Als häufigste Diagnose wurde pränatal eine "Hydronephrose" angegeben. Dieser Begriff umschreibt jedoch in dem hier verwandten Sinne eine Harntransportstörung jeglicher Ursache. Echte Diagnosen obstruktiver Uropathien wurden lediglich zu 30% in den einzelnen Gruppen gestellt. Die pränatalen Verdachtsdiagnosen bestätigen sich zu zwischen 80 und 90% wenn: - eine isolierte Hydronephrose mit einem Nierenbeckendurchmesser von über 10 mm als Ureterabgangsstenose befundet wurde - die typische Konfiguration einer Multizystischen Nierendysplasie gefunden wurde - aus der Kombination von Oligohydramnion, Megazystis und bilateraler Harntransportstörung des männlichen Feten auf Urethralklappen geschlossen wurde. Lediglich bei der unilateralen multizystischen Nierendysplasie und der subpelvinen Obstruktion wird im pränatalen Befund bezüglich der definitiven Diagnose eine akzeptable Sensitivität und Spezifität erreicht. Alle anderen Diagnosen werden zu 70% postnatal gestellt. Der Einfluss der pränatalen Diagnostik auf das postnatale Management bezieht sich in erster Linie auf die Aufdeckung vorerst symptomloser Fehlbildungen. Eine pränatale Aussage über die zu erwartende Nierenfunktion ist bei einseitigen Fehlbildungen derzeit nicht möglich. Zusammenfassung: Obstruktive Uropathien sind häufige, zumeist benigne Fehlbildungen. Sie sind der pränatalen Diagnostik gut zugänglich. Konkrete Diagnosen mit Aussagen zur postnatalen therapeutischen Relevanz können jedoch nur gestellt werden, wenn sonografisch pathognomonische Konstellationen dies ermöglichen. In allen anderen Fällen muss die pränatal beschriebene Auffälligkeit Anlass zu postnataler sorgfältiger Diagnostik sein, um im präsymptomatischen Intervall die Entscheidung zu konservativer oder operativer Therapie stellen zu können.Introduction: Among congenital dysplasias the anomalies of kidney and urogenital tract are among the most frequent encountered. Their rate in prenatally made diagnoses is about 50 %. Modern prenatal diagnostic facilities have changed the therapeutic access to these anomalies in the last decade. After a phase of overtreatment in the beginning, nowadays new insights in the natural course of these dysplasias and the results of long-term follow-up studies resulted in a more differentiated apporach. Questions and methods: In this retro- and prospective study we looked for the the influence of prenatal diagnostics on the postnatal course and management. The question was to examine the relationship between the prenatal ultrasound results, the suggested prenatal diagnosis and then the defintive postnatal disease. Of interest was the prognostic impact of typical prenatal sonographic imaging on the postnatal course of the baby. Because of its frequency we focused on anomalies of the kidney and urogenital tract. Patients: Between 1984 and 1996 21.616 pregnancies were examined by ultrasound in our Department of Prenatal Medicine. Among these, 1.574 anomalies of surgical relevance were described. 1.077 cases were available for follow-up including 990 cases of urogenital anomalies. Among these, the records of 693 cases were complete and these patients form the collective of this study. Results: When the CNS was excluded we found organic anomalies in 7,28 % of these cases. Among them 63% were attributed to the urogenital system. The most common prenatal diagnosis was "hydronephrosis". But this term was used only in a descriptive manner because proof of a real obstructive uropathy postnatally was made only in 30% of these cases. Concerning all anomalies of the urogenital tract, the prenatal diagnosis proved correct in the overwhelming majority of cases ( 90%) if these sonographic signs have been described: - diameter fo the renal pelvis of more than 10 mm in isolated hydronephrosis predicted ureteropelvic junction obstruction - typical formation of a multicystic dysplastic kidney - combination of oligohydramnion, megacystis and bilateral kidney anomalies in a male fetus predicted posterior urethral valve disease Sensitivity and specifity in regard to the definitive diagnosis were acceptable in multicystic dysplasia of the kidney and ureteropelvic junction obstruction. In all other cases, the correct diagnosis was made postnatally in 70 %. Therefore, the main value of prenatal sonography was to reveal otherwise symptomless dysplasias. Until now, a prenatal prediction of kidney function in the unilateral case is not possible. Conclusion: Obstructive uropathies are common an in most cases benign anomalies. They are easily detected by prenatal ultrasound. Therapeutical consequences, however, only arise in selected cases if typical sonographic signs can be seen. In the majority of cases, therefore, the main purpose of prenatal diagnostic ultrasound points out the necessity for postnatal diagnostic workup in order to detect and treat severe diseases before symptoms occur.
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Kaya, Ş Abdullah Savaş Mustafa Çağrı. "Deneysel hidronefrozda nitrik oksit ve vasküler endotelyal growth faktörü arasındaki bağıntı /". Isparta: SDÜ Tıp Fakültesi, 2006. http://tez.sdu.edu.tr/Tezler/TT00269.pdf.
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Jackson, Ashley R. "Significance of Renal Urothelium During Development and Disease". The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1459778047.
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Junior, José de Bessa. "Acurária do estudo dos jatos ureterais à ultra-sonografia do Doppler Colorido no diagnóstico das hidronefroses". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-19022009-102447/.
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Introdução e Objetivo: Hidronefrose e Obstrução são condições associadas, entretanto dilatações da via excretora podem ocorrer na ausência de obstruções clinicamente importantes. Ultra-sonografia convencional e Renograma com Diuréticos são os métodos diagnósticos complementares mais utilizados na avaliação das hidronefroses na infância. Recentes trabalhos têm demonstrado a possibilidade de observarmos os jatos ureterais com o Estudo Ultra-sonográfico com Doppler Colorido e sugerido a sua aplicação no diagnóstico diferencial das hidronefroses. O objetivo do presente trabalho foi avaliar a aplicabilidade do estudo dos jatos ureterais como método diagnóstico na identificação das hidronefroses obstrutivas e não obstrutivas na população pediátrica. Métodos: Foram estudadas 48 crianças (35 meninos e 13 meninas) com idade que variou de um mês a 14 anos (mediana de 4 anos), que se apresentaram com Hidronefroses Unilaterais, Graus III e IV, e com suspeita de obstrução da junção pieloureteral. Todos os sujeitos foram submetidos ao Estudo dos jatos ureterais e ao Renograma com Diuréticos num período de duas semanas. As unidades hidronefróticas foram consideradas obstruídas quando a Função Renal Diferencial era menor do que 40%, ou em indivíduos mais velhos que apresentavam dor lombar intermitente. Os jatos ureterais de cada meato foram contados por um período de 5 minutos e considerados separadamente. Freqüência Relativa dos Jatos (FRJ) foi definida como o numero de jatos ureterais no lado afetado dividido pela soma dos jatos ureterais observados bilateralmente. Resultados: Vinte e duas (45,8%) unidades hidronefróticas foram consideradas obstruídas.A média da FRJ diferiu significativamente entre as hidronefroses obstrutivas (0,09 ± 0,15) e não obstrutivas (0,41 ± 0,11). (p<0.001). Análise da Curva ROC revelou que FRJ < 0,25 é o melhor valor que distingue as hidronefroses obstrutivas e não obstrutivas e o faz corretamente em 91,2 % dos casos, com uma Sensibilidade de 86,4% (IC95%=78,6-98,2%) e Especificidade de of 96.15% (IC95%=87.8-99%). O Índice de Probabilidade Positivo foi de 22,45 e a Razão de Chances Diagnóstica de 158,3. A área sob a curva ROC foi de 0,91 (IC95%=0,86-0,98) indicando a excelente acurácia do método. Conclusões: FRJ < 25 % mostrou ser um bom indicador de obstrução nas hidronefroses unilaterais da infância. O estudo dos jatos ureterais a Ultrasonografia com Doppler Colorido é método simples, não invasivo e pode ser utilizado na abordagem inicial e no seguimento, na diferenciação das hidronefroses obstrutivas e não obstrutivas na população pediátricaIntroduction and Objective: Hydronephrosis (HN) and obstruction are closely associated, but upper urinary tract dilatation can occur without significant obstruction. Despite some pitfalls, conventional ultrasonography and diuretic renography (DR) are the main modalities in the evaluation of HN in children. Recent reports have demonstrated the usefulness of Color Doppler Ultrasonography (CDUS) as a reliable method to identify the ureteric jets (UJ) in the bladder. The aim of this study was to evaluate CDUS evaluation of the UJ in the bladder as a diagnostic tool to distinguish obstructive from non-obstructive dilatations of the upper tract in pediatric population. Methods: We evaluated 48 patients (35 boys and 13 girls), aged 1 month to 14 years (median = 4 ys.), who presented with unilateral grade III and IV hydronephrosis suspicious of pyeloureteral junction obstruction. All patients underwent DR and evaluation of UJ by transverse CDSG of the bladder within a maximum of 2 weeks. Obstruction was considered in the DR when the hydronephrotic unit showed Differential Renal Function of less than 40%, or when symptomatic intermittent renal colic was present in older children. The number of UJ was counted over a 5 min period and its frequency was calculated for each ureteral orifice. Relative Jet Frequency (RJF) was defined as the UJ frequency of hydronephrotic side divided by total UJ frequency. Receiver-Operating Characteristic (ROC) plots were constructed to determine the best cuttoff for RJF, in order to identify renal units with obstructive hydronephrosis. Results:Twenty-two(45.8%) hydronephrotic units were considered obstructed. The mean RJF differed significantly between obstructive (0.09 ± 0,15) and non-obstructive hydronephrosis (0.41± 0.11)(p<0.001). ROC analysis revealed that RJF< 0.25 was the best threshold and it correctly discriminates obstruction in 91.2% of the childrens with a sensitivity of 86.4% (95%CI=78.6-98.2%) and specificity of 96.15% (95%CI=87,8-99%). The Positive Likelihood Ratio was 22.45 and Diagnostic Odds Ratio was 158.3.The area under the ROC curve was 0.91 (95%CI=0.86-0.98), indicating excellent discrimination power. Conclusions: In this study RJF < 25% was found to be a good indicator of obstruction in children with unilateral hydronephrosis. CDUS evaluation of UJ is an easy and non-invasive method that can be used as an initial diagnostic tool and in follow-up cases, to differentiate obstructed from non-obstructed hydronephrosis in the pediatric population
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BONNIN, THIERRY. "Hydronephrose de l'adulte : considerations diagnostiques et therapeutiques : a propos d'une serie de 43 cas". Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20394.
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MOLINER, FRANCOIS NATHALIE. "Devenir des foetus porteurs d'une dilatation pyelique moderee, sans autre anomalie de l'arbre urinaire : a propos de 51 cas". Toulouse 3, 1994. http://www.theses.fr/1994TOU31542.
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Pereira, Gustavo de Paula. "Acompanhamento ultrassonográfico, análise da evolução das pieloectasias fetais leves bilaterais e proposta de seguimento pré-natal". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-18022014-154712/.
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OBJETIVO: Este estudo teve por objetivo descrever o resultado dos casos de pieloectasia fetal leve bilateral, encaminhados ao serviço de Medicina Fetal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), avaliados com ultrassonografias obstétricas dos rins e do trato urinário do feto e propor, com base nos dados, o melhor acompanhamento em termos de frequência de repetição de exames de ultrassonografia (US), no período pré-natal. METODOLOGIA: Pesquisa longitudinal prospectiva com 62 fetos com diagnóstico ultrassonográfico de pieloectasia leve bilateral (PELB), encaminhados de unidades de cuidados primários, realizada no HCFMUSP. PELB foi considerada quando o diâmetro anteroposterior da pelve renal (DAPPR), media >= 5,0 mm, >= 7,0 mm e >= 10,0 mm à US, respectivamente, em idades gestacionais <= 23 semanas (s) 6 dias (d), 24 s a 31 s 6 d e >= 32 s gestação, sem dilatação de ureteres e cálices. A cada 3 semanas, as US verificaram se a PELB havia progredido, regredido ou tinha ficado inalterada. Assim, quando possível, era realizada uma US de rins e vias urinárias neonatais para confirmação dos desfechos. A progressão foi considerada quando o DAPPR aumentou ou a imagem calicial foi encontrada em um ou ambos os rins. Regressão ocorreu quando os DAPPR entraram nos valores normais. A estabilidade foi considerada quando os DAPPR permaneceram dentro dos parâmetros considerados para pieloectasia leve. RESULTADOS E DISCUSSÃO: A idade gestacional ao diagnóstico foi de 19,2 para 30,1 semanas (média de 23,2 s). Regressão ocorreu em 29 casos (46,7%). Em 24 casos (38,7%), encontrou-se estabilidade. Houve regressão e estado estabilidade em 53 casos (85,4%). Progressão ocorreu em nove casos (14,6%), sendo unilateral em todos. Não foram observados casos graves. Já na avaliação pós-natal, foram examinados 32 neonatos, com 20 casos (62,5%) apresentando regressão; seis (18,7%) de estabilidade da pieloectasia; e seis de progressão da lesão (18,7%). Desfechos de regressão e estabilidade da pieloectasia foram encontrados em 26 casos (81,2%). Os resultados sugerem que as US não devem ser realizadas com frequência em casos de dilatação leve das pelves renais, sem cálices ou ureteres. Uma avaliação ultrassonográfica no terceiro trimestre tardio pode ser suficiente como uma estratégia de acompanhamento rotineiro nesses casos e que essa informação é útil para cuidados pós-natais imediatos. CONCLUSÃO: Esta série indica que PELB fetal, sem cálices ou ureteres visíveis, pode ser controlada ultrassonograficamente no terceiro trimestre tardio e, como não há casos progredindo o suficiente para indicar intervenção fetal, os procedimentos devem ser deixados para o período neonatal. A realização de US seriadas pode ser estressante e inútil nesses casos particularesOBJECTIVE: The objective of this study was to describe the outcome of cases of mild fetal bilateral pyelectasis, referred to the Fetal Medicine service of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), assessed with obstetric ultrasound of the kidneys and urinary tract of the fetus in order to propose the best follow-up in terms of repetition frequency of ultrasound examinations in the prenatal period, based on the data. METHODOLOGY: A prospective longitudinal study of 62 fetuses from primary care units with mild bilateral pyelectasis (MBPE) diagnosed using ultrasonography (US) was carried out at HCFMUSP. MBPE was considered when anteroposterior renal pelvis diameter (APRPD) measured >= 5.0 mm, >= 7.0 mm and >= 10.0 mm in US at <= 23 weeks (w) 6 days (d), 24 w to 31 w 6 d and >= 32w gestational age (GA) respectively, with no ureteric and calyces dilatation. US every 3 weeks checked if MBPE had progressed, regressed or remained unchanged. When possible, a neonatal US of kidneys and urinary tract of the newborn was performed to confirm outcomes. Progression was considered when renal pelvis (RP) dilatation increased or visible calyces was found in one or both kidneys. Regression occurred when RP presented normal values. Stability was considered when APRPD remained within the parameters considered for mild pyelectasis. RESULTS AND DISCUSSION: GA at diagnosis was 19.2 to 30.1 weeks (mean 23.2w). Regression occurred in 29 cases (46.7%). In 24 (38.7%) RP dilatation remained unchanged. Regression and unchanged status occurred in 53 cases (85.4%). Lesions worsened in 9 cases (14.6%, unilateral in all cases). No severe cases were observed. 32 newborns already on postnatal evaluation were examined, 20 cases (62.5%) showed involution; 6 cases with stable pyelectasis (18.7%), and 6 cases of lesion progression (18.7%). Outcomes: pyelectasis regression and stability was found in 26 cases (81.2%). Results suggest that US should not be performed too often in cases of RP dilatation with no visible calyces or ureter. A late third trimester US scan could be a sufficient routine follow up strategy in such cases and information is useful to immediate postnatal care. CONCLUSION: This study indicates that fetal MBPE with no visible calyces or ureter could be controlled at late third trimester and procedures should be left to the neonatal period as no cases progressed sufficiently to indicate fetal intervention. Proceeding serial ultrasound scans could be stressful and useless in these particular cases
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BARRA, CHIOUSSE MICHELE. "Traumatismes du rein sur hydronephrose chez l'enfant : a propos de deux observations". Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20016.
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LEBLANC, BERTRAND. "Hypertension arterielle severe et hydronephrose unilaterale : chez un enfant de 10 ans". Lille 2, 1990. http://www.theses.fr/1990LIL2M333.
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Klöpfer, Jana [Verfasser], i Margit [Akademischer Betreuer] Fisch. "Langzeitverläufe sonografisch diagnostizierter Hydronephrosen bei Kleinkindern / Jana Klöpfer. Betreuer: Margit Fisch". Hamburg : Staats- und Universitätsbibliothek Hamburg, 2016. http://d-nb.info/1103233556/34.
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Lossow, Julia-Janine von. "Prospektive Studie zur Diagnostik und Therapie der einseitigen kongenitalen asymptomatischen Hydronephrose". [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=967492289.
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TIRY, BERTRAND. "Hydronephrose de diagnostic antenatal : a propos de 103 interventions ; controverses actuelles". Lille 2, 1993. http://www.theses.fr/1993LIL2M287.
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Bertrand, Philippe. "Résonance magnétique nucléaire : résultats actuels de son application à la pathologie rénale : étude expérimentale de l'hydronéphrose". Université Louis Pasteur (Strasbourg) (1971-2008), 1987. http://www.theses.fr/1987STR1M045.
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CUZIN, BEATRICE. "Endopyelotomie endoscopique contre resection de la jonction pyelo-ureterale : etude de 100 traitements realises entre octobre 84 et mars 89". Lyon 1, 1989. http://www.theses.fr/1989LYO1M384.
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PEYRARD, GILLES. "Approche diagnostique et therapeutique actuelle de l'hydronephrose primitive de l'enfant : a propos de 67 jonctions pyelo-ureterales". Saint-Etienne, 1989. http://www.theses.fr/1989STET6205.
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Miranda, Eduardo de Paula. "Avaliação dos biomarcadores urinários no controle do tratamento de estenose de junção ureteropélvica em adultos". Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-20052016-160232/.
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INTRODUÇÃO E OBJETIVO: A estenose de junção ureteropélvica (EJUP) é importante causa de obstrução do trato urinário e pode levar a deterioração progressiva da função renal. Há espaço para o aprimoramento de novos métodos diagnósticos capazes de discriminar hidronefrose e uropatia obstrutiva. Acredita-se que os biomarcadores urinários podem fornecer indícios de lesão renal precoce na obstrução urinária. Neste contexto, KIM-1 pode elevar-se na urina por lesão tubular proximal, NGAL por lesão no túbulo proximal, distal ou alça de Henle, CA19-9 por produção excessiva no túbulo obstruído e ?2-microglobulina (beta2M) por injúria ao glomérulo ou ao túbulo proximal. O objetivo do presente estudo foi avaliar as propriedades diagnósticas dos biomarcadores urinários citados em adultos com EJUP, sendo o primeiro estudo na literatura a avaliar tais moléculas nesta população. MÉTODOS: Foram estudados de modo prospectivo pacientes consecutivos acima de 18 anos com diagnóstico de EJUP submetidos a pieloplastia videolaparoscópica de dezembro de 2013 a fevereiro de 2015. Foram excluídos do estudo pacientes com EJUP bilateral, rim contralateral patológico, EJUP em rim único, antecedentes de tratamento cirúrgico para estenose de JUP ou taxa de filtração glomerular inferior a 60 ml/min/1,73m2. Cada paciente forneceu quatro amostras de urina para medição de biomarcadores, uma no pré-operatório e outras com 1, 3 e 6 meses de seguimento pós-operatório. O grupo controle foi constituído por voluntários saudáveis sem hidronefrose à ultrassonografia. RESULTADOS: Foram incluídos 47 pacientes com idade média de 38,6 ± 12,7 anos (intervalo 19 a 64 anos), sendo 17 (36,2%) do sexo masculino e 30 (62,8%) do sexo feminino. O grupo controle foi composto por 40 indivíduos semelhantes ao grupo com EJUP no que concerne idade (p = 0,95) e sexo (p = 0,82). KIM-1 foi o marcador com melhores propriedades diagnósticas, apresentando área sob a curva (AUC) de 0,79 (95% CI 0,70 a 0,89). O NGAL, por sua vez, teve AUC de 0,71 (95% CI 0,61 a 0,83), CA19- 9 teve AUC de 0,70 (95% CI 0,60 a 0,81) e (beta2M) apresentou AUC de 0,61 (95% CI 0,50 a 0,73), sendo o único biomarcador com propriedades inadequadas neste cenário. O KIM-1 foi o marcador mais sensível com o ponto de corte 170,4 pg/mg de creatinina (sensibilidade 91,4%, especificidade 59,1%) e o CA 19-9 o mais específico para o ponto de corte de 51,3 U/mg de creatinina (sensibilidade 48,9%, especificidade 88,0%), enquanto o NGAL foi o que apresentou maior queda após desobstrução, com 90,0% dos pacientes apresentando clareamento superior a 50%. CONCLUSÕES: A avaliação dos biomarcadores urinários é útil no diagnóstico de obstrução em adultos com EJUP submetidos a pieloplastia videolaparoscópica. O KIM-1 foi o marcador mais sensível e o CA 19-9 o mais específico, enquanto o NGAL foi o que apresentou maior que com a desobstrução. Houve queda das concentrações dos marcadores após pieloplastia no período estudado. O papel exato dos biomarcadores urinários no cenário de obstrução em adultos deve ser mais amplamente investigadoINTRODUCTION AND OBJECTIVE: Ureteropelvic junction obstruction (UPJO) is an important cause of urinary tract obstruction and can lead to progressive deterioration of renal function. Thus the development of novel non-invasive methods capable of discriminating obstruction and hydronephrosis may be useful. Elevation of urinary biomarkers may provide early evidence of kidney damage in urinary obstruction. In this scenario, urinary concentrations of KIM-1 may be elevated following proximal tubular injury, while NGAL may increase as result of injury to proximal or distal tubule as well as to loop of Henle, CA19-9 after overproduction in the obstructed tubule and ?2 microglobulin (beta2M) after injury to the glomerulus or the proximal tubule. The aim of this study was to evaluate the diagnostic properties of these urinary biomarkers in adults with UPJO. METHODS: We prospectively studied consecutive patients older than 18 years diagnosed with UPJO undergoing laparoscopic pyeloplasty from December 2013 to February 2015 in our institution. Exclusion criteria included patients with bilateral UPJO, unilateral UPJO with contralateral pathologic kidney, solitary kidney, history of previous surgical treatment for UPJO or glomerular filtration rate below 60 ml/min/1,73m2. Each patient provided four voided urine samples for biomarker measurement, one at preoperative consultation and the others at 1, 3 and 6 months of postoperative follow-up. Healthy individuals with no hydronephrosis on ultrasound evaluation constituted our control group. RESULTS: We included 47 patients with a mean age of 38.6 ± 12.7 years (range 19-64 years), from which 17 (36.2%) were males and 30 (62.8%) were females. The control group consisted of 40 subjects with no statistical difference to the study group regarding age (p = 0.95) and gender (p = 0.82). KIM-1 had an area under the curve (AUC) of 0.79 (95% CI 0.70 to 0.89) and was the biomarker with the best diagnostic properties. CA19-9 had an AUC of 0.70 (95% CI 0.60 to 0.81), NGAL had an AUC of 0.71 (95% CI 0.61 to 0.83) and beta2M had an AUC of 0.61 (95% CI 0.50 to 0.73). KIM-1 was the most sensitive marker with a cutoff of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%) whereas CA 19-9 as the most specific one, displaying a cutoff of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). NGAL showed the greatest decrease in urinary concentrations after pyeloplasty, in which 90.0% of patients had a clearance greater than 50% in comparison to preoperative values. CONCLUSIONS: The evaluation of urinary biomarkers is useful in the assessment of UPJO in adults undergoing laparoscopic pyeloplasty. Urinary concentrations of CA 19-9, NGAL and KIM-1 were elevated in patients with UPJO and significantly decreased after pyeloplasty. The exact role of those biomarkers in the setting of obstruction in adults should be further evaluated
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Lanfrey, Pierre. "Hydronéphrose bilatérale de diagnostic anténatal : facteurs pronostiques et évolution". Montpellier 1, 1998. http://www.theses.fr/1998MON11077.
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Vignes, Jean-Pierre. "Urétéro-hydronéphrose et pontage aorto-bifémoral". Bordeaux 2, 1991. http://www.theses.fr/1991BOR2M192.
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Lenzen, Nora Christine [Verfasser], i Wolfgang [Akademischer Betreuer] Rösch. "Sonographisch relevante isolierte Hydronephrosen im Säuglings- und Kindesalter: Assoziation zwischen Nierensonographie und MAG3-Szintigraphie, Indikationskriterien zur MAG3-Szintigraphie sowie Operationsrisiko / Nora Christine Lenzen ; Betreuer: Wolfgang Rösch". Regensburg : Universitätsbibliothek Regensburg, 2019. http://d-nb.info/1186968907/34.
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"Alterations in glomerular dynamics in congenital unilateral hydronephrosis". Tulane University, 1993.
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Hydronephrosis can be defined most easily as an accumulation of fluid in the renal pelvicalyceal system and often is accompanied by a significant reduction in glomerular filtration rate (GFR). In rats with congenital unilateral (right sided) hydronephrosis, treatment with either the angiotensin II receptor antagonist saralasin or the thromboxane A$\sb2$ receptor antagonist SQ-29,548 returns GFR to normal levels. The current study defines the single nephron hemodynamic defect in congenital hydronephrosis and evaluates the roles of angiotensin II (Ang II) and thromboxane A$\sb2$ (TxA$\sb2)$ in this glomerular derangement. Renal micro- puncture studies were performed on animals with a right hydronephrotic kidney (HYDRO, n = 8), non-affected litter mates (CONTROL, n = 6), and four groups of hydronephrotic animals treated with the following antagonists; the TxA$\sb2$ receptor antagonist SQ-29,548 (SQ, n = 7) either one of two Ang II receptor antagonists, saralasin (SAR, n = 7) or DuP-753 (DUP, n = 7), and combined treatment with DuP-753 and SQ-29,548 (S&D, n = 7). SNGFR was significantly reduced in the hydronephrotic kidney compared to control (17.6 $\pm$ 2.0 vs. 35.9 $\pm$ 3.7 nl/min, respectively). Treatment with SQ-29,548 completely restored single nephron function (29.0 $\pm$ 3.0 nl/min), while saralasin and DuP-753 only partially restored function (25.6 $\pm$ 1.6 and 27.8 $\pm$ 1.4 nl/min respectively). Combined SQ-29,548 and DuP-753 treatment resulted in a full recovery of single nephron function to 32.9 $\pm$ 4.4 nl/min. The glomerular ultrafiltration coefficient (K$\sb{\rm f})$ was reduced approximately 45% when comparing CONTROL (2.84 $\pm$.22 nl/min/mmHg) to HYDRO (1.64 $\pm$.08 nl/min/mmHg). K$\sb{\rm f}$ returned to control in SAR, DUP and SQ, and increased above control in S&D (5.58 $\pm$ 1.6 nl/min/mmHg). There were no differences in $\rm P\sb{GC},\ P\sb{T},\ or\ \bar\pi\sb{GC}$ between any of the groups studied. These data indicate that the reduction in SNGFR in congenital hydronephrosis is precipitated by a fall in K$\sb{\rm f}$ which is mediated by both Ang II and TxA$\sb2.$ The observation of an increase in K$\sb{\rm f}$ above CONTROL with combined SQ-29,548 and DuP-753 treatment suggests that Ang II and TxA$\sb2$ alter the ultrafiltration coefficient via separate mechanismsacase@tulane.edu
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Chang, Chi-Hao, i 張其皓. "Studies on the Importance of Hydronephrosis and mTORCs Regulation in Urothelial Cell Carcinoma". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/57713309456982376295.
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博士國立陽明大學
臨床醫學研究所
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Obstructive nephropathy is the most common presentation of urothelial carcinoma. The role of the urine in the obstructed kidney namely “hydronephrotic urine” in urothelial carcinoma has not been extensively explored. This study aims to evaluate whether hydronephrotic urine in the obstructed kidney could promote urothelial carcinoma. The hydronephrotic urine was collected from the obstructed kidneys of Sprague-Dawley rats induced by different periods of unilateral ureteral obstruction (UUO). By the inhibition of LY294002 and PD184352, we confirm that hydronephrotic urine promotes urothelial carcinoma cell (T24) and immortalized normal urothelial cells (E6) proliferation, migration and invasion in a dose-dependent manner through the activation of the mTORC2-AKT and ERK signaling pathways. Hydronephrotic urine also increases the expression of cyclin-D2, cyclin-B and CDK2. It also decreases the expression of p27 and p21 in both urothelial carcinoma cells and normal urothelial cells. By the protein array study, we demonstrates that many growth factors which promote tumor cell survival and metastasis are over-expressed in a time-dependent manner in the hydronephrotic urine, including β-FGF, IFN-γ, PDGF-BB, PIGF, TGF-β, VEGF-A, VEGF-D and EGF. These results suggest that hydronephrotic urine promotes normal and malignant urothelial cells proliferation, migration and invasion, through the activation of the mTORC2-AKT and ERK signaling pathways. Further investigation using live animal models of tumor growth may be needed to clarify aspects of these statements. In the first part of study, we found that EGF is the major growth factor in hydronephrotic urine and EGF is important for mTORC2 activation in urothelial carcinoma. Accordingly, to identify the regulation of mTORCs upon EGF stimulation is necessary. In the second part of study, we focused on regulation of mTORCs after EGF stimulation. mTOR integrates signals from growth factors via mTOR Complex 1 (mTORC1) and mTOR Complex 2 (mTORC2). The mechanism of mTORC1 action has been widely studied; however, the regulation of mTORC2 has not been well studied. Here, we demonstrate that Gab1 is an important upstream regulator in EGF-mediated activation of mTORCs. In our study, we confirm that mTORCs translocate from the cytoplasm to the plasma membrane via the PH domain of Gab1 upon EGF stimulation. Moreover, Gab1 associates with mTORCs. This association stabilizes the integrity of mTORCs and induces mTORC activity. Compared to normal bladder tissue, the expression of Gab1 and activity of mTORCs are elevated in urothelial carcinoma. Collectively, our results suggest that Gab1 is an essential regulator of the EGF-mediated mTORC pathways and may potentially be used as a biomarker for urothelial carcinoma to predict diagnosis and drug response.
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Ferreira, Ana Isabel Valente da Cruz e. Santos. "Renogram indicators of renal risk on antenatal hydronephrosis : contribution of the cortical transit time for the therapeutic decision". Doctoral thesis, 2017. http://hdl.handle.net/10362/20714.
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RESUMO: INTRODUÇÃO: Com a introdução e desenvolvimento da ecografia obstétrica, o diagnóstico pré-natal de anomalias congénitas tem vindo a aumentar. O mais frequente destes achados é o da hidronefrose (HN). Em 10% a 30% destas situações pode estar presente uma obstrução da junção pieloureteral (OJPU). Na presença desta malformação, após o nascimento, as crianças são submetidas frequentemente a pelo menos dois exames complementares de diagnóstico – a ecografia renal e o renograma – com o objetivo de
tentar identificar sinais de risco para o rim. Com base nos resultados destes exames será decidida ou não a realização de uma intervenção cirúrgica – a pieloplastia. Vários investigadores estão a tentar identificar exames preditivos de risco renal, de modo a apoiar a decisão de intervir cirurgicamente ou não. HIPÓTESE DE ESTUDO E DESENHO DO ESTUDO: O atual projeto teve como objetivo contribuir para a pesquisa de biomarcadores de risco renal na OJPU, com a seguinte hipótese de estudo: “O tempo de trânsito cortical é um indicador de lesão renal e, como tal, pode ser usado como critério para a decisão cirúrgica na obstrução congénita da junção pieloureteral”. Consistiu num estudo observacional com um desenho de casocontrolo,
numa razão de 1:1, com uma amostra estimada de pelo menos 184 crianças.ABSTRACT: INTRODUCTION: With the introduction and development of ultrasonography in obstetrics, the prenatal diagnosis of foetal anomalies is increasing. Antenatal hydronephrosis (ANH) is the most frequent of these findings, and in between 10 to 30% of these conditions an ureteropelvic junction obstruction (UPJO) can be present. In the presence of such an anomaly, after birth, children are frequently submitted to at least two diagnostic procedures – the kidney ultrasonography and the renogram – to try to identify signs of renal risk, and to be able to timely decide a suitable surgical intervention – the pyeloplasty. Many researchers are pursuing the identification of predictors of renal risk to help in this decision. STUDY HYPOTHESIS AND STUDY DESIGN: The present project aimed at contributing to the on-going research topic of biomarkers of renal risk in UPJO, with the following study hypothesis: “Cortical transit time is an indicator of renal lesion and, as such, can be used as a criterion for surgical decision in congenital ureteropelvic junction obstruction”. It was an observational study, with a case-control design, with a 1:1 ratio and an estimated sample size of at least 184 children.
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Choi, Sharon Seung Hee. "The effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin on growth factor expression in the developing mouse ureter: Implications in aryl hydrocarbon receptor-mediated hydronephrosis". 2008. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=742662&T=F.
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Santos, Diana Magalhães dos. "Gravidade da Hidronefrose Pré-natal como Preditor de Uropatia Pós-natal". Master's thesis, 2018. http://hdl.handle.net/10316/82804.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaObjetivos: Esta investigação tem como objetivo colocar em evidência estudos que permitem relacionar a hidronefrose fetal com a existência de patologia urológica em pós-natal.Metodologia: Foi realizada uma revisão sistemática da literatura segundo as recomendações PRISMA, com recurso à base de dados PubMed e ClinicalKey. Foram selecionados artigos que avaliaram o estado do conhecimento sobre a hidronefrose pré-natal como fator preditivo de uropatia pós-natal, publicados entre 2011 e 2017.Resultados: Foram identificados dez artigos, de um total de 3376 que, após a aplicação dos critérios de inclusão e de exclusão, possibilitaram uma agregação em cinco domínios: relação entre o grau de hidronefrose pré-natal (ANH) e o risco de uropatia pós-natal e complicações associadas; relação entre o grau de ANH e o risco de necessidade cirúrgica; correlação entre o diâmetro ântero-posterior (APD) do bacinete e a evolução subsequente; a utilidade da ecografia no diagnóstico e seguimento da ANH; aconselhamento parental quando se faz o diagnóstico de ANH. A maioria dos artigos mencionou fatores que apontam para a utilidade do APD da pélvis renal como preditor do risco de um achado pós-natal patológico. Esta associação baseia-se na avaliação do grau de hidronefrose pré-natal (ligeiro, moderado e grave), sendo que no grau grave é consensual a existência de maior risco de uropatia pós-natal, não se evidenciando essa associação nos outros dois graus. Conclusões: De acordo com a revisão da literatura, perante um diagnóstico de hidronefrose pré-natal, este constitui-se como um fator preditor de uma uropatia pós-natal, sendo que o grau da hidronefrose é tradutor dessa predição, de acordo com o APD da pélvis renal, mais evidente no grau grave.
Objectives: The present investigation aims to highlight studies that allow the association of fetal hydronephrosis with post-natal urologic pathology.Methodology: A systematic review of the literature was performed according to the PRISMA recommendations, using the PubMed and ClinicalKey databases. Were selected articles wich evaluated the state of knowledge about prenatal hydronephrosis as a predictive factor of postnatal uropathy, published between 2011 and 2017.Results: Ten articles were identified from a total of 3376 articles that, after applying the inclusion and exclusion criteria, allowed an aggregation in five domains: relationship between the degree of prenatal hydronephrosis (ANH) and the risk of postnatal uropathy and associated complications; relationship between the degree of ANH and the risk of surgical necessity; correlation between the antero-posterior diameter (APD) of the renal pelvis and the subsequent evolution; the utility of ultrasound in the diagnosis and follow-up of ANH; parental counseling in the presence of ANH diagnosis. Most of the articles mentioned factors that point to the utility of renal pelvic APD as a predictor of the risk of a pathological postnatal finding. This association is based on the assessment of the degree of prenatal hydronephrosis (mild, moderate and severe) and in the severe degree it is consensual the existence of a higher risk of postnatal uropathy, not evidencing this association in the other two degrees. Conclusions: According to the literature review, if there’s a diagnosis of prenatal hydronephrosis, this constitutes a predictive factor of a postnatal uropathy, and the degree of hydronephrosis is a translator of this prediction, according to the APD of the renal pelvis, most evident in the severe degree.
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Heuer, Roman. "Experimentelle Untersuchung von molekularen Markern bei Hydronephrose im Rattenmodell /". 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=013038819&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Yang, Chii-Shen, i 楊啟伸. "Measurements of subcapsular blood flow with laser-doppler flowmetry on normal and hydronephrotic kidney of rats". Thesis, 1992. http://ndltd.ncl.edu.tw/handle/04527089360209976926.
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Kaiser, Daniel Fridolin [Verfasser]. "Renale Wirkung eines selektiven Adenosin-A1-Rezeptorantagonisten bei der Hydronephrose der Ratte / vorgelegt von Daniel Fridolin Kaiser". 2010. http://d-nb.info/100046637X/34.
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Lossow, Julia-Janine von [Verfasser]. "Prospektive Studie zur Diagnostik und Therapie der einseitigen kongenitalen asymptomatischen Hydronephrose / vorgelegt von Julia-Janine von Lossow, geb. Krapf". 2001. http://d-nb.info/967492289/34.
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