• Childhood Kidney Diseases
• /
• 제23권2호
• /
• pp.116-120
• /
• 2019

Bilateral renal obstruction is a rare critical condition, requiring a prompt diagnostic approach and treatment to restore the renal function. The most commonly observed obstructive uropathy in children is congenital malformation, such as posterior urethral valves and bilateral ureteropelvic junction obstruction. Malignant pelvic masses obstructing the ureter are widely reported in adults but are rarely observed in children. The treatment of ureteral obstruction related to pelvic malignancy is a therapeutic challenge with a median survival duration of 3-7 months in adults; however, pediatric patients with pelvic malignancy leading to ureteral obstruction had better outcomes, with a reported 5-year mortality rate of 20%, than the adult patients. Here, we report a rare case of bilateral ureteral obstruction associated with pelvic rhabdomyosarcoma presenting with acute kidney injury treated by ureteral diversion with double J stent, and concommittent emergency hemodialysis, leading to restoration of good renal function. We suggest that bilateral ureteral obstruction should be released as soon as possible using surgical or interventional approach to minimize the obstruction period, and subsequential chemotherapy may contribute to improvement of survival and recovery of renal function.

• The Korean Journal of Physiology and Pharmacology
• /
• 제10권6호
• /
• pp.343-347
• /
• 2006

The present study was designed to investigate the effects renin-angiotensin-aldosterone system (RAAS), endothelin (ET) and local natriuretic peptide (NP) system for glomerulopathy induced in the experimental bilateral ureteral obstructive rats. Sprague-Dawley male rats ($200{\sim}220g$ body weight) were bilaterally obstructed by ligation of the proximal ureters for 24 hours. Control rats were treated in the same ways, except that no ligature was made. The glomeruli were isolated from cortex by graded sieve methods, and the mRNA expressions of local renin-angiotensin system (RAS), aldosterone synthase (CYP11B2), endothelin-1 (ET-1) and NP system were determined by real-time polymerase chain reaction. Following the bilateral ureteral obstruction, the mRNA expressions of renin, angiotensin converting enzyme 1 as well as ET-1 were increased, while that of angiotensin converting enzyme 2 was not changed. The expressions of CYP11B2 and angiotensin II receptors were not changed. C-type natriuretic peptide (CNP) expression was increased, while its receptors (natriuretic peptide receptor-B) were not changed. We suggest that the upregulation of local RAS and ET playa role in the progressive glomerular injury, and that the enhanced CNP activity also plays a compensatory role in obstructive uropathy in the glomerulus.

• Investigative and Clinical Urology
• /
• 제59권6호
• /
• pp.376-382
• /
• 2018

Purpose: The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis. Materials and Methods: Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling. Results: Before stenting, 91 patients were CKD stages 1-3 and 26 patients were CKD stages 4-5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1-3 group and 23 in the CKD stages 4-5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors. Conclusions: Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.

• Childhood Kidney Diseases
• /
• 제2권1호
• /
• pp.86-89
• /
• 1998

A bladder diverticulum occurs when the bladder mucosa herniates or protrudes through the muscular wall of the baldder. The majority of congenital bladder diverticula occurs in males. They are the most common in the region of the bladder base, most frequently in the region of the ureteral hiatus, in which case they are known as Hutch's diverticula. They can give rise to obstruction or reflux. We had experienced a case of bilateral Hutch's diverticulum associated with vesicoureterai reflux in a 23 month old male. Chief complaints were urinary frequency and dysuria. Voiding cystourogram and CT scan revealed large bilateral Hutch's diverticulum with bilateral vesiciureteral reflux grade VI. There was evidence of urinary infection. This patient was successfully treated by ureteroneocystostomy. We report this case with a brief review of related literatures.

• 대한핵의학회지
• /
• 제1권2호
• /
• pp.75-84
• /
• 1967

$^{131}I$-labeled-O-iodohippurate renograms in 15 cases of epidemic hemorrhagic fever(E.H. fever)during oliguric, diuretic and convalescent phase were analysed quantitatively and qualitatively, namely by its configuration, Tmax T 1/2 and renal index of Hirakawa. The results were as following: 1) Changes on the renograms in E.H. fever showed simultaneous bilateral renal impairment. 2) The characteristic configurations of renogram in the oliguric phase were: (1) Moderately decreased absolute amplitude of initial spike. (2) Continous rising second slope. (3) No appearance of terminal descent. Those were mast likely to those of renograms in acute ureteral obstruction or acute dehydration state. 3) During the diuretic phase, the renogram showed the point of maximal amplitude, but the steepness of 2nd slope was markedly decreased. The appearance of terminal descents was observed with unusually high amplitude despite of the tremendously large amount of urinary output during this phase. 4) In convalescence, the renograms were essentially normal in configuration, but the renal index of Hirakawa was not recovered until this phase. 5) Renograms in E.H. fever showed the characteristic patterns in each phase of its clinical course. 6) $^{131}I$-OIH-Renogram might be an useful method for the evaluation of renal function in E.H. fever during its course.

• Clinical and Experimental Pediatrics
• /
• 제52권4호
• /
• pp.464-470
• /
• 2009

목 적 : 산전 초음파로 발견된 선천성 신 요로 기형의 빈도와 임상 결과에 대해 알아보고자 하였다. 방 법 : 1989년 10월부터 2007년 10월까지 18년간 산전 초음파에서 발견되어 출생 후 서울아산병원 소아청소년과에서 선천성 신 요로 기형이 진단된 906예를 대상으로 의무 기록과 검사 결과를 조사하였다. 결 과 : 발생 빈도는 수신증, 다낭성 이형성 신, 중복 신장, 방광 요관 역류, 단일 신, 수뇨관 신증, 이소성 신장, 다낭성 신, 요관류, 후부 요도 판막의 순이었다. 수신증은 520예로 57.4%를 차지하였으며 이 중 20%가 수술이 필요하였다. 다낭성 이형성 신은 25.4%에서 다른 동반된 신 요로 기형이 있었다. 중복 신장은 57.9%에서 수술이 필요하였다. 방광 요관 역류는 남아에서 10배 많았다. 상염색체 열성형 다낭성 신의 7예 중 2예가 만성 신부전으로 진행하였다. 후부 요도 판막은 9예(1%)로 빈도가 낮았으며, 그 중 1예가 만성 신부전으로 진행하였다. 결 론 : 산전 초음파로 발견되는 선천성 신 요로 기형은 그 종류가 다양하며 임상 결과는 많은 예에서 양호하여 특별한 처치가 필요 없는 경우도 많으나, 일부에서는 신장 기능을 감소시키는 원인이 되거나, 반복적인 요로 감염의 원인이 되어 수술이 필요한 경우가 있으며 특히 양쪽 신장에 발생하는 기형은 적절한 처치를 하지 않으면 만성 신부전으로 진행하는 원인이 될 수 있다. 그러므로 각각의 기형에 대한 정확한 분포와 임상 결과를 알기 위해서는 장기적으로 다기관 뿐 아니라 전국적인 조사 연구가 필요하다.