• Childhood Kidney Diseases
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• v.23 no.2
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• pp.116-120
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• 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.

• Childhood Kidney Diseases
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• v.28 no.1
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• pp.1-7
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• 2024

Antenatally diagnosed urinary tract dilatation (UTD), previously referred to as antenatal hydronephrosis, is the most commonly detected abnormality by prenatal ultrasonography. Several grading systems have been developed for the classification of antenatal UTD using prenatal and postnatal ultrasonography. UTD comprises a wide variety of congenital abnormalities of the kidney and urinary tract ranging from transient UTD to more significant abnormalities such as vesicoureteral reflux, ureteropelvic junction obstruction, ureterocele, ureterovesical junction obstruction, posterior urethral valves, and non-refluxing megaureter. Optimizing the evaluation of antenatally detected UTD is essential to recognize children with important disorders while avoiding excessive investigations. Conservative approach with close follow-up is increasingly accepted as an appropriate treatment option for patients with asymptomatic vesicoureteral reflux and ureteropelvic junction obstruction in recent years. However, predicting permanent kidney damage in an unselected group of children with antenatal UTD is still challenging. The management and follow-up of children with UTD should be individualized based on recommendations from a pediatric nephrologist, a pediatric urologist, or both. Future research directed at predicting long-term outcomes of children diagnosed with UTD from mild findings to severe disease is needed to refine management for those at higher risk of kidney disease progression.

• The Korean Journal of Physiology
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• v.16 no.2
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• pp.165-175
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• 1982

Changes in handling of $Li^+$ by contralateral kidney during acute $Li^+$ loading were investigated immediately after unilateral ureteral obstruction. Carotid artery, jugular vein, renal vein and ureter of experimental animal were catheterized and renal venous flow was shunted to .external jugular vein. In experimental group right ureter was ligated. One to two hours after operation a single shot of LiCl solution (2 mEq/kg) was intravenously injected and then .arterial, renal venous blood and urine samples were taken sequentially for 1 to $1{\frac{1}{2}}$ hours. Urine volume, plasma and urinary concentrations of $Li^+$, $Na^+$ and $K^+$ were measured and urinary excretion of them were calculated. Results obtained were as follows: 1) In experimental group urine volume, urinary excretion of $Na^+$, and $K^+$ by contralateral kidney after unilateral ureteral obstruction were slightly larger than mean value of both kidney in control group. 2) During acute $Li^+$ loading contralateral kidney in experimental group showed limited $K^+$ excretion, but urinary flow and $Na^+$ excretion were comparable to mean value of both kidney in control group. 3) Urinary osmolar concentration in experimental group was much lower than that in control group, and it was maintained at low level even after Li loading. 4) In experimental group plasma$Li^+$ concentration decreased more slowly than in control group after a single shot of LiCl solution. 5) Urinary excretion of $Li^+$ in experimental group was markedly decreased, even lesseer than mean of both kidney in control group. 6) From the above results it was concluded that immediately after unilateral ureteral obstruction contralateral kidney showed normal water and $Na^+$ diuretic response to Li load but urinay $Li^+$ excretion was decreased and reclaimed $Li^+$ to systemic circulation.

• Korean Journal of Radiology
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• v.1 no.3
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• pp.152-158
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• 2000

Objective: The purpose of this study was to compare the effectiveness of MR urography (MRU) with that of ultrasonography (US) in the evaluation of urinary tract when this failed to opacify during excretory urography (EXU). Materials and Methods: Twelve urinary tracts in 11 patients were studied. In each case, during EXU, the urinary system failed to opacify within one hour of the injection of contrast media, and US revealed dilatation of the pelvocalyceal system. Patients underwent MRU, using a HASTE sequence with the breath-hold technique; multi-slice acquisition was then performed, and the images were reconstructed using maximal intensity projection. Each set of images was evaluated by three radiologists to determine the presence, level, and cause of urinary tract obstruction. Results: Obstruction was present in all twelve cases, and in all of these, MRU accurately demonstrated its level. In this respect, however, US was successful in only ten. The cause of obstruction was determined by MRU in eight cases, but by US in only six. In all of these six, MRU also successfully demonstrated the cause. Conclusion: MRU is an effective modality for evaluation of the urinary tract when this fails to opacify during EXU, and appears to be superior to US in demonstrating the level and cause of obstruction.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.14 no.2
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• pp.224-230
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• 2001

In the Clinical study on 1 Case of Patient with Obstruction of the retinal artery, the results were as follows. 1. Obstruction of the retinal artery is acute disease that vision isdiminished fastly and become a blindness. 2. It belong to the cathegory of Pock Maeng(暴盲) in Oriental Medicine. 3. The causes of Obstruction of the retinal artery were the yin-deficiency of liver and kidney, the stagnation of vital energy and blood stasis, the abundance of phlegm-heat, the yang-deficiency of spleen and kidney, the yin-deficiency of spleen and kidney, the nonfastness of primordial energy etc. 4. We could get the effective result by providing the patient with Jinkansikpung-tang-gami(鎭肝熄風湯加味) in the acute period 5. In Acupuncture treament and other treament, Electro-acupuncture theraphy ana Lodestone theraphy were useo for neurologic stimulation, Body acupuncture and Auricula-acupuncture were used for promoting the circulation of vital energy and blood.

• Childhood Kidney Diseases
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• v.22 no.1
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• pp.28-31
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• 2018

Ureteropelvic junction obstruction is one of the common causes of hydronephrosis in infancy and childhood. Most cases of ureteropelvic junction obstruction are diagnosed prenatally and are usually asymptomatic. Although less common, older children can experience ureteropelvic junction obstruction that presents with symptoms including flank or abdominal pain. Here, we present the case of a nine-year-old healthy girl who had repeated flank pain and abdominal symptoms, with mild left hydronephrosis, for several months. Computed tomography that was performed during the period of acute flank pain revealed aggravated hydronephrosis on her left kidney, which was secondary to an ureteropelvic junction obstruction. She underwent laparoscopic pyeloplasty, and a crossing vessel that passed the ureteropelvic junction was identified. In addition, we reviewed the current literature of this rare entity.

• Childhood Kidney Diseases
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• v.4 no.2
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• pp.170-174
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• 2000

Ureteropelvic junction obstruction and duplicated collecting system are common urologic anomalies in upper urinary system, but they seldom occur in combination. These obstruction can occur in both partial or complete duplicated collecting system. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obsturction, damage and potential fir regeneration in growing kidney. We report our experience of successful surgical interventions in the ureteropelvic junction obstruction of the lower pole with complete duplicated collecting system.

• Korean Journal of Veterinary Research
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• v.39 no.1
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• pp.230-239
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• 1999

Digital color doppler ultrasonographic system(DCDUS) has a lot of diagnostic functions. One of these is a detection of low velocity vessels in the organs of abdominal cavity. The purpose of study was to determine the clinical usefulness of DCDUS. Interlobar artery resistive index(RI), pulsatility index(PI) and systolic diastolic ratio(SDr) were measured for diagnosis of obstructed urinary tract. RI, PI and SDr were a measure of intrarenal blood flow impedance. This study was consisted of 2 groups. The normal group was studied in 16 normal adult dogs and the study group was studied 7 dogs with surgically induced, unilateral ureteral obstruction. In the study group, parameters were checked in normal condition and on 1, 2, 3, 5, 7 and 10th day after ligation. The result were summarized as follows. In the normal group, RI, PI and SDr of the left kidney was $0.65{\pm}0.04$, $1.25{\pm}0.12$ and $292.45{\pm}29.40$, respectively. RI, PI and SDr of the right kidney were $0.64{\pm}0.05$, $1.28{\pm}0.20$ and $282.25{\pm}37.26$, respectively. In the study group, RI of the left kidney induced ligation was increased significantly on 1, 2, 3, 5, 7 and 10th day. RI of the left kidney on 1, 2, 3, 5, 7 and 10th day were $0.75{\pm}0.05$, $0.71{\pm}0.03$, $0.74{\pm}0.04$, $0.74{\pm}0.02$, $0.73{\pm}0.02$ and $0.73{\pm}0.04$, respectively. PI of the left kidney was increased significantly on 1, 3, 5 and 7th day. PI of the left kidney on 1, 3, 5 and 7th day were $1.57{\pm}0.21$, $1.54{\pm}0.24$, $1.60{\pm}0.15$ and $1.60{\pm}0.26$, respectively. SDr of the left kidney increased significantly on 1, 2, 3, 5 and 7th day. SDr of the left kidney on 1, 2, 3, 5 and 7th day were $412.18{\pm}86.69$, $352.14{\pm}47.05$, $399.77{\pm}65.54$, $369.43{\pm}48.34$ and $365.57{\pm}22.46$, respectively(p<0.05). In the study group, RI of the left kidney was more increased than that of the right kidney on 1, 2, 3, 5, 7 and 10th day. PI of the left kidney was more increased than that of the right kidney on 1, 3, 5, and 7th day. SDr of the left kidney was more increased than that of the right kidney on 1, 2, 3, 5 and 7th day(p<0.05). RI was effective in the diagnosis of an acute unilateral ureteral obstruction. PI and SDr were insufficient in the diagnosis of an acute unilateral ureteral obstruction.

• The Korean Journal of Physiology and Pharmacology
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• v.25 no.2
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• pp.139-146
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• 2021

Mitochondrial NADP+-dependent isocitrate dehydrogenase 2 (IDH2) produces NADPH, which is known to inhibit mitochondrial oxidative stress. Ureteral obstruction induces kidney inflammation and fibrosis via oxidative stress. Here, we investigated the role and underlying mechanism of IDH2 in unilateral ureteral obstruction (UUO)-induced kidney inflammation using IDH2 gene deleted mice (IDH2-/-). Eight- to 10-week-old female IDH2-/- mice and wild type (IDH2+/+) littermates were subjected to UUO and kidneys were harvested 5 days after UUO. IDH2 was not detected in the kidneys of IDH2-/- mice, while UUO decreased IDH2 in IDH2+/+ mice. UUO increased the expressions of markers of oxidative stress in both IDH2+/+ and IDH2-/- mice, and these changes were greater in IDH2-/- mice compared to IDH2+/+ mice. Bone marrow-derived macrophages of IDH2-/- mice showed a more migrating phenotype with greater ruffle formation and Rac1 distribution than that of IDH2+/+ mice. Correspondently, UUO-induced infiltration of monocytes/macrophages was greater in IDH2-/- mice compared to IDH2+/+ mice. Taken together, these data demonstrate that IDH2 plays a protective role against UUO-induced inflammation through inhibition of oxidative stress and macrophage infiltration.

• Investigative and Clinical Urology
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• v.59 no.6
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• pp.376-382
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• 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.