改进后的肾囊肿CT引导下硬化剂治疗术

目的观察改进肾囊肿CT引导下硬化剂治疗术的疗效。方法386例肾囊肿经皮穿刺抽吸乙醇治疗,其中,单纯性肾囊肿243例,多发囊肿113例,双肾均有囊肿30例。囊肿直径1.5~7 cm。用9-14 G穿刺针穿刺抽吸,抽出囊液5~700 ml,注入99.7%无水乙醇保留而不抽出,乙醇量以抽出量的25%~50%计算。结果随访193例(251个囊肿),时间3个月~12个月,囊肿治疗有效率达98%以上,囊腔消失率达87%,并发症仅为局部腰部胀痛,无严重后遗症。结论改进后的CT引导下肾囊肿硬化剂治疗术是一种安全、并发症少,操作简单的有效治疗方法。     

超声引导下肝肾包膜下囊肿穿刺抽液最佳路径

目的对比分析超声介导下两种穿刺路径对于肝肾包膜下囊肿的抽液疗效。方法将129例肝肾包膜下囊肿患者,随机分为改良组及传统组,于超声引导下行囊肿穿刺抽吸术。改良组将穿刺路径定于囊腔偏心侧靠近肝肾实质处,传统组将穿刺路径定于囊腔中心处,比较两组的囊液抽吸率及安全性。结果改良组63例,抽吸完全56例(56/63,88.89%),7例有残液,残液量13~34ml,抽吸率为78.3%~100%。传统组66例,抽吸完全51例(51/66,77.27%),15例有残液,残液量18~57ml,抽吸率为60.8%~100%。改良组囊液抽吸完全例数及抽吸率均高于传统组,差异均有统计学意义(P均0.05)。两组操作过程中均未出现明显并发症。传统组中3例行抽液时针尖脱落在外,无法进行硬化治疗。结论改良的穿刺路径更适用于肝肾包膜下囊肿,对于抽吸更多的囊液及进一步硬化治疗具有重要的意义。     

肾脏炎性假瘤的诊断与治疗(附9例报告)

目的:提高对肾脏炎性假瘤(RIP)的认识及诊治水平。方法:回顾性分析我院近年来诊治的9例RIP患者的临床资料,并结合文献复习探讨RIP的诊治方法。结果:9例患者中,5例误诊为肾癌,行肾切除术;1例误诊为肾盂癌,行肾、输尿管、膀胱切除术;3例经穿刺病理活检证实为炎症,行抗炎治疗后痊愈。密切随访1~6年,6例行切除术的患者中,3例未见肿瘤复发;3例确诊的患者也未见肿瘤复发。结论:RIP诊断困难,临床上极易误诊,细针穿刺活检是其确诊的主要依据。     

Role of CT scan in diagnosis of renal lymphangiectasia: our single-center experience

Background: Renal lymphangiectasia is rarely reported benign renal disorder of lymphatic malformation. Though found incidentally; it presents with nonspecific symptoms and shows characteristic findings in radiological imaging studies.

Aim: Here, we report eight patients with symptoms, laboratory and imaging findings compatible with renal lymphangiectasia. This report describes clinical and laboratory characteristics, treatment, Imaging findings and outcome of a series of patients with renal lymphangiectasia and reviews the literature.

Methods and material: Eight patients (mean age 45?years, male:female ratio 3:1) from 1st January 2011 to 30th June 2016; showing renal lymphangiectasia as incidental finding on CT IVP were included in the series. Imaging and laboratory findings were reviewed. Two out of eight patients (25%) underwent aspiration of collection and laboratory findings confirmed the diagnosis of renal lymphangiectasia. Four out of eight patients (50%) did not undergo aspiration of fluid and were offered conservative treatment. Two out of eight patients (25%) were donors for renal transplantation who were managed conservatively.

Results: Renal lymphangiectasia was diagnosed on CT IVP. In each case, where aspiration of collection fluid was offered, the laboratory diagnosis of renal lymphangiectasia was confirmed and patients were managed conservatively. However, large collection in one patient was relieved by percutaneous aspiration.

Conclusions: Renal lymphangiectasia can be diagnosed with CT scan and confirmed by laboratory tests. As it may be confused with other cystic lesions of kidney; proper diagnosis and exclusion of other differentials can be effectively offered by CT scan IVP, which can avoid unnecessary invasive treatment options.     

Successful Treatment of Renal Abscess with Percutaneous Needle Aspiration in a Diabetic Patient with End Stage Renal Disease Undergoing Hemodialysis

Renal abscesses in patients with end stage renal disease are quite rare, and misdiagnosis or delaying in diagnosis is frequent. This report examines a case of renal abscess in a patient with end stage renal disease on maintenance hemodialysis and diabetes mellitus, which presented with a prolonged fever. An infected diabetic foot was impressed initially. Purulent urine, pyuria, bacteriuria, and bacteremia were noted after admission. Renal abscess was diagnosed by percutaneous needle aspiration under computerized tomography guidance. The patient was treated with parenteral antibiotics and percutaneous aspiration of the abscess. Follow-up ultrasonography showed renal abscess resolution. This case demonstrated that nephrectomy was not required in selected uremic patients with renal abscess.     

Laparoscopic management of symptomatic simple renal cysts

Objective: To evaluate the efficacy of retroperitoneoscopy for the treatment of symptomatic renal cyst disease. Patients and methods: We evaluated the efficacy and morbidity of aspiration versus open and laparoscopic surgical techniques in a paired institution over a 20-year period. Prospectively recorded parameters for the 11 cases dealt with by primary retroperitoneoscopic techniques were compared with historical controls dealt with by open surgery. Results: Small volume cysts were satisfactorily dealt with by aspiration alone. All patients undergoing laparoscopic cyst decortication for the larger volume cysts had a satisfactory outcome with improvement in their symptoms and objective cure on follow up imaging studies. Conclusion: Laparoscopic management for all cysts is a safe, effective and minimally invasive alternative to open surgery for symptomatic renal cysts. Simple drainage under radiological guidance is also highly effective and should probably be first line treatment for cysts up to 6 cms in diameter whereas primary laparoscopic treatment should be suggested for larger cysts. This revised version was published online in August 2006 with corrections to the Cover Date.     

低位负压吸引提高经皮肾镜取石术效率的临床研究

目的探讨低位负压吸引超声碎石清石系统在肾结石治疗中的临床应用价值。方法25例。肾结石患者随机分成2组,对照组15例采用EMS三代超声碎石清石系统进行经皮肾镜碎石术,改良组10例采用低位负压吸引超声碎石清石系统进行经皮。肾镜碎石术。对两组清石时间、术中出血量、结石清除率、出血、感染和住院天数等进行比较分析。结果两组患者均顺利完成手术,无1例穿刺失败或中转开放手术。改良组清石时间（开始碎石取石到取石结束）、术中出血量明显少于对照组（P〈0．05）。而两组患者的结石清除率、出血和感染等并发症、住院天数差别无显著性（P〉0．05）。结论低位负压吸引超声碎石清石系统可以提高清石效率,减少清石时间及手术时间。     

B超引导结合穿刺注药治疗肾囊肿

本文报告采用B超引导经皮穿刺注药治疗肾囊肿25例,取得满意疗效。并就肾囊肿的诊断方法及治疗进行讨论。     

肾小管上皮细胞模拟缺血缺氧时黏附力的改变

目的：直接测定模拟缺血缺氧时肾小管上皮细胞－基底膜黏附力。方法：用细胞流变学新手段－微管吸吮技术,对培养肾小管上皮细胞在模拟单纯缺血、单纯缺氧和同时缺血缺氧时与人工基底膜之间的黏附力进行测定。结果：模拟缺血缺氧时肾小管上皮细胞与人工基底膜之间黏附力较正常时明显降低（P＜0．001）.结论：微管吸吮技术是定量研究肾小管上皮细胞黏附力及其改变的有效手段。肾小管上皮细胞与基底膜直接黏附力下降验证了国内外传统研究对其黏附力改变的间接推测。     

CT引导改良平头针行肾囊肿穿刺及硬化剂治疗临床研究

目的：探讨应用改良平头针在CT引导下行肾囊肿穿刺及硬化剂治疗的方法及疗效。方法：使用带锐角针芯的去斜面18—21G穿刺针或16号肾活检穿刺针（即平头针面）在CT引导下对38例42个直径3．0～17.2cm的单纯性肾囊肿经皮穿刺抽吸，并行99．7％无水乙醇硬化剂治疗。结果：42个囊肿治疗后，随访3个月～1年。32个囊肿消失。7个囊肿缩小，无严重并发症，总有效率达92．9％（39／42）；临床症状缓解率为86．2％（25,／29）。结论：在CT引导下，用带针芯的改良平头针经皮穿刺及硬化剂治疗单纯性肾囊肿定位准确、创伤轻微、安全有效、简便易行，临床值得推广。     

Renal cell carcinoma presenting as solitary foot metastasis

Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.     

Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts

Objective: To assess the effectiveness and long-term results of two repeated ethanol injections in the treatment of symptomatic renal cysts. Methods: Sixty-eight patients 47to 75 years old with 77 large (6.3–14.8 cm; mean 8.62 cm)symptomatic cysts were included in this study. Of the 68patients, in 4 cases there were renal cysts associated with renal calculi. An 8FR Pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of cystic fluid. Two repeated ethanol 95% injections were performed every 24 hours. Patients were followed-up by ultrasonography for a period of 12–48 months (mean 30). Results: In two patients the cyst puncture was not feasible because of poor visualization of puncture site while in one patient there was communication of cystic cavity with the pelvocaliceal system. In these patients surgical resection of cysts was performed. Complete and partial regression rates were 57/68 (83.82%) and 8/68 (11.76%)respectively. In four patients with renal stones and renal cysts, extracorporeal shock wave lithotripsy (ESWL) was successfully executed 1 month after sclerotherapy. Conclusion: Our results suggest that percutaneous aspiration followed by two repeated ethanol injections is highly effective on reducing recurrence of simple renal cysts. This revised version was published online in September 2006 with corrections to the Cover Date.     

经皮肾镜碎石取石术联合负压吸引治疗肾结石的Meta分析

目的比较经皮肾镜碎石取石术（PCNL）联合负压吸引与无负压的PCNL在治疗肾结石的安全性和有效性。 方法检索英文数据库PubMed、EMBASE、the Cochrane Controlled Trial Register of Controlled Trials;中文数据库中国知网（CNKI）、万方、中国生物医学数据库（建刊至今）。收集两种术式治疗肾结石的随机对照研究,2位研究者独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。 结果共纳入12篇随机对照研究（RCT）,样本量为1 100例肾结石患者（负压组538例,无负压组562例）。Meta分析表明,两组在感染性休克[RR=0.43,95%CI（0.12,1.63）,P=0.22]、ClavienⅠ级并发症[RR=0.83,95%CI（0.47,1.48）,P=0.53]及ClavienⅢ级以上并发症[RR=1.12,95%CI（0.40,3.15）,P=0.83]方面差异无统计学意义,但PCNL联合负压吸引组结石清除率更高[RR=1.11,95%CI（1.00,1.23）,P=0.05],在手术时间[MD=-10.03,95%CI（-15.79,-4.27）,P=0.0006]、术后发热[RR=0.41,95%CI（0.27,0.61）,P<0.001]、出血量[MD=-71.63,95%CI（-136.89,-6.37）,P=0.03]、Clavien总体并发症[RR= 0.54,95%CI（0.41,0.71）,P<0.001]、ClavienⅡ级并发症[RR=0.43,95%CI（0.30,0.60）,P<0.001]及肾盂内压方面[MD=-10.47%,95%CI（-11.49,-9.45）,P<0.001]也优于无负压组。 结论与无负压组相比,PCNL联合负压吸引能够提高结石清除率,缩短手术时间,降低肾盂内压,减少术后发热、出血等并发症。同时并未增加感染性休克、ClavienⅠ级及Ⅲ级以上并发症的发生率。     

运用新型定位架减少CT引导肾囊肿穿刺治疗中辐射剂量的研究

目的：观察运用新型定位架在CT引导下行肾囊肿穿刺及硬化剂治疗的疗效及减少治疗中辐射剂量的综合效果。方法：分为使用新型定位架组（43例52个肾囊肿）及未使用新型定位架组（38例42个肾囊肿）,比较两组患者在CT引导下经皮肾囊肿穿刺抽液并行99.7%无水乙醇注射治疗中CT扫描引导、穿刺次数、穿刺效果、治疗疗效（有效率）及CT扫描时患者接受电离辐射的剂量。结果：CT扫描引导次数、穿刺次数、电离辐射量分别为：使用新型定位架组（52人次）（2.35±0.52）次、（1.35±0.52）次、（2.66±0.23）毫西伏（mSv）;未使用新型定位架组（42人次）（3.71±0.92）次、（2.71±0.92）次、（3.63±0.98）mSv。两组比较差异有统计学意义（P〈0.01）。两组穿刺成功率均达100%,治疗有效率皆分别为94.2%、92.9%,使用新型定位架组略高于未使用新型定位架组,但差异无统计学意义（P〉0.05）。结论：CT扫描引导下经皮肾囊肿穿刺抽液并行无水乙醇治疗,若同时使用新型定位架定位,可提高肾囊肿穿刺针定位的准确性,明显减少CT扫描定位次数,避免反复调整进针角度、深度。减少穿刺次数,减少对患者的电离辐射剂量;同时减少了CT机械（尤其是球管）的耗损,间接地节约了CT扫描定位的成本。该新型定位架设计轻巧,结构合理,操作简单,临床值得推广运用。     

Primitive neuroectodermal tumor of kidney mimicking as an inflammatory renal mass

Introduction

Renal primitive neuroectodermal tumor (PNET) is a rare and aggressive renal tumor with few reported cases in the literature.

Renal involvement in leprosy

Renal involvement in Hansen's disease was evaluated in 94 Portuguese patients, average age and duration of disease of 47.6 and 6.8 years respectively. Sixty-seven were studied retrospectively and 27 prospectively; renal biopsy was obtained in 4, fat-tissue needle aspiration for amyloidosis in 20, and tubular function was tested in ten. Mild proteinuria and/or haematuria was found in 33 patients, the severity increasing during erythema nodosum leprosum reactions, but without overt nephritic or nephrotic syndrome. Two patients had renal amyloidosis on biopsy and two more were confirmed by fat biopsy, a 10.5% incidence in those studied prospectively; all but one were of the lepromatous type, with frequent bouts of erythema nodosum leprosum. The two other renal biopsies showed mesangial glomerulonephritis, and one unexplained acute tubular necrosis; none had immune deposits by immunofluorescence. Proximal acidification was always normal, distal acidification tested by bicarbonate infusion was abnormal in one of nine patients, and six of nine patients had concentration defects. Leprosy causes frequent urinary sediment changes and concentration defects, usually without clinical expression; proteinuria and/or glomerular involvement is mainly due to amyloidosis.     

Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts

OBJECTIVES: Symptomatic simple renal cysts can be treated by combination of percutaneous aspiration and sclerotherapy. A number of sclerosing agents including glucose, phenol, iophendylate, polidocanol, minocycline and pantopaque have been used in the past to prevent reformation of cyst. In this study, tetracycline HCL solution is evaluated as a sclerosant for treatment of simple renal cysts. METHODS: Our study treated 76 cysts in 70 patients with symptomatic renal cysts. Aspiration and sclerotherapy was performed on 56 cysts, and 20 cysts aspirated without sclerotherapy as a control group. Treatment was performed under local anesthesia and punctured under ultrasound guidances with an 18-gauge needle. Tetracycline HCL (20%) was injected into the cystic cavity according to cyst diameter. All patients were followed up with an ultrasound examination at 3 months, 6 months, and then at yearly intervals. The reduction rate was estimated by a comparison of the volume of the cyst before and after treatment. A cyst reduction of 50% or greater in diamater was considered as a successful treatment. RESULTS: The average follow-up period was 9.8 months in the sclerotherapy group and 9.9 months in the control group. The success rate was 85.7% in the sclerotherapy group. There was a significant difference in the reduction rate of tetracycline HCL sclerotherapy group and control group. No major complications were encountered.     

Solitary Thyroid Metastasis of Renal Clear Cell Carcinoma: Report of a Case

A case of solitary thyroid metastasis of renal clear cell carcinoma is described. The patient was a 77-year-old Japanese woman, who was referred to our department after a thyroid tumor was identified in May 1999. She had a history of renal clear cell carcinoma of the left kidney, which had been partially resected 3 years previously. Ultrasound sonography demonstrated that a well-demarcated hypoechoic mass containing high-echo spots representing small calcifications, which measured 45 × 34 × 31 mm in size, occupied the left lobe. Computed tomography revealed a low-density mass containing small calcifications. The results of preoperative fine-needle aspiration cytology strongly suggested a clear cell carcinoma metastasizing to the thyroid. A left hemithyroidectomy was performed on July 27, 1999. A histological examination revealed that the neoplasm was composed of tumor cells with abundant clear cytoplasm and round nuclei. The histological characteristics of this thyroid tumor were virtually identical to the renal cell carcinoma resected3 years previously. Thyroglobulin stained negatively in the clear cells of the resected thyroid tumor in an immunohistochemical analysis. Clinically, the thyroid gland is a rare site of tumor metastasis; however, we should also consider the possibility of metastasis in the case of thyroid tumor patients with a history of renal cell carcinoma. Received: March 3, 2000 / Accepted: September 26, 2000     

Influence of renal nerves on renal function during development

The present review summarizes recent studies describing the role of renal sympathetic innervation in the regulation of renal function during development. The afferent renal innervation appears early during fetal life and probably precedes the development of efferent renal nerves. There is suggestive evidence that renal nerves are required for the proper development of the kidney and that neurotrophic growth factors play an important role in renal embryogenesis and in renal tubular differentiation. Renal sympathetic innervation modulates renal hemodynamics early during development. Renal nerve stimulation during -adrenoceptor blockade produces renal vasodilation in fetal and newborn animals but not in adults. Unlike the effect of renal nerves on fetal renal hemodynamics which is observed in the young fetus, the role of renal sympathetic nerves in modulating fluid and electrolyte homeostasis seems to develop during late gestation. Recent studies have also shown that renal nerves play an important role in regulating renin secretion during the transition from fetal to newborn life. For example, renal denervation during fetal life suppressed the physiological rise in plasma renin activity associated with delivery and decreased renal renin mRNA levels after birth. Taken together, these studies suggest that renal nerves influence fetal renal development and that the influence of renal sympathetic innervation on renal hemodynamics and function changes with maturation.     

Urinary tract infection in the newborn: clinical and radio imaging studies

The objective of this study was to assess clinical characteristics and results of radio imaging studies and compare community-acquired urinary tract infection (UTI) with nosocomial UTI in 301 neonates with UTI consecutively admitted to 28 neonatal units in Spain over 3 years (community-acquired UTI, n = 250; nosocomial UTI, n = 51). UTI was diagnosed in the presence of symptoms of infection together with any colony growth for a single pathogen from urine obtained by suprapubic aspiration, or >or=10(4) CFU/ml for a single pathogen from urine obtained by urethral catheterization. Abnormal renal ultrasound was present in 37.1% of cases (34% in community-acquired UTI and 54.5% in nosocomial UTI, P < 0.01). The voiding cystourethrography (VCUG) showed vesicoureteral reflux (VUR) in 27% of cases (23.8% in community-acquired UTI and 48.6% in nosocomial UTI, P < 0.01). In patients with abnormal renal ultrasound and VUR, renal scan with dimercaptosuccinic acid (DMSA) performed early after UTI revealed cortical defects in 69.5% of cases. However, in patients with abnormal renal ultrasound and normal VCUG, DMSA also revealed cortical defects in 39% of cases. The absence of VUR in neonates with UTI and abnormal renal ultrasound does not exclude the presence of cortical defects suggestive of pyelonephritis.