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Acute kidney injury due to bilateral malignant ureteral obstruction:Is there an optimal mode of drainage?

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World Journal of Nephrology 2022年第6期11卷 146-163页

作者： Rabea Ahmed Gadelkareem Ahmed Mahmoud Abdelraouf Ahmed Mohammed El-Taher Abdelfattah Ibrahim Ahmed Department of Urology Assiut Urology and Nephrology HospitalFaculty of MedicineAssiut UniversityAssiut 71515AssiutEgypt

There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology.It warrants urgent drainage of the kidneys in emergency settings.However,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients.This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature.Also,we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy.Despite the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced malignancy.However,the disturbance of the quality of life of those patients remains a major unresolved concern.Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.

关键词： Acute kidney injury Kidney Malignancy Percutaneous nephrostomy ureteral obstruction Ureter

Huoxue Jiedu Huayu recipe(活血解毒化瘀方)alleviates contralateral renal fibrosis in unilateral ureteral obstruction rats by inhibiting the transformation of macrophages to myofibroblast

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Journal of Traditional Chinese Medicine 2023年第1期43卷 105-112页

作者： XIONG Yunzhao LIU Lingjin LIU Ziqian CHEN Gege HAO Juan GAO Xiaomeng QIANG Panpan WANG Zheng XU Qingyou Graduate School Hebei University of Chinese MedicineHebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineHebei University of Chinese MedicineShijiazhuang 050091China Graduate School Hebei University of Chinese Medicine Hebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineShijiazhuang 050091China Graduate School Hebei University of Chinese MedicineHebei Key Laboratory of Integrative Medicine on Liver-Kidney PatternsHebei University of Chinese MedicineDepartment of Internal MedicineHebei University of Chinese MedicineShijiazhuang 050091China

OBJECTIVE:To investigate the action and underlying mechanisms of Huoxue Jiedu Huayu recipe(活血解毒化瘀方,HJHR)against unilateral ureteral obstruction(UUO)-induced injury in the contralateral kidney.METHODS:Forty-eight male Sprague-Dawley rats weighing(200±10)g were used in this study and randomly assigned to 4 groups:a sham group,a UUO group,a UUO+eplerenone(EPL)group,and a UUO+HJHR group.The contralateral kidneys were harvested for further study 180 d after surgery.Histological analysis,immunohistochemistry and immunofluorescence were used to study the fibrosis of the contralateral kidneys obtained from UUO rats.Contralateral kidney damagerelated pathway proteins were detected by real-time polymerase chain reaction and Western blot analysis.RESULTS:HJHR significantly inhibited fibrosis of the contralateral kidney in UUO rats by attenuating the UUOinduced macrophage-to-myofibroblast transition(MMT)in the contralateral kidney.Moreover,HJHR attenuated fibrosis in the contralateral kidney of UUO rats by preventing MMT through the aldosterone/mineralocorticoid receptor/serum/glucocorticoid regulated kinase 1 pathway.CONCLUSIONS:Our findings suggest that HJHR may be a potential treatment for renal interstitial fibrosis of obstructive nephropathy.

关键词： ureteral obstruction renal fibrosis aldosterone receptors,mineralocorticoid macrophages myofibroblast Huoxue Jiedu Huayu recipe

Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention:A technical report

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Asian Journal of Urology 2015年第4期2卷 238-243页

作者： Zhixiang Wang Bing Liu Xiaofeng Gao Yi Bao Yang Wang Huamao Ye Yinghao Sun Linhui Wang Department of Urology Changzheng HospitalSecond Military Medical UniversityShanghaiChina Department of Urology Changhai HospitalSecond Military Medical UniversityShanghaiChina

Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.

关键词： ureteral obstruction Laparoscopic ureterolysis Ureteroscopy Percutaneous nephrostomy

Yishen Huoxue decoction(益肾活血方) attenuates unilateral ureteric obstruction-induced renal fibrosis and hypoxia-induced reactive oxygen species generation via adenosine monophosphate-activated protein kinase/peroxisome proliferator-activated receptor coa

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Journal of Traditional Chinese Medicine 2021年第6期41卷 875-882页

作者： ZHONG Jian FANG Guiyu WANG Zixia CHEN Ping LU Dengyong SHI Xiaodong Department of Nephrology the First Affiliated Hospital of Guangxi University of traditional Chinese MedicineNanning 530023China

OBJECTIVE:To investigate the effeicacy of Yishen Huoxue decoction(YSHX)on renal fibrosis induced by unilateral ureteric obstruction(UUO),and on reactive oxygen species(ROS)homeostasis in human umbilical vein endothelial cells(HUVECs).METHODS:Forty male mice were randomly divided into six groups,sham group,UUO group,UUO+resveratrol(RSV)(15 mg/kg)group,UUO+YSHX20 mg/kg group(UUO+YSHX-L),UUO+YSHX 40 mg/kg group(UUO+YSHX-M),UUO+YSHX 80 mg/kg group(UUO+YSHX-H).Western blotting was used to measure protein expression levels.Reverse transcription-quantitative polymerase chain reaction was used to measure the m RNA expression.Immunohistochemistry was used to examine the histopathological changes of kidney tissue sample.Cell apoptosis was measured by Annexin V/PI staining.Cell viability was measured using CCK-8/WST-8 assay.RESULTS:YSHX treatment reducedα-SMA and Col-4 expressions,and increased CD31 and VE-cadherin expressions in UUO model mice.In vitro,YSHX increased cell viability and decreased apoptosis of HUVECs under hypoxic conditions.YSHX inhibited ROS generation by activating adenosine monophosphate-activated protein kinase(AMPK)/peroxisome proliferator-activated receptor coactivator-1α(PGC-1α)/silent mating-type information regulation2 homolog 3(Sirt3)signaling.CONCLUSION:YSHX treatment reduced 109 KJ UUO-induced renal injury and fibrosis.Furthermore,YSHX treatment attenuated hypoxia-induced oxidative stress by regulating AMPK/PGC-1α/Sirt3 signaling.

关键词： renal fibrosis ureteral obstruction Sirtuin 3 reactive oxygen species hypoxia Yishen Huoxue decoction

Renovascular Morphological Changes in a Rabbit Model of Hydronephrosis

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第4期34卷 575-581页

作者：李万强董自强周小兵龙兵张路生杨简周晓光郑壬平张杰 Department of Urology Renmin Hospital of Wuhan University Department of Urology the First College of Clinical Medical Science China Three Gorges University Yichang Central People’s Hospital The Central Laboratory of Human Morphology University of South China Department of Urology the First College of Clinical Medical Science China Three Gorges University Department of Cardiology the First College of Clinical Medical Science China Three Gorges University

Obstructive nephropathy ultimately leads to end-stage renal failure. Renovascular lesions are involved in various nephropathies, and most renal diseases have an ischemic component that underlies the resulting renal fibrosis. The aim of this study was to investigate whether morphological changes occur in the renal vasculature in hydronephrosis and the possible mechanisms involved. A model of complete unilateral ureteral obstruction（CUUO） was used. Experimental animals were divided into five groups： a normal control group（N） and groups of animals at 1st week（O1）, 2nd week（O2）, 4th week（O4） and 8th week（O8） after CUUO. Blood pressure was measured, renal arterial trees and glomeruli were assessed quantitatively, and renovascular three-dimensional reconstruction was performed on all groups. Glomerular ultrastructural changes were examined by transmission electron microscopy. The results showed that the systolic blood pressure was significantly increased in the obstructed groups（O1, O2, O4 and O8）. Three-dimensional reconstruction showed sparse arterial trees in the O8 group, and a tortuous and sometimes ruptured glomerular basement membrane was found in the O4 and O8 groups. Furthermore, epithelial media thickness and media/lumen ratio were increased, lumen diameters were decreased, and the cross-sectional area of the media was unaltered in the segmental renal artery, interlobar artery and afferent arterioles, respectively. In conclusion, renal arterial trees and glomeruli were dramatically altered following CUUO and the changes may be partially ascribed to vascular remodeling. Elucidation of the molecular mechanisms of renovascular morphological alterations will enable the development of potential therapeutic approaches for hydronephrosis.

关键词： renal artery hydronephrosis ureteral obstruction vascular cast rabbit

Metallic ureteral stent in restoring kidney function: Nine case reports

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World Journal of Clinical Cases 2020年第13期8卷 2841-2848页

作者： Wei Gao Tong-Wen Ou Xin Cui Jiang-Tao Wu Bo Cui Department of Urology Xuanwu HospitalCapital Medical UniversityBeijing 100053China

BACKGROUND Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum.It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.CASE SUMMARY Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis(IRPF)in patients who presented to the Department of Nephrology or Department of Rheumatology,Xuanwu Hospital,Capital Medical University,Beijing,China,between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction.Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function.Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results.To restore kidney function,a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission.No perioperative complications occurred in any patient,but postoperative complications occurred in two patients as follows:Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment;and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement(contrary to instruction).Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.CONCLUSION Our 9-case series underscores the utility and efficacy of applying the Resonance®metallic ureteral stent to treat ureteral obstruction in patients with IRPF.For all retroperitoneal fibrosis cases in our series,ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.

关键词： Retroperitoneal fibrosis Metallic ureteral stent ureteral obstruction Computed tomography Kidney function Plastic stent Case report

Diagnosis and management of ureteral complications following renal transplantation

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Asian Journal of Urology 2015年第4期2卷 202-207页

作者： Brian D.Duty John M.Barry Department of Urology Oregon Health&Science UniversityPortlandORUSA Department of Surgery Division of Abdominal Organ TransplantationOregon Health&Science UniversityPortlandORUSA

When compared with maintenance dialysis,renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life.Approximately 9% of patients will develop a major urologic complication following kidney transplantation.ureteral complications are most common and include obstruction(intrinsic and extrinsic),urine leak and vesicoureteral reflux.Ureterovesical anastomotic strictures result from technical error or ureteral ischemia.Balloon dilation or endoureterotomy may be considered for short,low-grade strictures,but open reconstruction is associated with higher success rates.Urine leak usually occurs in the early postoperative period.Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression(nephrostomy tube,ureteral stent,and indwelling bladder catheter).Proximal,large-volume,or leaks that persist despite urinary diversion,require open repair.Vesicoureteral reflux is common following transplantation.Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment.Deflux injection may be considered in recipients with low-grade disease.Grade IV and V reflux are best managed with open reconstruction.

关键词： Renal transplantation ureteral stricture ureteral obstruction Urine leak Vesicoureteral reflux

ureteral reconstruction with decellularized small intestinal submucosa matrix for ureteral stricture: A preliminary report of two cases

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Asian Journal of Urology 2020年第1期7卷 51-55页

作者： Qingkang Xu Chen Chen Zhefeng Xu Feng Chen Yongtao Yu Xiang Hong Shengli Xu Jiajia Chen Qin Ding Hong Chen Department of Urology Zhejiang Provincial Corps Hospital of Chinese People’s Armed ForcesJiaxingChina Department of Urology First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina

Objective:To determine the feasibility of decellularized small intestinal submu-cosa(5IS)matrix in repairing ureteral strictures.Methods:Two patients with ureteral stenoses underwent ureteral reconstruction with SIS ma-trix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016.The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed.Results:Both operations were successfully completed.The average operative time was 90 min and the average length of hospital stay was 15 days.No fevers,incision infections,intestinal obstruction,graft rejection,or other serious complications were noted.After 2 months,ure-teroscopic examinations showed that the surfaces of the original patches were covered by mu-Cosa and there were no apparent stenoses in the lumens.The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively.No infections or uri-nary leakage occurred after removal of the stents.Intravenous urography was performed 6 and 12 months postoperatively.The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites.The average follow-up time was>12 months.Long-term follow-up is still ongoing,and computed tomography examin ations of the urinary tract have been conducted in the outpatient department of our hospital 1,3,and 6 months after removal of the double-J stents,suggesting the absence of hydronephrosis.The serum creatinine levels remained stable during the follow-up.Conclusion:SIS matrix reconstruction is a feasible method to repair ureters stenosis.

关键词： ureteral stenosis Decellularized matrix Ureteroplasty ureteral reconstruction ureteral obstruction