Ağır Skarlı Böbreklerin Üreter Alt Uç Patolojik Özellikleri Az Skarlı Tarafla Karşılaştırıldığında Belirgin Farklılık Göstermektedir

Abstract

Objective: This study aims to describe the pathological features of the distal end of ureters and their correlation with scar formation patterns in the kidney. Methods: The study includes 83 children (49 male, 34 female), who underwent ureteroneocystostomy (UNC) operations from 2008-2010. The distal end of ureters (approximately 3-4 mm) were resected and 110 ureter specimens from 83 patients were available for pathological examination. The presentation age, clinical presentation pattern, reflux grade and scar patterns on dimercaptosuccinic acid (DMSA) scan were obtained from record and correlation with histopathological findings were investigated. Scar patterns were defined as presence of no scar (NS), diffuse scar (DS) or focal cortical scars (FS). General structural changes were also investigated histopathologically including inflammatory changes graded for intensity (G1-G3), extracellular matrix and smooth muscle content, ureteric diameter and wall thickness. Results: Histological examination of the ureterorenal units showed that there were 35/110 (33%), 30/110 (27%) and 45/110 (40%) in the NS, DS and FS groups, respectively. When scar rates were investigated by grade of reflux (G1-2 low grade vs. G3-5 high grade reflux) the scar rates were 39.5%and 90.3% respectively. High grade inflammation (G3) was found in 66%, 28.9% and 36.4% in kidneys in the DS, FS and NS scar groups respectively (p<0.05). Conclusion: This investigation shows that there are significant differences of histologic structure of the distal end of the ureters when they are classified by kidney scarring. There is more intense inflammation, more collagen deposition, less ssmooth muscle content and increased ureteric wall thickness in the ureters of the kidneys with diffuse scar when compared to others with less or no scar.