泌尿器科疾患における小児腎の発育

Abstract

The renal growth in children with primary reflux, congenital hydronephrosis, non-refluxing megaloureter, neurogenic bladder, renovascular hypertension, solitary kidney and glomerulonephritis was investigated.Renal ratio (renal length/length of L2 plus its disc), Parenchymal ratio (renal Parenchymal section area/renal section area) and Parenchym-Vertebral ratio (renal Parenchymal section area/the distance from the top of L1 to the bottom of L4 vertebral bodies×width of L2) in children with these diseases were compared with those in normal children.1) Primary reflux: Renal ratio and Parenchymal ratio were useful to make prognosis and to follow up the primary reflux.In 64% of grade 3 reflux, Parenchymal ratio of initial IVP was below -2 S. D. Before the 5 years of age the Parenchymal ratio was below -2 S. D. in only 17% while after the 6 years of age it was below -2 S. D. in 83% of the patients.Disturbance of renal growth seems to appear after the 5 years of age, thus indicating antireflux surgery to be done before then in grade 3 reflux.In grade 1 and 2 reflux, there is no indication for an immediate operation since there remains a possibility of spontaneous cessation of reflus providing Renal ratio and Parenchymal ratio were in the normal range.2) Congenital hydronephrosis: Prenchymal ratio was the most useful index to determine the result of plastic surgery. In the follow up of renal growth after the operation, Parenchym-Vertebral ratio and Renal ratio were useful when compared with normal growth chart.3) Non-refluxing megaloureter: By serial determination of Parenchymal ratio after the operation, we can perceive the improvement of the kidny, and if reflux occurred in the operated unit, we can predict it fairly accurately.4) Congenital neurogenic bladder: The parenchyma) ratio and Renal ratio were under -2 S. D. in the initial IVP only in the refluxing kidney. The Renal ratio and Parenchymal ratio were useful in determining the choise of treatment for the neurogenic bladder.5) In the children with suspected glomerulonephritis: Renal ratio and Parenchymal ratio were all in the normal range.6) Congenital or acquired solitary kidney: In all solitary kidneys, Parenchymal ratio was normal. Renal ratio and Parenchym-Vertebral ratio were useful to estimate the rate of hypertrophy. Hypertrophy of residual kidney after unilateral nephrectomy was seen already in a month postoperatively and continued for another six months.In two cases of Wilms tumor who demonstrated severe side effect from chemotherapy, hypertrophy was less significant than in another 3 cases without adverse reaction to it.