Studies on pathophysiologic changes of upper urinary tract following acute complete ureteral obstruction: Influence of elevated intrapelvic pressure on thoracic duct lymph flow and renal venous blood flow (author's transl)

Abstract

The right kidney was removed from each dog; the ureter was obstructed on the left to elevate the intrapelvic pressure; and the alterations that then occurred in the thoracic duct lymph flow and the renal venous blood flow were followed up. At the same time, various isotopes were injected into the renal pelvis; and the ureter was obstructed, to follow up the behaviors of the isotopes in the thoracic duct lymph and the renal venous blood; and the followings were found:I. Alterations in the Thoracic Duct Lymph Flow1. The obstruction of the ureter was followed by a gradually increased thoracic duct lymph flow; the flow came to a plateau at about its maximum, and then tended to gradually decrease.2. In the dogs with the urine flow of not less than 0.17ml/5min/kg before the obstruction, there was a correlation between the urine flow and the rate of increase in the thoracic duct lymph flow after the obstruction of the ureter (Table I).3. The obstruction of the ureter was first followed by an increased intrapelvic pressure, and then by an increased thoracic duct lymph flow; the pressure and the lymph flow then showed a similar pattern of increase to each other; the lymph flow came to a plateau in 79% of the experimental animals with the intrapelvic pressure of not less than 50mmHg, and then tended to gradually decrease.From the findings presented in 1, 2 and 3 above, it may be presumed that the thoracic duct lymph flow after the obstruction of the ureter is affected by the urine flow before the obstruction and the intrapelvic pressure after the obstruction.4. Transfer into the thoracic duct lymph of various isotopes injected into the renal pelvis: The isotopes used consisted of 131I-hippuran as a soluble isotope, and 131I-PVP and 131I-HSA as microparticulate ones.1) The soluble isotope tended to appear in the lymph earlier and in a larger amount after the obstruction of the ureter than the microparticulate isotopes.2) The hippuran level in the lymph was the higest of the 3 isotopes, followed by PVP and HSA in a decreasing sequence of significance (Fig. 6).3) Of the three isotopes, it was the soluble isotope that appeared in the lymph first, with a lag of about 5 minutes between the soluble isotope and the microparticulate ones. It was also with the soluble isotope that the maximum level in the lymph was attained earliest, with the maximum levels with the microparticulate isotopes, PVP and RISA, similarly lagging.From the findings presented in 1), 2) and 3) above, it may be presumed that the smaller the molecular weight of isotope, the more rapidly it is transferred into the lymphatic ducts.4) When the time required for the thoracic duct lymph flow to begin to increase after the obstruction of the ureter was compared with the times required for the radioactivities of the isotopes to appear in the lymph, the former took place 5-10 minutes earlier than the latter. The times required for the isotopes to reach their maxima tended to be longer.From the findings presented in 4) above, it may be presumed that the portion of lymph that increases between the start of increase in the thoracic duct lymph flow after the obstruction of the ureter and the appearance of radioactivity of an isotope is not derived directly from the renal pelvis, but from that portion of lymph that has increased iu the renal parenchyma and that portion of lymph that has been retained in the renal parenchyma aud the thoracic duct up to its terminal and has been pressed out by the former.5) Relationship between intrapelvic pressure and the thoracic duct lymph isotopes: (1) The intrapelvic pressure at the stage when the radioactivities in the 5-minute thoracic duct lymph flow came to a plateau was in the range of from 40-70mmHg in 86% of the experimental dogs. (2) The isotope concentrations increased as the intrapelvic pressure was increased as a whole, with the isotope concentrations reac