Non-obstructive Disorders Research Articles

Diuretic Renal Scintigraphy

Hydronephrosis can be caused by obstruction or by nonobstructive disorders such as infection, vesicoureteral reflux, or congenital anomalies. Diuretic renal scintigraphy is critical in differentiating between obstructive and nonobstructive hydronephrosis. Under physiologic conditions, urine may pool

The Rating System of Urodynamics Upper Urinary Tract in Children under Three Years Old with Congenital Hydronephrosis

Background. One of the main reasons for the incorrect differentiation of obstructive and non-obstructive disorders of the upper urinary tract (UUT) is age-related morphofunctional immaturity of the kidney and its structures in children of the first three years of life. Aims to investigate to determine the peculiarities of urodynamic disorders of the UUT in infants with congenital hydronephrosis using diuretic pyeloehography (DРG) method. Methods. There were studied DPG data of 55 patients aged 336 months with unilateral hydronephrosis of IIII grades SFU, which were divided into groups in accordance with the variant of violation of the urodynamics of the UUT (obstructive, obstructive-hypertensive and disadaptive). The variants established according to the parameters of the DPG (transient coefficient PUJ (Kpus), the coefficients of postfurosemide adaptation (Ka) and the efficiency of emptying (Ko) pelvis). The obtained data are compared with the conclusions of morphometric studies of the operated 20 children with ureteropelvic junction obstruction (UPJO). Results. The obstructive-hypertensive variant was determined in 18 patients, obstructive in 20, and disadaptive in 17. The severity of pelvic dysfunction (according to Ka and Ko) did not correlated to the grade of UPJO (according Kpus) in most cases. Intergroup and intragroup variability in the values of the DРG coefficients is confirmed by the results of PUJ and pelvis morphometry. The correlation between hystological modification in the pelvis and DPG parameters was revealed. Obtained data allowed to introduce a new indicator urodynamic indicator of quantitative assessment of functional insufficiency of the UUT. And the score gradation of each DРG coefficient (from 0 to 4 points) in accordance with deviation from the reference values was developed. The total indicator functional insufficiency is expressed by the sum of points (SP) for each coefficient (Ka, Ko, Kpus). When SP is less than 3 points light, 46 moderate, 79 expressed and 1012 severe grade of violation of urodynamics. The severity of dysfunctions of the UUT in 88% of children (n = 15) with a disadaptive variant corresponded to light degree, in 75% of patients (n = 14) with an obstructive-hypertensive variant expressed (50%) and severe (25%) grades. Moderate degree of dysfunction revealed in 65% of patients (n = 13) with an obstructive variant. Conclusion. The severity of urodynamic dysfunction of the UUT in this age group can be determined by the score gradation of the DPG parameters which reflects the functionality of the pelvis/PUJ and the grade of their violation adaptive reactions in response to diuretic.

Disorders of cardiorespiratory coupling in hypercapnic respiratory test and moderate physical exercise in patients with pulmonological pathology

Relevance.The comprehensive assessment of cardiorespiratory coupling (CRC) for the diagnosis of functional adaptation in pulmonological patients is presented.The objective of the studywas to test the complex criteria of CRC for objective differential diagnosis of individual adaptive reactions of pulmonological patients.Methods and materials. 30 volunteers without verified pathology and 31 patients with restrictive and obstructive disorders were examined. All subjects underwent physical examination with traditional routine method using spiroarteriocardiorhythmography (SACR) at rest and during performing functional tests with hypercapnia and moderate physical exercise.Results. We proposed the methodology of integrated assessment of multicomponent system of CRC, which increases the diagnostic precision of SACR in the tasks of predicting the adaptive defects of the organism at different pulmonary syndromes.Conclusion. Breathing with a fixed frequency normalizes the regulation of CRC, both in healthy and pulmonological patients. Moderate physical activity (80 W) modifies the indicators of CRC in pulmonological patients in comparison with the control group statistically due to disorders of the heart rate and circulation. During moderate physical activity, stroke volume (SV) statistically decreases in patients differently: SV were significantly lower in the group with obstructive disorders than in the group with non-obstructive disorders.

Can Neonatal Hepatitis Be More Fatal than Biliary Atresia?

Background/Aims: The basic problem in diagnosis of neonatal cholestasis (NC) is to differentiate biliary atresia (BA) from other non-obstructive disorders. Because if bile flow cannot be provided by surgery, BA leads to cirrhosis and death within the first year of life. The aim of the present study is to determine histopathological features that may help to differentiate BA from neonatal hepatitis (NH). Material and Methods: This retrospective study was carried out on 105 liver biopsy specimens of 74 infants with NC who were diagnosed between 2003 and 2012. Results: The mean age was 76.5 ± 40.64 days. The most valuable biopsy findings for the discrimination between NH and BA, in decreasing order of importance, were ductular proliferation (p < 0.001), cholestasis in neoductuli (p < 0.001), fibrosis (p = 0.002), and extramedullar hematopoiesis (p = 0.02). While Kasai operations were performed in 19 cases, liver transplantation was performed in 10 cases. Survival rate among the death cases with BA was longer than the survival time of the death cases with NH (p = 0.023). Currently more children live with a close to normal quality of life with portoenterostomy and/or liver transplantation. On the contrary, NH can be more fatal with associated disorders such as growth retardation, specific infections, respiratory distress, and metabolic or endocrine diseases.

The Type and Frequency of Fetal Renal Disorders and Management of Renal Pelvis Dilatation

Although fetal renal anomalies are frequently detected by prenatal ultrasonography, pre- and postnatal follow up of these disorders is not standardized. The investigators determined the incidence of the most common renal abnormalities seen in their ultrasound unit and correlated the presence of fetal renal pelvic dilatation (RPD) with the need for postnatal surgery in 342 prospectively studied fetuses who had isolated renal abnormalities and were followed from 3 months to 10 years. RPD was defined as an anteroposterior renal pelvis measurement of 4 mm or more at less than 33 weeks gestation or 7 mm or more afterward. Two thirds (227 of 342) of fetuses had RPD as their major sonographic finding. Obstructive lesions requiring surgical treatment were present in 60 fetuses (26% of all RPD cases), and the remainder had nonobstructive lesions that either resolved spontaneously or remained stable and did not require surgery. Approximately 70% of fetuses with obstructive and 77% with nonobstructive lesions were male. Other relatively frequent abnormalities included multicystic dysplastic kidney (10.5%), urinary tract duplication malformations (9.4%), and reflux (8.2%). The other category included bladder outlet obstruction, prune belly sequence, pelvic or horseshoe kidney, and bladder extrophy. Average RPD values were 11 mm in fetuses with nonobstructive conditions and 23 mm in those with obstruction. Ninety-five percent of fetuses with obstructive RPD underwent voiding cystourethrography (VCUG) and 92% had renal scintigraphy. VCUG demonstrated vesicoureteral reflux in 23% of these cases, and the renal perfusion scan showed urinary stasis in 96%. VCUG also was performed in 74% of fetuses with nonobstructive RPD but demonstrated reflux in only 4%. Among the 29% of nonobstructed fetuses who had a renal perfusion scan, 49% had urinary stasis. An obstructive process was identified in 10% of fetuses with a RPD of 6 to 10 mm (no fetuses with maximum RPD less than 6 mm required postnatal surgery); these fetuses accounted for approximately one fifth of the postnatal surgeries. Obstruction was also found in 27% of fetuses with a RPD of 11 to 20 mm (33% of all surgeries) and nearly 70% with a RPD exceeding 20 mm (48% of all surgeries). The overall ratio of obstructive to nonobstructive disorders was approximately 1:3. These findings endorse a conservative approach to prenatal sonographic monitoring of the kidneys. The RPD reflects the likelihood of obstruction, but there is substantial overlap, and in this ultrasound unit, RPD did not alter the timing of delivery. If RPD is detected early in pregnancy, a single follow-up sonographic study late in pregnancy or after delivery is sufficient.