J.Jpn. Surg. Soc.. 61(3): 409-436, 1960
EXPERIMENTAL STUDY ON THE LIMIT OF RECOVERY OF HYDRONEPHROSIS BY RELEASE OF URETERAL OBSTRUCTION
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Surgical Department, Tokyo Medical College (Director: Prof. Kingo SHINOI) Yoshikatsu INOUE |
Even when those various causes are removed, recovery of the renal function cann't be always expected. Therefore, establishment of the standard limit of recovery of the renal function in cases of hydronephrosis is very important. From the view point mentioned above the standard limit of recovery of the renal function in cases of hydronephrosis was clarified by the following experimental study : By ligation of the ureter hydronephrosis was made in adult dogs and rabbits, and its recovery process was traced in detail patho-physiologically, roentgenologically and patho-histologically.
The folloeing items were studied:
1) Fluctuation of the renal weight.
2) Measurments of the kidney.
3) Patho-physiological observation of the kidney.
i) Fluctuation of the urine volume.
ii) Indigocarmin-excretion-test.
iii) Fluctuation of blood N.P.N.
iv) Maximum excretory volume of the urinary tubles. (TmPAH)
v) Acid-bace balance (mainly arterial blood pH)
4) Roentgenological study on the intrarenal blood circulation.
5) Histological study on the kidney.
Experiments
1) Fluctuation of the renal weight and renal volume.
Fluctuations of renal weight and volume after release of the ureteral obstruction were most remarkable in the greater diameter of the kidney, and increase of the renal volume by the ligation stopped 4 weeks after the release and gradually decresed for 2 weeks.
2) Patho-phytiological study.
Daily fluctuation of the urine volume, Indiogocarmin test, blood N.P.N., TmPAH and arterial blood pH after release of the ureteral ligation was traced systematically.
According to the result of the study mentioned above, it was known that the functional recovery of the kidney after release of the ligation can be expected during 3 weeks after the ligation.
3) Roentgenological study on the intrarenal blood circulation.
After the 3rd week after the ureteral ligation recovery of the blood circulation is delayed and after the 4th week the recovery is hardly seen.
4) Patho-histological study.
Until the 16th-18th day after the ureteral ligation the renal unit, renal blood flow and interstice were highly resistant against the back pressure due to urinary retention, then the resistance was rapidly decreasing. The main reason of the rapid decrease is thought to be highly influenced by the back pressure and change of the renal bloof flow caused by the back pressure.
Conclusions
1) Changes of hydronephrosis caused by the ureteral ligation is completely reversible until 16th-18th day after the ligation from the histological point of view. However, after the 3rd week irreversible change of the renal unit was partially seen and after the 4th week destruction of the most parts of the kidney was seen.
2) From the view point of the renal function, compensation of the function by the remained healthy parts of the kidney was seen until the 4th week after the ligation, but the renal function could not be recovered thereafter.
(Author's abstract)
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