| Objective:By testing blood,urine β2-MG and pelvis and urine pH and measuring the glomerular filtration rate by the radionuclide renal imaging which is most widely used in clinical to evaluate the damage of renal function of severe hydronephrosis caused by upper urinary tract stones. Rechecking the GFR to observe the recovery of renal function after the surgery. The aim is providing a theoretical basis for selection of the surgical approach if we meet this kind of patients.Methods:Collected 32 cases of sever hydronephrosis caused by unilateral upper urinary tract calculi of Urinary Surgery Department of First Affiliated Hospital of Nanchang University from Sept. 2013 to Juan. 2015.All the cases must do the tests like below such as imaging test,for example CT of kidneys and the radionuclide renal imaging to know the damage of renal function of severe hydronephrosis;Ultrasound,Chest X-ray,Lung function,Normal renogram and Echocardiography to exclude the diseases of other systems;blood routine,urine routine liver and kidney function,electrolytes,blood β2-MG to exclude the diseases of blood system.All the cases do the surgery to remove the stones,and distil the urine of pelvis to do the urine routine and testβ2-MG.According to the pH of urine of pelvis,we divided all cases into three groups:Group A,pH is 5.0~6. 0;Group B,pH is 6. 1~7.0;Group C,pH is greater than7.1.Rechecking the radionuclide renal dynamic imaging 3 months after the operation and Comparing the GFR before and after the surgery to understand the recovery of renal function and to study the relationship between urine pH and the recoverability of the renal function.Select 24 patients with single kidney and ureteal calculi but no hydronephrosis as the control group.Contrasting the blood and urine β2-MG to know the damage level of the renal function. Collecting all data such as the blood and urineβ2-MG, the pH of urine of pelvis,the relevant date before and 3 months after the upper urinary obstruction was removed,and analyze the date by the use of SPSS 20.0statistical software(Paired Sample T test).The statistics processing data are allindicated in the form of X±S, paired sample T test is used for measurement data,there was a statistically significant(P<0.05).Results:First,All the selected cases do the radionuclide renal dynamic imaging before the surgery,among them 20 cases have function,12 cases of no functional.Average GFR is 15.1±5.1ml/min.Recheck the radionuclide renal dynamic imaging 3 months after the operation,Among the all the cases,23 cases of full or partial recovery of renal function, 9 cases results suggest no significant improvement in renal function and 14 cases the results tell us a dramatic drop in the kidney.The average GFR is21.5±11.4ml/min after 3 months.Compared with the preoperation,the renal function has been improved, there is a statistically significant(P<0.05).2 patients which kidney function is serious damage had been cutting the kidney, and pathological examination showed a small number of glomeruli and tubules with its structural disorder, renal interstitial fibrosis.Second,According to the pH of urine of pelvis,we divided all cases into three groups:Group A,pH is 5.0 ~ 6. 0,10 cases.The result of radionuclide renal dynamic imaging after admission shows all the kidney is developable.The average GFR is20.2±0.9ml/min.The average GFR of 3 months later is 33.6±9ml/min;Group B,pH is6. 1~7.0,10 cases.The result of radionuclide renal dynamic imaging after admission shows average GFR is 16.2±3.5ml/min,which 2 kidney is not developing.The average GFR of 3 months later is 21.7±6.2ml/min.The test shows 1 patient’s kidney is partial developable which his renal has no function before surgery,it shows the renal function is partial recovery.This case is a 51 y male.His renal function recovered slowly maybe cause of his age.Long-term observation of the specific circumstances to be restored;Group C,pH is greater than 7.1,12 cases.The average GFR of before surgery is 9.9±3.1ml/min.The average GFR of 3 months later is 11.2±4ml/min.The result of radionuclide renal dynamic imaging after admission shows 10 cases all the kidney is not developing which means the renals have no function.2 of 10 is partial developable after the obstruction removed.The GFR is both greater than 10ml/min.8 of 10 was found pyonephrosis.We do the nephrostomy in phase I and treat calculus in phase II.We found that its pelvis urinary pH is 8, considering the infection.By comparingthe three groups before surgery and postoperative renal function test results,it shows renal function were improved, P <0.05, it means statistically significant.Third,According to the study results,blood and urine β2 microglobulin content was significantly higher than the control group.It shows that the function of glomeruli and renal tubular had been damaged.For the patients whose renal function did not recover or get worse, its preoperative serum β2-MG levels were greater than 5.2mg/ L, urinary β2-MG levels were greater than 1.2mg / L.However, there are some patients’ renal function has improved after surgery, and P <0.05, it has statistically significant.Conclusion:1、When we meet the patients with severe hydronephrosis caused by upper urinary tract obstruction,we can not determining non-function kidney by GFR<10ml /min and remove the renal.2、We can not judge non-function kidney by urinary pH greater than 7.1 and removal of the kidney.3、Comprehensive analysis of the preoperative detection of indicators to determine renal function can be refolded. Where blood and urine β2 microglobulin content was significantly higher as a reference. |
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