Post-Obstructive Diuresis: Physiopathology, Diagnosis and Management after Urological Treatment of Obstructive Renal Failure

Obstructive acute renal failure is both a medical and a surgical emergency. The first treatment modality is urological by relief of obstruction. Post-obstructive diuresis is an abnormal condition of prolonged polyuria, involving both excessive solute and water loss, after acute drainage of obstructed urinary tract system. Physiopathology mechanisms are multiples. In most patients, diuresis will resolve once the kidneys normalize the volume and solute status and homeostasis is achieved. Post-obstructive diuresis can occur in up to 50% of patients with substantial urinary tract obstruction and can be life-threatening if it becomes pathologic. It can be detected by hourly monitoring of diuresis. Medical treatment of post-obstructive diuresis consists of oral or intravenous fluids adjusted to the findings of clinical examination, diuresis (volume and electrolytes) and close monitoring of patient. Fluid compensation should be tapered off over several days. Patients at high risk of post-obstructive diuresis should be identified and appropriately monitored.

44例肾后性肾功能不全临床治疗分析

目的：探讨肾后性肾功不全的临床治疗。方法：通过 Ｂ超引导下肾穿刺造瘘术（ＰＣＮ）、膀胱镜下逆行双Ｊ管内置术、开放手术、体外震波碎石（ＥＳＷＬ）、血透达到治疗目的。结果：４１例患者临床症状改善或消失，血尿素氮（ＢＵＮ）、血肌酐（Ｃｒｅ）有不同程度的改善或正常。２例放弃治疗后死亡，１例合并感染后死于败血症，结论：肾后性肾功不全的治疗均为尽快解除梗阻。且根据其梗阻病因及梗阻时间选择相应治疗方法，分别为手术、ＰＣＮ术、膀胱镜下内置双Ｊ管术等。

肾后性肾功能衰竭临床疗效分析

目的探讨肾后性肾功能衰竭的病因及临床诊治方法。方法对该院1986年8月～2005年10月收治的各种原因尿路梗阻导致的肾后性肾功能衰竭70例进行分析。根据病因选择经皮肾穿刺造瘘术、膀胱镜逆行留置输尿管导管或双J管内引流、输尿管镜气压弹道碎石后双J管内引流术及开放手术。结果尿石症52例。前列腺增生伴尿潴留12例,神经原性膀胱1例,泌尿系肿瘤5例。经治疗56例症状消失,血尿素氮、血肌酐正常。8例症状改善但血尿素氮、血肌酐未正常。5例症状及血尿素氮、血肌酐无改善。1例死于晚期恶性肿瘤。结论尿路梗阻导致肾后性肾功能衰竭的治疗应根据不同病因,尽早解除梗阻,选择相应治疗方法,恢复尿流畅通,最大限度地挽救和恢复肾功能。

肾后性梗阻致肾纤维化机制研究进展

肾纤维化是指各种原因引起正常肾组织结构破坏,被纤维组织取代的病理过程,主要表现为细胞外基质沉积,可引起肾功能减退或肾功能衰竭。急、慢性肾后性梗阻是肾功能损伤及肾纤维化的常见病因。肾后性梗阻致肾纤维化是多种因素共同作用的结果,可能涉及肾组织缺氧微环境,炎症介质释放及炎症细胞浸润,肾间质细胞活化及促纤维化因子释放等。本文就肾后性梗阻致肾纤维化机制的研究进展作一综述。