Comparison of the hydronephrotic kidney in renal parenchymal growth after operation

초록

Introduction and Objectives: Despite various methods for evaluating renal growth in kidneys with hydronephrosis, there is still no reliable way that can measure this change regardless of causes in children. Renal length and parenchymal measurement are used mostly to follow renal growth in kidneys with hydronephrosis due to vesicoureteral reflux and urinary tract obstruction, respectively. The purpose of this study was to determine one parameter for measuring renal growth in kidneys with hydronephrosis due to any cause and compare the results between children with vesicoureteral reflux and urinary tract obstruction. Materials and Methods: We analyzed the serial urograms and clinical data from 321 children with ureteral obstruction(UO) and 217 with vesicoureteral reflux(VUR) who were treated at severance hospital and Inha University Hospital between March 1994 and February 1998. An pyeloplasty and an antireflux operation were performed in 194 renal units with UO and 140 with VUR respectively. Among operated patients, 66 renal units with UO and 132 with VUR were included in this study without ambiguity in radiologic study. Renal size was measured on the ultrasonography and average parenchymal thickness(APT) was calculated. and then the growth velocity was defined as the change of APT during basic F/U Period (3Mo). Results: In UO, APT increased in 70 % and decresed in 30 % after relief of obstruction(Fig. 1). The lower the grade of hydronephrosis by UO, the faster the growth velocity of kidney. The older the patient, the slower the growth velocity of kidney. In VUR, APT increased in 87 % and decreased in 13 % after operation(Fig.2). The higher grade of VUR, The slower growth velocity. There was a decreasing tendency of APT in bilateral cases. There was no definite correlation to the age in VUR. Conclusion Despite some variability of results, a fundamental assumption of outcome analysis is that the APT index will be fundamental to understanding the characteristic