化学療法の効果を目標とした腎結核のX線学的分類

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There have been various opinions on the treatment of renal tuberculosis. Subsequently, various guide lines of the treatment have been reported. Although some of the questions on the effect of the treatment have been answered, the others remains still unsolved. Most of the specialists in the world prefer chemotherapy to the surgical interventions in renal tuberculosis. The guide line to treat renal tuberculosis is not determined mainly because lesions of renal tuberculosis are various. If we could know the effect of chemotherapy by the degree of pathological changes, the therapeutic guide line would be clarified to some extent. Paying attention to this point, Dr. Lattimer classified the degree of the pathological changes comparing with pyelograms. This classification was widely adopted at the beginning of the chemotherapeutic age. However, when time went on and the age of the longterm chemotherapy came on, the previous conclusion by Lattimer's classification had to be changed. Furthermore, this classification was not applicable to the cases of our country. Different classifications have been reported in this country. They are more or less same and not excellent. This paper reports our new classification to know the therapeutic guide line at the early stage of clinical examination. This classification was made by reviewing mainly IVP, retrograde pyelograms and surgical specimens in 206 cases of renal tuberculosis (254 diseased kidneys as 48 cases showed bilateral renal tuberculosis). The author divided renal tuberculosis into the following five large groups, two of which were subdivided into two smaller groups. 1. Group N: no changes of pyelogram but tuberculous bacilli present in renal urine. 2. Group C: localized lesions in small calyces. a) Group Ca: localized tuberculous or questionable lesions in one or two calyces. Tuberculous bacilli present in urine. b) Group Cb: Localized tuberculous lesions of more than three calyces (including the occlusion of small calyces) 3. Group H: hydronephrosis and or hydroureter due to stricture of U-P junction or ureters. 4. Group P: changes in large calyces. a) Group Pa: stricture in large calyces without obstruction (disfigured pyelogram). b) Group Pb: obstruction of a one or two large calyces (localized cavity with obstruction and etc.) Partial nephrectomy and conservative surgery might be indicated in this group. 5. Group E: more deteriorated changes of Group P (including the cases of no renal function due to obstruction of pelvis, calyces or sometimes ureters-e.g. mortar kidney, pyonephrosis and etc.) If we investigate pyelograms before and after treatment by this classification, no marked changes, were seen in them except for those belonging to Group H. Therefore, the therapy for renal tuberculosis would be determined at the early urological examination by judging from pyelograms reviewed by our classification.
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化学療法の効果を目標とした腎結核のX線学的分類

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