人水腎症の組織学的研究 : 特に腎機能恢復と組織学的変化の関係について

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Histological studies were performed in 29 renal specillnens obtained from hydronephrotic kidney of various degrees (A to F, Iow to high, after Huzino's grading) at the time of kidney-conserving operation. Special references were made to the correlation of recovery of renai function and histological findings. The results were as follows : In lower degree of hydronephrosis (up to C grade), hydronephrotic changes ran histologically parallel to those appeafed on the pyelogram. Beyond that degree, these two changes were not always parallel, Remarkable infection (renal pyuria) was found in 16 cases. The higher the grade of hydronephrosis, the more the kidney was apt to be infected. Inflammatory changes of renal parenchyma were histologically not always parallel to the intensity of pyuria, -sometimes thcse two behaved opposingly. In lower degree of hydronephrosis (B-C) (Fig. 1-7) histological changes were not remarkable, and if present, slight atrophy of glomeruli, slight degeneration of tubular epithelium and sometimes focal proliferation of stromal connective tissue were seen. The recovery of renal function was satisf actory. In D grade of hydronephrosis (Fig. 8-10) atrophied glomeruli increased in number, and some showed regressive degeneration. Slight diffusive proliferation of stromal connective tissue began to appear, and more or less sclerosis of the blood vessels occured. Hydronephrotic changes of tubules did not always increase. The renal function recovered sufriciently in over a half of cases. In E grade of hydronephrosis (Fig. 11) hydronephrotic changes were less than what was expected. However, the proliferation of stromal connective tissue became more diffusive with even strong proliferation in some part. The blood vessels were moderately sclerotic. Functional recovery were nevertheless comparatively satisfactory. The most essential factors regulating the recovery of renal function were the proliferation of stromal connective tissue and vascular sclerosis. The extent and grade of cellular infiltration itself did not directly control the recovery of renal function, but cellular infiltration must follow secondarily, especially in cases of chronic infection, proliferation of connective tissue, vascular sclerosis and glomerular degeneration. So it was essential to check the infection as early as possible. We do not actively agree to the renal counterba]ance theory of Hinman. The functional recovery of hydronephrotic kidney apparently seems to be influenced by the condition (healthy or not) of the opposite kidney. From our studies, however, it becomes clear that the curability of the hydrone-phrotic kidney was very reflexion of the histological changes already occured, regardless of the condition of the opposite kidney. In the cases in which the demand for renal function is keen, such as patients with bilateral renai diseases or nephrectomized patients, the functional recovery is more satisfactory than patients with unilateral renal disease, who shows similar remarkable changes histologtcally It Is not reasonable to decide the Indlcatlon of conservatlve operation in hydronephrosis only either from the pyelographical degree of hydronephrosis or from the existence or not of apparent infection of the upper urinary tract. There are not a few cases of remarkably infected and relatively promoted hydronephrosis, which will recover satisfactori]y after kidney-conserving operation .
社団法人日本泌尿器科学会の論文

人水腎症の組織学的研究 : 特に腎機能恢復と組織学的変化の関係について

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