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[Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery].

The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

Adolescent

[Possible factors affecting dilatation of maternal kidney calices in pregnancy].

In a retrospective analysis we examined several factors in regard to the dilatation of the renal calyces during pregnancy in a normal group of 187 pregnant women between 8 and 42 weeks of pregnancy. The dilatation of the calyceal system was more frequent in case of preceded pyelonephritis, in primipara and bipara, and in younger pregnant patients. We found a significant increase of the dilatation with progress of pregnancy.

Adult

[Ultrasonography of pregnancy-induced dilatation of maternal kidney calices in a normal patient sample].

To examine the physiological changes of the calyceal system during pregnancy, we selected a normal group of 187 pregnant women by anamnestic, clinical, ultrasonic and laboratory findings. The sonographic investigation of renal pelvis, renal calyces and ureters revealed a more frequent and more pronounced dilatation of the right side. The dilatation was more marked as expected by literature. The complete involution post partum occurred mostly during the first ten days. Even after marked dilatations, a parenchymal reduction could not be found.

Adolescent

[The quantitative analysis of the x-ray changes in the kidney calices in chronic pyelonephritis in children].

As many as 89 patients aged 6 months to 14 years with microbial inflammatory diseases of the urinary tract and 40 controls of the same age were examined. Of the patients, 55 had chronic pyelonephritis, 21 acute pyelonephritis, and 13 an infection of the urinary tract. For examination use was made of the planimetric method of measuring the width of the fornix and the cervix of the renal calyces on excretory urography. The fornicocervical index, product of the indicated parameters of the calyces, was computed. In health, that index did not exceed 24 units. In the majority of patients suffering from chronic pyelonephritis, it turned out higher. The false negative results were obtained in 7 cases. The fornicocervical index remained unchanged in patients with acute pyelonephritis and urinary tract infection. It is suggested that the fornicocervical index be computed for use as an objective criterion in the diagnosis of chronic pyelonephritis in children.

Adolescent

[Controversies on extracorporeal shockwave lithotripsy].

We analyzed our experience in 3,000 patients submitted to ESWL. Patient age ranged from 6-92 years. Stone size was 1 cm. in 33.2%, 1-3 cm. in 43.8%, and 23% had incomplete or complete staghorns. Following treatment 83.2% were stone-free, 13.1% had stone fragments that could be passed spontaneously, 3.4% had fragments larger than 4 mm., and 0.3% were submitted to surgery because attempts at stone fragmentation had failed. Our results show that indication of ESWL may be questionable in renal anomalies (horseshoe kidney, caliceal diverticulum, pyeloureteric stricture, urinary diversion), in some cases of lithiasis (cystine stone, infundibular lithiasis, staghorn or ureteral calculi) and in some patients (para and tetraplegics and those with solitary kidneys).

Adolescent

The ultrasonic characteristics of the renal pelvicalyceal echo complex.

The pelvicalyceal echo complex has a characteristic appearance as an echo-filled cylinder in which minimal sonolucency may normally be seen. Alteration in the pelvicalyceal echo complex is a helpful guide in the diagnosis of a variety of pathological processes involving the kidneys. Reliable diagnosis of moderate and marked hydronephrosis may be made by the appearance of uniformly sized, sonolucent collections in the pelvicalyceal echo complex which show communication with the renal pelvis. An adjacent simple renal cyst produces a sharply defined crescent shaped deformity of the pelvicalyceal echo complex, and scalloping is seen with multiple impinging renal cysts. Gross deformity of the central echo complex is seen with polycystic kidney disease, as well as in neoplasia. Edema and infiltrating hypernephroma may result in diminution of the pelvicalyceal echo complex. Amputation or a "V"-shaped splitting of the pelvicalyceal echo complex may be seen with neoplasia.

Edema

Stimulation of calcium uptake by norepinephrine or high external potassium in human calyces and renal pelvis.

The effects of stimulation with either 10 mumol/l norepinephrine or 85 mmol/l extracellular potassium concentration on calcium uptake were studied in muscle strips from human renal calyces and from the renal pelvis. The apparent uptake of calcium under control conditions was essentially complete after 30 min. Stimulation of the muscle strips with norepinephrine or high external potassium significantly (P less than 0.05) increased the calcium uptake over the control values at 30 and 100 min, whereas 45Ca efflux was virtually not affected. It is concluded that the mechanical responses of the muscle strips to norepinephrine or high external potassium correspond with an increased uptake of calcium suggesting that both types of activation are mediated by an increase of intracellular calcium concentration similar to that described in other smooth muscles.

Calcium

Upper calyx reno-vascular obstruction in children: Fraley's syndrome.

Intrarenal vascular obstruction of the upper calyceal infundibulum has been distinguished by Fraley as an entity separate from an asymptomatic vascular impression. Clinically, this form of intrarenal vascular obstruction presents as nephralgia or hematuria. This infundibular obstruction is caused by normal renal vessels, usually the upper segmental artery: radiologically, the vessels produce a constant well-defined filling defect in the infundibulum at IVP, and, the upper calyx group is distended and shows delay in emptying. We found this condition in 14 children from 1968-1975. Control studies showed no progression in the radiological findings, even over a long period. In one of our cases angiography was indicated to exclude tumour or cyst; in another case, surgery was necessary. Complications are urinary tract infection or stone formation. Therefore, children with Fraley's syndrome require regular clinical examination.

Child

Results of operative treatment of Fraley's syndrome.

Relying on their own observations, the authors describe nine patients in whom Fraley's syndrome was diagnosed and treated operatively. In six of them, calycopyeloneostomy was performed. In three of the patients, because of complications, the upper pole of the kidney was excised together with the changed calyx. In noncomplicated cases the calycopyeloneostomy with a transposition of the artery beyond the cervix of the upper calyx allows to retain the active parenchyma of the upper pole of the kidneys.

Adolescent

Milk of calcium renal stone: a case report.

A case of milk of calcium renal stone was reported. It is an unusual condition in which there is suspension of calcium salt within a pyelogenic cyst. The diagnosis is difficult because of its rarity. Reviewing literature, plain abdominal X-ray in different positions were emphasized. We found that fluoroscopy with spot films in different positions is worthwhile. It has to be differentiated from gallstone and also from usual renal stone. Conservative treatment is advised if there is no suggestive malignancy.

Adult