[Vesico-ureteral reflux in children. Results of treatment].
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Biomedical subjects
Publications and source records attributed to S Olesen.
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A total of 126 children with 193 refluxing renal units were treated for vesico-ureteral reflux during the period 1966-74. The grading of the cases into mild, moderate and severe reflux revealed renal scarring in 5, 22 and 28% of the three groups. Conservative treatment was used in 10% of the patients, surgery on the urethra in 25%, and reimplantation of the ureter by the Politano-Leadbetter technique in the last two-thirds of the patients. Reflux was eliminated in 50% of the renal units treated conservatively, in 60% of renal units treated with surgery on the urethra, and in 86% of units treated with reimplantation. The overall results seemed to be better in mild than in moderate or severe reflux. The dilatation of the upper urinary tract returned to or approached normal in 85%. Of the children, 80% were without symptoms postoperatively, whereas urinary-tract infection persisted in 36%. The value of the grading of reflux is emphasised, and indications for treatment are discussed.
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The compensatory renal hypertrophy and hyperfunction following unilateral nephrectomy have been studied in dogs over a two-year period. It was found that a sharp increase in function and volume of kidney tissue takes place during the first two weeks. CCr and volume of kidney tissue continue to increase reaching average values after two years of 88% and 92% respectively of those for two kidneys. CPAH and TmPAH remain almost stable at 65% and 57% respectively after an initial increase during the first two weeks. All values are expressed in percent of the function of two normal kidneys before unilateral nephrectomy. The filtration seems to be increasingly efficient and the functional integrity of the nephrons is preserved, although a glomerular predominance is encountered two years following unilateral nephrectomy.
Compensatory renal hypertrophy and hyperfunction during contralateral chronic hydronephrosis was investigated. It was found that graded impairment of the function in hydronephrotic kidneys causes proportional compensatory hypertrophy and hyperfunction in the contralateral normal kidney. The functional pattern both "per kidney" and "per nephron" was the same in the kidneys investigated here and in kidneys where contralateral nephrectomy had been performed, but whereas a decreased ability to concentrate the urine maximally and to reabsorb sodium was encountered in the latter, this could not be detected in this study. On the other hand, a decreased COSM in the diseased kidney did not stimulate a corresponding increase in the contralateral kidney as did unilateral nephrectomy. Adaptive and growth dependent changes in compensatory renal hypertrophy are discussed.
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