腎積水
维基百科，自由的百科全书
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| ICD-10 | N13.0-N13.3 |
| ICD-O: | {{{ICDO}}} |
| ICD-9 | 591 |
| OMIM | {{{OMIM}}} |
| MedlinePlus | {{{MedlinePlus}}} |
| eMedicine | {{{eMedicineSubj}}}/{{{eMedicineTopic}}} |
| DiseasesDB | {{{DiseasesDB}}} |
腎積水 是腎盂腫脹、擴大的現象，最常見的原因是尿液排泄受到阻塞所致。
目录 |
[编辑] 症狀
由於尿流阻塞可以是急性或慢性，腎積水的症狀也就有輕重不同的表現。有些單側腎積水的患者完全沒有症狀。
Blood tests can show elevated creatinine and electrolyte imbalance. Urinalysis may show an elevated pH due to the secondary destruction of nephrons within the affected kidney.
Symptoms that occur regardless of where the obstruction lies include loin or flank pain. An enlarged kidney may be palpable on examination.
Where to obstruction occurs in the lower urinary tract, suprapubic tenderness (with or without a history of bladder outflow obstruction) along with a palpable bladder are strongly suggestive of acute urinary retention, which left untreated is highly likely to cause hydronephrosis.
Upper urinary tract obstruction is characterised by pain in the flank, often radiating to either the abdomen or the groin. Where the obstruction is chronic renal failure may also be present. If the obstruction is complete, an enlarged kidney is often palpable on examination.
[编辑] 病因
The obstruction may be either partial or complete and can occur anywhere from the urethral meatus to the calyces of the renal pelvis.
The obstruction may arise from either inside or outside the urinary tract or may come from the wall of the urinary tract itself. Intrinsic obstructions (those that occur within the tract) include blood clots, stones, sloughed papilla along with tumours of the kidney, ureter and bladder. Extrinsic obstructions (those that are caused by factors outside of the urinary tract) include pelvic or abdominal tumours or masses, retroperitoneal fibrosis or neurological defecits. Strictures of the ureters (congenital or acquired), neuromuscular dysfunctions or schistosomiasis are other causes which originate from the wall of the urnary tract.
[编辑] 檢驗與檢查
- 尿液一般檢查與尿液沈渣顯微鏡檢查，看看有沒有糖尿、蛋白尿、血尿、結晶物、細菌等。
- 腹部 X光片，檢查有無結石。進一步可做靜脈腎盂造影或超音波檢查。
- 血液檢查：檢查腎功能是否正常。如果兩側腎臟同時有積水，很可能會造成腎功能異常。
- 如果發現是腫瘤梗阻而造成腎積水，就需要做電腦斷層掃瞄或核磁共振成像了解週邊器官是否受到侵犯，以擬定手術或後續治療方針。
- 若患者不適合做靜脈腎盂造影時，可以考慮做逆行腎盂造影或順行腎盂造影來查明阻塞的原因。
[编辑] 併發症
腎積水若是長期不治療，則隨著腎盂擴大，腎實質（由腎絲球和腎小管構成）漸漸萎縮，功能也越來越差。最後腎臟變成水球一般，只剩一層薄薄的外層，這時即使解決了阻塞問題，腎功能也不能恢復。如果一側腎積水，另一側會加倍工作以排除體內的廢物，伹如果兩側腎都有積水，患者將會面臨腎衰竭，必須靠血液透析也就是俗稱的洗腎維持生命。
腎積水的患者同時也比一般人容易產生結石與受到細菌感染。
[编辑] 治療
腎積水的治療原則就是解決阻塞問題，所以針對不同部位和不同程度的阻塞，各有不同的治療方案。
- 腎結石或輸尿管結石引起的阻塞：輕微者可用肌肉解痙劑使輸尿管擴張，有助於讓結石隨尿液排出。嚴重結石阻塞則須由泌尿外科醫師介入治療，將結石打碎或取出。
- 體外震波碎石術（ESWL）：不需麻醉就能震碎結石，成功率約為 70-80%，而且患者通常不需住院，自 1980 年代問世後之後，已成為腎結石及輸尿管結石最主要的治療方法。
- 輸尿管鏡碎石術（URSL）
- 經皮穿腎碎石術（PCNL）
- 開刀取出結石
- 非結石造成之阻塞
- 腎臟造廔術
- 腎盂整形術 Acute obstruction of the upper urinary tract is usually treated by the insertion of a nephrostomy tube. Chronic upper urinary tract obstruction is treated by the insertion of a ureteric stent or a pyeloplasty.
- 膀胱出口阻塞 Lower urinary tract obstruction (such as that caused by bladder outflow obstruction secondary to 良性前列腺增生症) is usually treated by insertion of a urinary catheter or a suprapubic catheter.
