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Erschienen in: Der Urologe 2/2007

01.02.2007 | Leitthema

Prognostische Marker bei kongenitalen Harntransportstörungen

verfasst von: PD Dr. S. Conrad

Erschienen in: Die Urologie | Ausgabe 2/2007

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Zusammenfassung

Die abwartende Verlaufsbeobachtung ist die Standardtherapie der meisten kongenitalen unilateralen Harntransportstörungen bei nicht eingeschränkter Nierenfunktion. Es wäre wünschenswert, verlässliche, einfach und nicht-invasiv zu bestimmende prognostische Parameter anwenden zu können, die entweder bereits in der Erstuntersuchung ein erhöhtes Risiko für einen Funktionsverlust signalisieren oder in der Verlaufskontrolle einen drohenden Verlust rechtzeitig anzeigen. Der Parameter mit der größten Aussagekraft ist zur Zeit die Dilatation des Nierenbeckens in der Sonographie und insbesondere ihre Zunahme, während die Aussage einer „obstruierten „Auswaschkurve im Furosemid-Isotopennephrogramm sehr begrenzt ist. Präklinische und erste klinische Studien weisen daraufhin, dass die Bestimmung von Molekülen der Signaltransduktion der hydronephrotischen Nierenschädigung wie TGF-β1 und MCP-1 im Urin der betroffenen Kinder in naher Zukunft eine wesentliche Rolle als prognostische Parameter spielen können.
Literatur
1.
Zurück zum Zitat Baskin LS, Zderic SA, Snyder HM, Duckett JW (1994) Primary dilated megaureter: long-term followup. J Urol 152: 618–621PubMed Baskin LS, Zderic SA, Snyder HM, Duckett JW (1994) Primary dilated megaureter: long-term followup. J Urol 152: 618–621PubMed
2.
Zurück zum Zitat Bartoli F, Gesualdo L, Paradies G et al. (2000) Renal expression of monocyte chemotactic protein-1 and epidermal growth factor in children with obstructive hydronephrosis. J Pediatr Surg 35: 569–572CrossRefPubMed Bartoli F, Gesualdo L, Paradies G et al. (2000) Renal expression of monocyte chemotactic protein-1 and epidermal growth factor in children with obstructive hydronephrosis. J Pediatr Surg 35: 569–572CrossRefPubMed
3.
Zurück zum Zitat Beetz R, Bökenkamp A, Brandis M et al. (2001) Diagnostik bei konnatalen Dilatationen der Harnwege—Konsensusgruppe der Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) in Kooperation mit dem Arbeitskreis Kinderurologie der Deutschen Gesellschaft für Urologie und mit der Arbeitsgemeinschaft Kinderurologie in der Deutschen Gesellschaft für Kinderchirurgie. Urologe A 40: 495–509CrossRefPubMed Beetz R, Bökenkamp A, Brandis M et al. (2001) Diagnostik bei konnatalen Dilatationen der Harnwege—Konsensusgruppe der Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) in Kooperation mit dem Arbeitskreis Kinderurologie der Deutschen Gesellschaft für Urologie und mit der Arbeitsgemeinschaft Kinderurologie in der Deutschen Gesellschaft für Kinderchirurgie. Urologe A 40: 495–509CrossRefPubMed
4.
Zurück zum Zitat Carr MC, Peters CA, Retik AB, Mandell J (1994) Urinary levels of the renal tubular enzyme N-acetyl-beta-D-glucosaminidase in unilateral obstructive uropathy. J Urol 151: 442–445PubMed Carr MC, Peters CA, Retik AB, Mandell J (1994) Urinary levels of the renal tubular enzyme N-acetyl-beta-D-glucosaminidase in unilateral obstructive uropathy. J Urol 151: 442–445PubMed
5.
Zurück zum Zitat Chevalier RL (1999) Molecular and cellular pathophysiology of obstructive nephropathy. Pediatr Nephrol 13: 612CrossRefPubMed Chevalier RL (1999) Molecular and cellular pathophysiology of obstructive nephropathy. Pediatr Nephrol 13: 612CrossRefPubMed
6.
Zurück zum Zitat Chevalier RL (2004) Biomarkers of congenital nephropathy: Past, present and future. J Urol 173: 852–857CrossRef Chevalier RL (2004) Biomarkers of congenital nephropathy: Past, present and future. J Urol 173: 852–857CrossRef
7.
Zurück zum Zitat Conrad S, Kemper M, Müller-Wiefel DE, Huland H (1995) Non-obstructive non-refluxive hydronephrosis: reliability of diagnosis and need for follow-up. J Urol A 153: 375 Conrad S, Kemper M, Müller-Wiefel DE, Huland H (1995) Non-obstructive non-refluxive hydronephrosis: reliability of diagnosis and need for follow-up. J Urol A 153: 375
8.
Zurück zum Zitat Conrad S, Stephan M, Eggert T, Huland H (2000) Urinary concentrations of transforming growth factor-beta 1 indicates the degree of hydronephrotic atrophy. J Urol A 163: 137CrossRef Conrad S, Stephan M, Eggert T, Huland H (2000) Urinary concentrations of transforming growth factor-beta 1 indicates the degree of hydronephrotic atrophy. J Urol A 163: 137CrossRef
9.
Zurück zum Zitat Conrad S, Eggert T, von Lossow J et al. (2002) Increased urinary concentration of monocyte chemoattractant protein-1 (MCP-1) in children with progressive hydronephrotic damage. Eur Urol 41: 114 Conrad S, Eggert T, von Lossow J et al. (2002) Increased urinary concentration of monocyte chemoattractant protein-1 (MCP-1) in children with progressive hydronephrotic damage. Eur Urol 41: 114
10.
Zurück zum Zitat Conrad S, Eggert T, Kemper M et al. (2003) Which parameters are relevant to predict the risk of renal detrioration in watchful waiting for ureteropelvic junction (UPJ) obstruction? J Urol 169(Suppl): 172 Conrad S, Eggert T, Kemper M et al. (2003) Which parameters are relevant to predict the risk of renal detrioration in watchful waiting for ureteropelvic junction (UPJ) obstruction? J Urol 169(Suppl): 172
11.
Zurück zum Zitat Dhillon HK (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 81(Suppl 2): 39–44PubMed Dhillon HK (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 81(Suppl 2): 39–44PubMed
12.
Zurück zum Zitat Eisenhardt A, Arntzen D, Conrad S et al. (2003) Vorkommen, Diagnostik und Therapie schwerwiegender kindlicher Anomalien des Harntraktes in Deutschland. Urologe A 42: 538–546PubMed Eisenhardt A, Arntzen D, Conrad S et al. (2003) Vorkommen, Diagnostik und Therapie schwerwiegender kindlicher Anomalien des Harntraktes in Deutschland. Urologe A 42: 538–546PubMed
13.
Zurück zum Zitat Eskild-Jensen A, Gordon I, Piepsz A, Frokiaer J (2005) Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment. J Urol 173: 1471–1476CrossRefPubMed Eskild-Jensen A, Gordon I, Piepsz A, Frokiaer J (2005) Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment. J Urol 173: 1471–1476CrossRefPubMed
14.
Zurück zum Zitat Everaert K, Delanghe J, van de Wiele C et al. (1998) Urinary alpha 1-microglobulin detects uropathy. A prospective study in 483 urological patients. Clin Chem Lab Med 36: 309–315CrossRefPubMed Everaert K, Delanghe J, van de Wiele C et al. (1998) Urinary alpha 1-microglobulin detects uropathy. A prospective study in 483 urological patients. Clin Chem Lab Med 36: 309–315CrossRefPubMed
15.
Zurück zum Zitat Fichtner J, Spielman D, Herfkens R et al. (1994) Ultrafast contrast enhanced magnetic resonance imaging of congenital hydronephrosis in a rat model. J Urol 152: 682–687PubMed Fichtner J, Spielman D, Herfkens R et al. (1994) Ultrafast contrast enhanced magnetic resonance imaging of congenital hydronephrosis in a rat model. J Urol 152: 682–687PubMed
16.
Zurück zum Zitat Freedman ER, Rickwood AM (1994) Prenatally diagnosed pelviureteric junction obstruction: a benign condition? J Pediatr Surg 29: 769–772CrossRefPubMed Freedman ER, Rickwood AM (1994) Prenatally diagnosed pelviureteric junction obstruction: a benign condition? J Pediatr Surg 29: 769–772CrossRefPubMed
17.
Zurück zum Zitat Furness PD 3rd, Maizels M, Han SW et al. (1999) Elevated bladder urine concentration of transforming growth factor-beta1 correlates with upper urinary tract obstruction in children. J Urol 162: 1033–1036CrossRefPubMed Furness PD 3rd, Maizels M, Han SW et al. (1999) Elevated bladder urine concentration of transforming growth factor-beta1 correlates with upper urinary tract obstruction in children. J Urol 162: 1033–1036CrossRefPubMed
18.
Zurück zum Zitat Gordon I (2001) Diuretic renography in infants with prenatal unilateralhydronephrosis: an explanation for the controversy about poor drainage. BJU Int 87: 551–555CrossRefPubMed Gordon I (2001) Diuretic renography in infants with prenatal unilateralhydronephrosis: an explanation for the controversy about poor drainage. BJU Int 87: 551–555CrossRefPubMed
19.
Zurück zum Zitat Grandaliano G, Gesualdo L, Bartoli F et al. (2000) MCP-1 and EGF renal expression and urine excretion in human congenital obstructive nephropathy. Kidney Int 58: 182–192CrossRefPubMed Grandaliano G, Gesualdo L, Bartoli F et al. (2000) MCP-1 and EGF renal expression and urine excretion in human congenital obstructive nephropathy. Kidney Int 58: 182–192CrossRefPubMed
20.
Zurück zum Zitat Hiraoka M, Taniguchi T, Nakai H et al. (2001) No evidence for AT2R gene derangementin human urinary tract anomalies. Kidney Int 59: 1244–1249CrossRefPubMed Hiraoka M, Taniguchi T, Nakai H et al. (2001) No evidence for AT2R gene derangementin human urinary tract anomalies. Kidney Int 59: 1244–1249CrossRefPubMed
21.
Zurück zum Zitat Hohenfellner K, Hunley TE, Schloemer C et al. (1999) Angiotensin type 2 receptor is important in the normal development of the ureter. Pediatr Nephrol 13: 187–191CrossRefPubMed Hohenfellner K, Hunley TE, Schloemer C et al. (1999) Angiotensin type 2 receptor is important in the normal development of the ureter. Pediatr Nephrol 13: 187–191CrossRefPubMed
22.
Zurück zum Zitat Hohenfellner K, Wingen AM, Nauroth O et al. (2001) Impact of ACE I/D gene polymorphism on congenital renal malformations. Pediatr Nephrol 16: 356–361CrossRefPubMed Hohenfellner K, Wingen AM, Nauroth O et al. (2001) Impact of ACE I/D gene polymorphism on congenital renal malformations. Pediatr Nephrol 16: 356–361CrossRefPubMed
23.
Zurück zum Zitat Homsy YL, Saad F, Laberge I et al. (1990) Transitional hydronephrosis of the newborn and infant. J Urol 144: 579–583PubMed Homsy YL, Saad F, Laberge I et al. (1990) Transitional hydronephrosis of the newborn and infant. J Urol 144: 579–583PubMed
24.
Zurück zum Zitat Huland H, Gonnermann D, Werner B, Possin U (1988) A new test to predict the reversability of hydronephrotic atrophy after stable partial unilateral ureteral obstruciton. J Urol 140: 1591–1594PubMed Huland H, Gonnermann D, Werner B, Possin U (1988) A new test to predict the reversability of hydronephrotic atrophy after stable partial unilateral ureteral obstruciton. J Urol 140: 1591–1594PubMed
25.
Zurück zum Zitat Kaneyama K, Yamataka A, Somey T et al. (2006) Magnetic resonance urographic parameters fo predicting the need for pyeloplasty in infants with severe hydronephrosis. J Urol 176: 1784–1785CrossRef Kaneyama K, Yamataka A, Somey T et al. (2006) Magnetic resonance urographic parameters fo predicting the need for pyeloplasty in infants with severe hydronephrosis. J Urol 176: 1784–1785CrossRef
26.
Zurück zum Zitat Klahr S, Morrissey J (2002) Obstructive nephropathy and renal fibrosis. Am J Physiol Renal Physiol 283: 861 Klahr S, Morrissey J (2002) Obstructive nephropathy and renal fibrosis. Am J Physiol Renal Physiol 283: 861
27.
Zurück zum Zitat Kullendorff CM, Larsson LT, Jorgensen C (1984) The advantage of antenatal diagnosis of intestinal and urinary tract malformations. Br J Obstet Gynaecol 91: 144–147PubMed Kullendorff CM, Larsson LT, Jorgensen C (1984) The advantage of antenatal diagnosis of intestinal and urinary tract malformations. Br J Obstet Gynaecol 91: 144–147PubMed
28.
Zurück zum Zitat Murer L, Benetti E, Centi S et al. (2006) Clinical and molecular markers of chronic interstitial nephropathy in congenital ureteral obstruction. J Urol 176: 2668–2673CrossRefPubMed Murer L, Benetti E, Centi S et al. (2006) Clinical and molecular markers of chronic interstitial nephropathy in congenital ureteral obstruction. J Urol 176: 2668–2673CrossRefPubMed
29.
Zurück zum Zitat O’Reilly P (1986) Diuresis renography 8 years later: an update. J Urol 136: 993–999PubMed O’Reilly P (1986) Diuresis renography 8 years later: an update. J Urol 136: 993–999PubMed
30.
Zurück zum Zitat Palmer LS, Maizels M, Kaplan WE et al. (1997) Urine levels of transforming growth factor-beta 1 in children with ureteropelvic junction obstruction. Urology 50: 769–773CrossRefPubMed Palmer LS, Maizels M, Kaplan WE et al. (1997) Urine levels of transforming growth factor-beta 1 in children with ureteropelvic junction obstruction. Urology 50: 769–773CrossRefPubMed
31.
Zurück zum Zitat Patti G, Menghini ML, Todini AR et al. (2000) The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral hydronephrosis. BJU Int 85: 308–312CrossRefPubMed Patti G, Menghini ML, Todini AR et al. (2000) The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral hydronephrosis. BJU Int 85: 308–312CrossRefPubMed
32.
Zurück zum Zitat Pope JC IV, Brock JW III, Adams MC et al. (2001) Congenital anomalies of the kidney and the urinary tract – role of the loss of function mutations in the pluripotent angiotensin type 2 receptor gene. J Urol 165: 196–202CrossRefPubMed Pope JC IV, Brock JW III, Adams MC et al. (2001) Congenital anomalies of the kidney and the urinary tract – role of the loss of function mutations in the pluripotent angiotensin type 2 receptor gene. J Urol 165: 196–202CrossRefPubMed
33.
Zurück zum Zitat Ransley PG, Dhillon HK, Gordon I et al. (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144: 584–587 Ransley PG, Dhillon HK, Gordon I et al. (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144: 584–587
34.
Zurück zum Zitat Rodriguez LV, Lock J, Kennedy WA Shortliffe LM (2001) Evaluation of sonographic renal parenchymal area in the management of hydronephrosis. J Urol 165: 548–551CrossRefPubMed Rodriguez LV, Lock J, Kennedy WA Shortliffe LM (2001) Evaluation of sonographic renal parenchymal area in the management of hydronephrosis. J Urol 165: 548–551CrossRefPubMed
35.
Zurück zum Zitat Rohrschneider WK, Becker K, Hoffend J et al. (2000) Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis. Pediatr Radiol 30: 523–532CrossRefPubMed Rohrschneider WK, Becker K, Hoffend J et al. (2000) Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis. Pediatr Radiol 30: 523–532CrossRefPubMed
36.
Zurück zum Zitat Rosendahl H (1990) Ultrasound screening for fetal urinary tract malformations: a prospective study in general population. Eur J Obstet Gynecol Reprod Biol 36: 27–33CrossRefPubMed Rosendahl H (1990) Ultrasound screening for fetal urinary tract malformations: a prospective study in general population. Eur J Obstet Gynecol Reprod Biol 36: 27–33CrossRefPubMed
37.
Zurück zum Zitat Seseke F, Tholen P, Ringert RH (2004) Charakterization of an animal model of spontanteous congenital obstructive uropathy by cDNA microarray analysis. Eur Urol 45: 374–381CrossRefPubMed Seseke F, Tholen P, Ringert RH (2004) Charakterization of an animal model of spontanteous congenital obstructive uropathy by cDNA microarray analysis. Eur Urol 45: 374–381CrossRefPubMed
38.
Zurück zum Zitat Shokeir AA, Nijman RJ, El-Azab M, Provoost AP (1997) Partial ureteral obstruction: role of renal resistive index in stages of obstruction and release. Urology 49: 528–535CrossRefPubMed Shokeir AA, Nijman RJ, El-Azab M, Provoost AP (1997) Partial ureteral obstruction: role of renal resistive index in stages of obstruction and release. Urology 49: 528–535CrossRefPubMed
39.
Zurück zum Zitat Shokeir AA, Provoost AP, El-Azab M et al. (1997) Renal Doppler ultrasonography in children with equivocal obstructive uropathy: effect of intravenous normal saline fluid load and frusemide. Br J Urol 80: 313–318PubMed Shokeir AA, Provoost AP, El-Azab M et al. (1997) Renal Doppler ultrasonography in children with equivocal obstructive uropathy: effect of intravenous normal saline fluid load and frusemide. Br J Urol 80: 313–318PubMed
40.
Zurück zum Zitat Silverstein DM, Travis BR, Thornhill BA et al. (2003) Altered expression of immune modulator and structural genes in neonatla unilateral ureteral obstrcution. Kidney Int 64: 361–362CrossRefPubMed Silverstein DM, Travis BR, Thornhill BA et al. (2003) Altered expression of immune modulator and structural genes in neonatla unilateral ureteral obstrcution. Kidney Int 64: 361–362CrossRefPubMed
41.
Zurück zum Zitat Stephan M, Conrad S, Eggert T, Huland H (1999) Expression of transforming growth factor-β1 depends on the degree of partial ureteral obstruction. J Urol A 161: 82CrossRef Stephan M, Conrad S, Eggert T, Huland H (1999) Expression of transforming growth factor-β1 depends on the degree of partial ureteral obstruction. J Urol A 161: 82CrossRef
42.
Zurück zum Zitat Stephan M, Conrad S, Eggert T et al. (2002) Urinary concentration and tissue messenger RNA expression of monocyte chemoattractant protein-1 asan indicator of the degree of hydronephrotic atrophy in partial ureteral obstruction. J Urol 167: 1497–1502CrossRefPubMed Stephan M, Conrad S, Eggert T et al. (2002) Urinary concentration and tissue messenger RNA expression of monocyte chemoattractant protein-1 asan indicator of the degree of hydronephrotic atrophy in partial ureteral obstruction. J Urol 167: 1497–1502CrossRefPubMed
43.
Zurück zum Zitat Wen JG, Chen Y, Ringgaard S et al. (2000) Evaluation of renal function in normal and hydronephrotic kidneys in rats using gadolinium diethylenetetramine-pentaacetic acid enhanced dynamic magnetic resonance imaging. J Urol 163: 1264–1270CrossRefPubMed Wen JG, Chen Y, Ringgaard S et al. (2000) Evaluation of renal function in normal and hydronephrotic kidneys in rats using gadolinium diethylenetetramine-pentaacetic acid enhanced dynamic magnetic resonance imaging. J Urol 163: 1264–1270CrossRefPubMed
44.
Zurück zum Zitat Whitaker RH (1973) Methods of assessing obstruction in dilated ureters. Br J Urol 45: 15PubMed Whitaker RH (1973) Methods of assessing obstruction in dilated ureters. Br J Urol 45: 15PubMed
Metadaten
Titel
Prognostische Marker bei kongenitalen Harntransportstörungen
verfasst von
PD Dr. S. Conrad
Publikationsdatum
01.02.2007
Verlag
Springer-Verlag
Erschienen in
Die Urologie / Ausgabe 2/2007
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-007-1293-x

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