narrowing or blockage of the intrarenal arteries
Introduction
Introduction Renal angiography of renal pelvic tumors and ureteral tumors may reveal thinning or obstruction of the intrarenal artery, often indicating infiltration. Nephropathy in the Balkans is interstitial nephritis, a common cause of ureteral ureteral cancer, including Yugoslavia, Romania, Bulgaria, Greece, etc. There are obvious regional, even villages have boundaries, slow development, renal dysfunction, similar incidence of men and women , both sides 10%. The reasons for environmental, occupational, and genetic investigations are still unclear. Because it is easy to have renal damage, superficial, and multiple, the treatment should preserve kidney tissue as much as possible.
Cause
Cause
Nephropathy in the Balkans is interstitial nephritis, a common cause of ureteral ureteral cancer, including Yugoslavia, Romania, Bulgaria, Greece, etc. There are obvious regional, even villages have boundaries, slow development, renal dysfunction, similar incidence of men and women , both sides 10%. The reasons for environmental, occupational, and genetic investigations are still unclear. Because it is easy to have renal damage, superficial, and multiple, the treatment should preserve kidney tissue as much as possible.
Analgesic tablets can cause renal pelvic cancer. In recent years, acetaninophen (Tylen01) is considered to be carcinogenic to its metabolites. Pain-killing tablets often need to accumulate more than 5 kg of cancer, similar to the carcinogenic opportunity of taking 15 cigarettes a day for 20 years.
Chronic stimuli such as inflammation caused by uroliths can cause renal pelvis cancer, most of which are squamous cell carcinomas. More than 50% of patients with squamous cell carcinoma have a history of calculus.
There is a familial morbidity. McCullough reported that the father and the second son had multiple upper urinary tract tumors. Gitte saw three brothers with multiple tumors and bladder tumors first. Familial onset may be associated with plum infection, metabolic abnormalities, and exposure to carcinogens.
Examine
an examination
Related inspection
Renal angiography retrograde pyelography
1. Excretory urography: visible filling defects, should be identified with uric acid stones, matrix stones, and sometimes defects due to blood clots. Renal parenchymal tumors and cysts may be associated with renal pelvis and renal pelvis filling defects, sometimes with B-ultrasound and CT can be diagnosed. A small defect in the renal pelvis may be caused by the renal artery and its branches. Tumors can cause ureteral non-development, especially in ureteral tumors. There is a statistically high incidence of invasive carcinoma of the squamous cell carcinoma when not developed, and 60% to 80% of invasiveness when ureteral cancer is not developed. Hydronephrosis accounted for 35%, and the ureter had a filling defect and 20% of the patients found hydronephrosis. 85% of patients with normal urography are low-grade tumors.
Retrograde urography should be accompanied by retrograde angiography or other examinations.
2. Retrograde urography: its importance is: 1 angiography is clearer, especially when the drainage dysplasia is poor; 2 may see the ureteral spurting of the disease side, the lower ureteral tumor protrudes to the ureteral orifice; 3 directly collect the disease Lateral urinary cytology or brush biopsy; 4 cystoscopy to exclude intravesical tumors. In retrograde angiography, too much contrast agent injected into the renal pelvis may cover a small filling defect, and ureteral angiography must fill the ureter to confirm the diagnosis. A bulbous catheter ureteral angiography, the ureteral catheter head resembles an olive or acorn block, inserted into the ureteral orifice under the screen to inject contrast agent, the tumor is pushed upwards, and the ureter under the expansion is like a "gob-shaped", such as a stone The underside does not expand, the surface of the infused tumor is not smooth, and the urolithic edema may be misdiagnosed. Sometimes urinary stones can be combined with tumors. Ureteral polyps often appear as smooth, long strips of filling defects. There can be branches. The following catheters can be bent or looped in a ureteral tumor. If the cannula passes through the tumor, it can be found that it is clear urine, and the blood flowing out beside the catheter is hematuria.
It is necessary to prevent misdiagnosis caused by air bubbles during angiography.
3. Brush biopsy: When the patient is suspected of tumor and the cytology is positive, after the contrast agent is injected intravenously, the suspicious part is selected to take the biopsy. The small brush passes through the F5 catheter, the tissue can be attached to the brush hair, and the brush is taken out. There may be small tissue fragments in the ureteral catheter effluent, repeated flushing with a small amount of saline, and collecting the liquid for examination. The ureteral catheter should be left overnight and pulled out.
4. Ultrasound examination: It can distinguish between stones and soft tissue lesions, tumors and necrotic nipples, blood clots, matrix stones and other difficult to identify. Ultrasound examination of ureteral lesions is not reliable.
5. CT: can distinguish between renal cell and renal cell carcinoma and renal cell carcinoma. Renal squamous cell carcinoma showed 1 solid tumor in the renal pelvis or pelvic stenosis, renal sinus fat displacement and compression; 2 no contrast enhancement after injection of contrast agent; 3 contrast curve filling of tumor; 4 renal parenchymal enhancement (The tumor has a large impact on drainage); 5 retains the kidney shape.
6. Renal artery angiography: The intrarenal artery can be found to be thin or obstructed, often indicating infiltration. Tumor hemorrhage can be seen above 3 cm in diameter.
7. Ureteroscopy and pyeloscopy: may be used for diagnosis and treatment. Renal sputum may cause tumor transplantation, and its actual value is still difficult to draw conclusions.
8. NMR: can be used to identify renal cancer and renal pelvic cancer, can also be used for the diagnosis of ureteral lesions, and can be free of contrast agents (allergic to contrast agents). If you can develop the application of contrast agents, you can improve the accuracy of the diagnosis.
9. Cytological examination: 80% false negative for well-differentiated low-stage tumors, and 60% positive or highly suspected poorly differentiated tumors.
Diagnosis
Differential diagnosis
Differential diagnosis of intrarenal artery thinning or obstruction:
1. Ureteral calculi: ureteral stones can cause upper urinary tract obstruction. When it is a negative stone, urography can be found in the ureter with filling defects, which need to be differentiated from ureteral tumors. Ureteral calculi are more common in young adults under the age of 40, characterized by colic, gross hematuria is rare, mostly intermittent microscopic hematuria, often coexisting with renal colic. Retrograde ureteral tumor local expansion, cup-like changes, and stones incomparable changes. The CT scan of the stone showed a high density of shadow, and the tumor showed a soft tissue shadow.
2. Ureteral polyps: more common in young adults under 40 years old, long history, blood coat is not obvious, ureteral angiography see filling defects, but the surface is smooth, elongated, the scope is larger than the ureteral tumor, more than 2cm. Most of the sites were at the junction of the proximal renal pelvis and the ureter and bladder, and the tumor cells were negative from the urine.
3. Ureteral stenosis: manifested as lumbar pain and hydronephrosis, should be differentiated from urinary cancer. There are various reasons for ureteral stricture, non-tumor-induced ureteral narrow hematuria, urography is simple stenosis, and there is no filling defect. Repeated urine to find tumor cells were negative.
4. Blood clots in the ureter: hematuria, ureteral filling defects and ureteral tumors are similar, but the ureteral clots are variability, two times of contrast examination at different times, can be found in its location, size and morphology changes.
5. Bladder cancer: Bladder cancer located around the ureteral orifice, covering the ureteral orifice, and need to be differentiated from the lower ureteral cancer such as the bladder. There are two cases of ureteral cancer in the human bladder: one is that the tumor has pedicles and the pedicle is in the ureter; the other is that the tumor is not pedicled, and the tumor is in the ureter and bladder.
