Care of individuals with renal failure continues to impose a tremendous burden on our national health care budget. Chronic renal failure is the final common denominator of a multiplicity of pathologic processes, some of which progress silently over years. Of these, obstructive uropathy is a prominent cause of kidney failure, accounting for 16.5% of all pediatric renal transplants in 1997. The pathophysiology of obstructive uropathy is reviewed as the basis for a differential diagnosis. In view of the significant role played by obstructive uropathy in the development of renal failure, early and definitive treatment of this clinical entity is imperative.
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References
1.
1. Roth KS, Carter WH Jr, Chan JCM. Obstructive uropathy in children: Long-term progression after relief of posterior urethral valves. Pediatrics. 2001;107:1004-1010.
2.
2. Edwards DR, Murphy G, Reynolds JJ. Transforming growth factor-beta modulates the expression of collagenase and metalloproteinase inhibitor. EMBOJ1987;6:1899-1904.
3.
3. Laiho M, Saksela O, Keski-Oja J. Transforming growth factor-beta induction of type-1 plasminogen activator inhibitor. J Biol Chem.1987;262:17467-17474.
4.
4. Border WA, Noble NA. Transforming growth factory in tissue fibrosis. N Engl J Med.1994;331:1286-1292.
5.
5. Bruijn JA, Roos A, de Geus B, deHeer E. Transforming growth factorand the glomerular extracellular matrix in renal pathology. JLab Clin Med.1994;123:34-47.
6.
6. Stoll M, Steckelings UM, Paul M, et al. The angiotensin AT2-receptor mediates inhibition of cell proliferation in coronary endothelial cells. J Clin Invest.1995;95:651-657.
7.
7. Nakajima M, Hutchinson HG, Fujinaga M, et al. The angiotensin II type 2 (AT2) receptor antagonizes the growth effects of the ATI receptor: gain-of-function study using gene transfer. Proc Natl Acad Sci USA. 1995;92:663-667.
8.
8. Yamada T, Horiuchi M, Dzau VJ. Angiotensin II type 2 receptor mediates programmed cell death. Proc Natl Acad Sci USA. 1996;93:156-160.
9.
9. Yoo KH, Norwood VF, El-Dahr SS, et al. Regulation of angiotensin II ATI and AT2 receptors in neonatal unilateral ureteral obstruction. Am J Physiol.1997;42:588-592.
10.
10. Chan JCM, Scheinman JI, Roth KS. Renal tubular acidosis. Pediatr Rev.2001;22:277-286.
11.
11. Churchill BM, Krueger RP, Fleisher MH, et al. Complications of posterior urethral valve surgery and their prevention. Urol Clin North Am.1983;10:519-530.
12.
12. Nakayama DK, Harrison MR, de Lorimier AA. Prognosis of posterior urethral valves presenting at birth. J Pediatr Surg.1986;21:43-45.
13.
13. Williams DL. Urethral valves: A hundred cases with hydronephrosis. In: Urinary System Malformations in Children: Birth Defects: Original Article Series. Vol. XIII, no. 5. 1977:55-62.
14.
14. Freedman AL, Bukowski TP, Smith CA, et al. Fetal therapy for obstructive uropathy: diagnosis specific outcomes. J Urol.1996;156:720-723.
15.
15. Freedman ALJohnson MP, Smith CA, et al. Long-term outcome in children after antenatal intervention for obstructive uropathies. Lancet. 1999;354:374-377.
17. Chevalier RL, Thornhill BA, Chang AY. Unilateral ureteral obstruction in neonatal rats leads to renal insufficiency in adulthood. Kidney Int.2000;58:1987-1995.
18.
18. Benfield MR, McDonald R, Sullivan EK, et al. The 1997 annual renal transplantion in children report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplantation. 1999;3:152-167.
19.
19. Executive Summary, United States Renal Data System 1999 Annual Data Report. Am JKidney Dis.1999;34:S9-S19.
