Coagulo fibrotico : nova causa de retenção de fragmentos pos leoc para calculo em calice inferior renal?

AUTOR(ES)
DATA DE PUBLICAÇÃO

1999

RESUMO

A prospective study was conducted with a sample of 20 patients presenting renal calculi specifically located in the lower calyx, treated with extracorporeal shock waves lithotripsy (ESWL), who presented fragments left behind in the lower pole ofthe kidney. In this study, we tried to confirm if there is a new reason for the existence of these residual fregments, that is, the formation of a fibrous caogulum in the lower calyx, not allowing fragments to be eliminated. Patients aged 25-60 years (13 males and 7 females), not presenting kidney side preference or urinary tract infection, were distributed according to the calyceal morphology and calculi size,as follows: 5 cases (25%) with calculi smaller than 2 em, being 2 with a favorable calyceal morphology (10%) and 3 with an unfavorable calyceal morphology (15%); 15 cases (75%) with calculi larger than 2 em, 5 ofthem with a favorable morphology (25%) and 10 with unfavorable calyceal morphology (50%). The methodology used consists of clinical history and radiological assessment. The results of this analysis were: 12 cases(60%) with unfavorable calyceal morphology and 8 cases (40%) with favorable calyceal morphology. All patients were submitted to extracorporeal shock wave lithotripsy on the same Phillips-Domier ML 5000 lithotriptor for two or three sessions, with a number of shock waves up to 3000 per session and wave power between 19 and 27 kV (median =23). A weekly follow-up of the patients was conducted with standart abdominal X-ray and clinical exams during an established period of ~ months. If after this period, patients had residual fragments, they were submitted to a kidney percutaneous puncture to remove the calculi fragments, as well as a cluster of soft t~nder tis sue, which was then sent to histopathological examination. In 12 cases(60%), the material analyzed by histology revealed fibrous tissue, blood clot and granulation. This material, called fibrous coagulum, was found in 9 of the 15 patients with calculi larger than 2 em, being 7 (75%) with an unfavorable calyceal morphology and 2 (10%) with favorable calyceal morphlogy. From the 5 patients with calculi smaller than 2 em, only 3 presented fibrous coagulum, being 2 (10%) with an unfavorable calyceal morphology and 1 (5%) with a favorable morphology. We can conclude that the presence of fibrous coagulum in the lower calyceal system caused by ESWL in the treatment of lower pole calculi has a significant relevance (12 patients,or 60%) in the occurrence ofresidual fragments associated with unfavorable calyceal morphology

ASSUNTO(S)

rins - doenças rins - calcificação

ACESSO AO ARTIGO

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