Læknablaðið - 15.12.1997, Blaðsíða 51

LÆKNABLAÐIÐ 1997; 83
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most of the kidneys on the antireflux side while
there was no scarring here. The micro-orga-
nisms were the same in the renal pelves as in
the conduits, suggesting ascending infection.
The findings imply that an antireflux ureteric
implantation is of significant importance in pa-
tients undergoing urinary diversion.
As tubular damage usually precedes glomer-
ular damage from postrenal causes, evaluation
of tubular function seems desirable in the fol-
low-up after urinary diversion. Renal tubular
dysfunction. slight in most cases, was found in
36% of patients after urinary diversion by de-
termining the urinary levels of protein HC.
The fall in the preoperative mean GFR was
greater in those patients with elevated levels of
protein HC than in those with normal levels
(p<0.01) indicating that protein HC ntay be a
suitable marker for detecting early renal im-
pairment after urinary diversion.
Absorption of ions and solutes across in-
testinal mucosa when in contact with urine,
demands compensation by lungs and kidneys.
Chronic absorption of acid demands increased
elimination by the kidneys and also, increased
utilization of bone buffers, mainly P042',
HCOj' and CO,2', to maintain stable acid-base
homeostasis. With decrease in GFR or renal
tubular function the risk of metabolic changes
is probably greater, however, the level of renal
function necessary for the development of me-
tabolic abnormalities is not known. In patients
with a colonic reservoirs and a moderate renal
impairment (mean GFR 55 ml/min. x 1.73m2)
a tendency towards hyperchloremic metabolic
acidosis was recognized. Morover, the serum
levels of total and ionized calcium were lower,
indicating that bone buffers might be increas-
ingly utilized in these patients with calcium
probably lost in urine. As long-standing me-
tabolic acidosis may cause altered bone meta-
bolism prophylactic treatment with alkali may
be considered in patients with a GFR below 55
ml per minute x 1.73m2.
Key words: urinary diversion, glomerular fil-
tration rate, tubular dysfunction, refluxing and
antirefluxing ureteric anastomosis, renal scar-
ring, bacteriuria, metabolism, acid-base ho-
meostasis.