title: Can a pressure-limited V-A shunt for obstructive uropathy really protect the kidney?
abstract: BACKGROUND
  In our fetal lamb model of lower urinary tract obstruction, a valved shunt preserves bladder function. This study investigates the effects on renal histology.
  
  
  METHODS
  We created obstructive uropathy (OU) in 60-day gestation fetal lambs, ligating the urethra and urachus, and delivering them at term (130-145days). We compared renal histology in 4 groups: group A-OU without shunt, group B-low-pressure shunt (15-54mmH2O), group C-high-pressure shunt (95-150mmH2O). Shunts were inserted 3weeks post-obstruction. Group D were normal controls.
  
  
  RESULTS
  We delivered 32 fetuses from 23 ewes: 13 fetuses in group A (9 survived), 6 fetuses in group B (5 survived), 7 fetuses in group C (5 survived), and 6 fetuses in group D. Histologically, we found renal tubular distention, vacuolated degeneration of tubular epithelial cells in 7 lambs, and cyst formation in 4 lambs in group A. There was renal tubular distention in two lambs, and cyst formation in one lamb in both groups B and C, with vacuolated degeneration of tubular epithelial cells observed in all but 1 lamb in each group.
  
  
  CONCLUSIONS
  V-A shunting prevents multicystic dysplastic kidney (MCDK). Some lambs have renal tubular distention and vacuolated degeneration of renal tubular epithelial cells.
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Shutaro
authors.initials: S
authors.lastname: Manabe
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ooyama
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Seki
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nagae
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Junki
authors.initials: J
authors.lastname: Koike
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Jane
authors.initials: J
authors.lastname: Zuccollo
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Pringle
authors.affiliation: Department of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. Electronic address: h2kita@marianna-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitagawa
mesh_terms: D000650:Amnion / Q000601:surgery*; D000714:Anastomosis, Surgical; D000818:Animals; D004108:Dilatation, Pathologic; D005260:Female; D005315:Fetal Diseases / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008026:Ligation; D008297:Male; D023421:Models, Animal; D011312:Pressure; D012756:Sheep; D014497:Urachus / Q000601:surgery; D014521:Urethra / Q000601:surgery; D014524:Urethral Obstruction / Q000473:pathology* / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
keywords: Fetal surgery; Obstructive uropathy; Vacuolated degeneration; Vesicoamniotic shunt