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OBJECTIVE@#To investigate factors influencing renal functional compensation(RFC) of the preserved kidney after radical nephrectomy (RN).@*METHODS@#A total of 286 patients treated with RN in Peking University People's Hospital were retrospectively analyzed. Preoperative body mass index (BMI), systolic blood pressure (SBP), history of smoking, history of chronic diseases and other basic information, as well as preoperative blood biochemistry, urine routine, imaging examination results were recorded. All the patients underwent 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scans before operation. The surgical method, pathology and blood creatinine values from 1 month to 60 months after RN were recorded. Preoperative and postoperative estimated glomerular filtration rate (eGFR) was calculated by the chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Renal functional compensation was defined as percent change in eGFR of the preserved kidney after RN compared with the preoperative eGFR. Univariate and multivariate regression analyses were used to identify predictive factors of RFC.@*RESULTS@#Median age was 61 years and 65.4% of the patients were male. Early stage (T1 or T2) tumors were found in 83.6% of the cases. 18.5% of the patients had preoperative diabetes mellitus, 39.5% had hypertension, 19.2% had a history of smoking, and 27.6% were found to have renal cyst on the contralateral side. In the study, 226 cases underwent laparoscopic radical nephrectomy and 60 cases underwent open radical nephrectomy. Renal clear cell carcinoma was the most common pathological type, accounting for 88.5%. The median tumor maximum diameter was 4.5 cm (0.7-13.5 cm). Median renal function compensation was 27% one month after radical nephrectomy. Functional stability was then observed to 5 years. The results of univariate analysis showed that age, gender, preoperative blood uric acid, preoperative urine protein, contralateral renal cyst, and percentage of split renal function of contralateral kidney were correlated with RFC (P < 0.05). Among them, UA level and split renal function of contralateral kidney were strongly negatively correlated with RFC. The results of multivariate linear regression analysis showed age (P < 0.001), blood uric acid (P < 0.001), urine protein (P=0.002), preoperative eGFR (P < 0.001) and the split renal function of contralateral kidney (P < 0.001) were independent predictors of RFC.@*CONCLUSION@#The basic examinations, such as blood biochemistry, urine routine and renal scan before RN are of great significance in predicting the compen-satory ability of the preserved kidney after RN, which is supposed to be taken into consideration when making clinical decision.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Renal Cell/surgery , Glomerular Filtration Rate , Kidney/physiology , Kidney Neoplasms/surgery , Nephrectomy , Renal Insufficiency, Chronic , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the diagnostic value of 99mTc-DTPA nuclide renal dynamic imaging in early renal damage in elderly essential hypertension(EH). Methods Among the elderly patients with essential hypertension who were enrolled in our hospital. 86 patients were enrolled as the study subjects. They were divided into two groups according to the results of 24-hour urinary microalbuminuria(MA):MA negative(A) group and MA posistive(B) group.Meanwhile,20 elderly healthy persons were selected as the control group. 99mTc-DTPA re-nal dynamic imaging was performed in all subjects to detect couple glomerular filtration rate(GFR),the peak time(TP),half emptying time(T1/2) and ration of 20 min and peak phase kidney radioactivity count(T20/P%).At the same time,MA,serum cystatin C(Cys-C),surem creatinine(SCr) and blood urea nitrogen(BUN) were de-tected and compared with three groups. Rusults(1)The positive rate of early renal damage with 99mTc-DTPA nu-clide renal dynamic imaging method was significantly higher than those of two later methods(P < 0.01).(2)The levels of GFR,TP,T1/2,and T20/P% in group A were significantly higher than those in the control group and those in group B significantly higher than those in group A(P<0.05).(3)The levels of MA and Cys-C in group A was sig-nificantly higher than that of the control group,and those in group B significantly higher than that of group A(P<0.05).In comparisons of SCr and BUN among the three groups,the results had no significant difference. Conclu-sion 99mTc-DTPA nuclide renal dynamic imaging can early detect the renal damage in elderly EH patients,and it has better clinical value.
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Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.
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Objective:To study the radiation dose rate around patients underwent renal dynamic imaging of SPECT with 99Tcm-DTPA, so as to provide the basis for ensuring the radiation safety of the surrounding environment and the general public.Methods: 109 patients who underwent renal dynamic imaging were enrolled in this study, and the radiation dose rates of different time and different distance after 99Tcm-DTPA was injected patients were measured. And then, the changes of dose rate following time and distance were analyzed. Results: At the 0.5h, 1h, 2h, 3h, 6h, and 7h after radiopharmaceuticals were injected patients underwent renal dynamic imaging, the radiation dose rates were 0.76-8.86 μSv/h, 0.68-7.27 μSv/h, 0.57-4.52 μSv/h, 0.56-3.90 μSv/h, 0.23-2.07 μSv/h and 0.21-1.05 μSv/h, respectively, between 0.5 m and 4 m away from patients. At 24h after radiopharmaceuticals were injected, all of radiation dose rates at different distances around patients were same with background values.Conclusion: The radiation dose rates around patients underwent renal dynamic imaging will rapidly decrease with the increasing of time and distance. At 24h after radiopharmaceuticals were injected, all of radiation dose rates at different distances away from patients were same with background values.
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Objective:To analyze the difference of glomerular filtration rate (GFR) among image processing of the renal dynamic imaging through various methods.Methods: The renal dynamic imaging was processed through various methods, and using the image post-processing software. Using SPSS statistic system to analyze the data.Results: The methods of image processing had impacts on GFR. (1)The difference of GFR data obtained from images which were processed by different operators were not statistically significant. (2) The difference of GFR data obtained from images which image processing repeatedly by the same operator were not statistically significant. (3)GFR data measured based on background detecting regions of interest (ROI) (manually defined or auto-defined ROI) placed in different positions of kidney image had statistical significant. (4) The difference of GFR data were measured by manually defined and auto-defined background ROI had statistical significant.Conclusion: Choosing the proper image processing way, combining clinical appearance and detection, and gaining real data help to ensure the accuracy of imaging diagnostic reports.
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Objective To analyze the factors associated with the outcome of pyeloplasty in term of renal function and morphology improvement in children with unilateral ureteropelvic junction obstruction,in order to provide clinical evidence for the treatment of hydronephrosis in children.Methods Clinical data of 174 children who underwent unilateral dismembered pyeloplasty from January 2009 to June 2014 were retrospectively studied.Differential changes in renal function and renal morphology after pyeloplasty were assessed by serial renal scan and ultrasound.On the basis of preoperative split DRF,these patients were divided into three groups:group Ⅰ with DRF ≥40％ (n =99),group Ⅱ with DRF 30％-40％ (n =29) and group Ⅲwith DRF ＜ 30％ (n =46).According to their age at surgery,the children were divided into four groups,including group A aged 1-3 months (n =52),group B aged 3 months-3 years (n =44),groupCaged3-6years (n =37),and group D aged more than 6 years (n =41).Results Inall 174 children,postoperative complication occurred in 7 cases,including urinary tract infection in 6 cases and renal atrophy in 1 case.A significant improvement of both function and morphology was confirmed in most patients (P ＜ 0.01).Patients in group Ⅰ showed stable renal function after operation(DRF 48.46％ ±4.80％ vs.50.78％ ± 5.45％,P ＜ 0.01),of them who underwent pyeloplasty at 1-3 months of age showed the best obvious recovery of renal morphology.Renal function of patients in group Ⅱ recovered obviously and most of them reached to the initial values (DRF 35.18％ ± 2.95％ vs.43.91％ ± 6.89％,P ＜ 0.01).While renal function of patients in group Ⅲ recovered significantly after surgery,most of them failed to restore the initial values(DRF 20.70％ ± 6.90％ vs.33.78％ ± 12.49％,P ＜ 0.01),and among them,the aged 1-3 months group possessed the best recovery.Moreover,the morphological improvement was similar to the functional improvement.The time for hydronephrosis recovered to less than Grade 2 of Society for Fetal Urology(SFU)was 6,24 and over 24 months respectively in group Ⅰ,Ⅱ and Ⅲll,and the renal morphology gradually improved with the increasing duration of follow-up.Conclusions The renal function and morphology of most patients improved significantly after pyeloplasty.Recovery of renal function and morphology after surgery was significantly correlated with the preoperative DRF.Early surgical intervention may improve the function and morphology recovery of the involved renal unit.
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Objective To explore the influence of different injection techniques on the quality of bolus in 99mTc-DTPA renal dynamic imaging.Methods 395 patients accepted 99mTc-DTPA renal dynamic imaging were retrospectively analyzed.All patients were divided into three groups according to injection techniques:direct injection group (187 cases),intravenous route injection group (84 cases)and venous indwelling needle injection group (124 cases).The three groups were injected by each technique.Areas of interest (ROI) were drawn on abdominal aorta by Xeleris workstation in blood flow perfusion imaging.The time-radioactivity curves of ROI were got.The patients whose ROI curve formed a peak was successfully injected,and did not formed was unsuccessfully injected.The number of patients in three groups who were successfully or unsuccessfully injected was respectively calculated.The data of three groups was taken Chisquare test by SPSS17.0 software.Results 174 patients of the direct injection group,46 of the intravenous route injection group and 115 of the venous indwelling needle injection group were injected successfully.The successful rate respectively was 93.0％,54.8％ and 92.7％.The successful rate of the direct injection group and venous indwelling needle injection group were higher than intravenous route injection group.The difference had statistical significance.The successful rate of the direct injection group and venous indwelling needle injection group hadn't statistical significance.Conclusions The successful rates of the direct injection group and venous indwelling needle injection group were similar.The venous indwelling needle injection technique can be chosen.The successful rate of the intravenous route injection group was lower than the other two groups.The intravenous route injection technique should be chosen prudently.
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Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate (GFR) for chronic obstructed kidneys, and to compare the correlations between the two morphologic indices of renal parenchyma and the GFR for chronic obstructed kidneys. Methods Seventy-one patients who had a diagnosis of unilateral chronic upper urinary tract obstruction were included in this analysis. (1) The renal parenchymal volume was mea-sured by non-contrast spiral CT. Both kidneys were scanned by non-contrast spiral CT. The renal parenchymal area of each section was marked manually. Renal parenchymal volume was calculated as the sum of renal parenchymal area multiplied by the width of each section. The volume percentage of obstructed kidney (%CTvol) was also calculated. (2) Renal parenchymal thickness was measured on the first and last non-contrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly contained the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The differential renal parenchymal thickness of the obstructed kidney (%CTt) was defined as the percentage of the obstructed renal parenchymal thickness to the total renal parenchymal thickness for both kidneys. GFR was determined with 99Tcm-DTPA dynamic imaging system by Gates method. The differential GFR for obstructed kidney (%GFR) was the GFR percentage of obstructed kidney to the total GFR for both kidneys. The Pearson relation test was carried out between the %CTvol, %CTt and the %GFR respectively. Results %CTvol and %CTt correlated well with %GFR in chronic obstructed kidneys among the 71 test group patients. Pearson correlation coefficient r was 0.80 (t=11.20, P＜0.05) and 0.66 (t=7.24, P＜0.05), respectively. The linear correlation equation respectively was %GFR=0.05+0.80×%CTvol (F=125.48, P＜0.05) and %GFR=0.12+0.66×%CTt (F=52.36, P＜0.05). Conclusions Renal parenchymal volume and thickness by non-contrast spiral CT might be used as clinical practical parameters to evaluate the differential GFR for chronic obstructed kidneys. Renal parenchymal volume is more accurate than renal parenchymal thickness.
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Objective To identify the accurate measurement of glomerular filtration rate (GFR) in chronic glomerulonephritis (CGN)patients. Methods Forty-two patients were enrolled in the study, including 15 females with age from 18 to 73 years old (mean 46 years old) and 27 males with age from 20 to 77 years old (mean 48 years old). The methods used for measuring GFR were classical dual plasma sample clearance method (tGFR), considered to be the gold standard,renal dynamic imaging method (dGFR), 24-hour creatinine clearance method (24hCcr). The difference and correlation amony them were analyzed. When the difference was significant, Pearson correlation and linear regression analysis were further performed. The difference of GFR detected by dGFR between left and right kidney of patients was compared simultaneously. A two-sided P value＜0.05 was considered as statistically significant. Results Either dGFR or 24hCcr was statistically different from tGFR, but had excellent correlation with tGFR, and the coefficient was 0.916 (P=0.000) and 0.957 (P=0.000) respectively. The linear regressions correlation existed and the regression equations were tGFR=0.936 dGFR-4.648 (F=208.941, P=0.000), tGFR =0.887 24hCcr+2.919 (F=376.513, P=0.000) respectively. Difference had not statistically significance between left and right kidney of patients (P=0.591). Conclusions Neither dGFR nor 24hCcr can substitute tGFR, but both can reflect the GFR of the CGN patients safely and effectively. The decrease of GFR is homochronous for left and right kidney of CGN patients. Therefore, the 24hCcr can be chosen to evaluate the GFR in the hospitals without SPECT.
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Objective To explore the clinical value of renal dynamic imaging and urinary N-acetyl-?-D-glucosaminidase(NAG),apoptosis DNA fragment(ADF) in evaluating the damage degree of hydronephrotic kidneys(HnK) in children with hydronephrosis.Methods Level of glomerular filtration rate(GFR) was detected in 41 children with congenital hydronephrosis by renal dynamic imaging,and urine NAG,ADF in pelvis in HnK and healthy kidneys (as controls) were detected by enzyme-linked immuno-sorbent assay(ELISA).Patholo-gic changes of HnK in 41 children were graded intoⅠ~Ⅴ according to Elder standard. And GFR,urinary NAG and ADF of HnK were divi-ded into subgroup according to pathologic changes ,at the same time statistical analysis was performed within each groups. And the correlations of pathologic grades with GFR,urinary NAG and ADF of HnK were analyzed.Results 1.Kindneys GFR in healthy kidneys and Hnk were (174.33?20.43)?10-3 L/min,(143.86?17.51)?10-3 L/min respectinely,and there was significant difference between healthy kidneys and Hnk (P0.05).3.There was significant negative correlation between GFR levels of HnK and pathologic grades(r=-0.814 P0.05).Conclusions For hydronephrotic kidneys,urinary NAG can eva-luate impaired nephric tubule whereas renal dynamic imaging may evaluate the damage level of glomeruli;urine ADF may not indicate the damage level of diseased kidneys in children with congenital hydronephrosis.