肾脏病理结合肾功能显像评价慢性肾病残余肾功能的临床意义

The clinical significance of renal pathology combining with functional imaging on evaluating the CKD residual renal function

目的探讨肾脏病理结合肾功能显像综合评价慢性肾病(CKD)残余肾功能的临床意义。方法 105例临床初步诊断为慢性肾炎伴慢性肾功能不全患者,同时进行经皮肾穿刺活组织检查及99 Tcm-DTPA肾动态显像(ECT)检查,对CKD残余肾功能进行综合评价,并确定治疗方案,动态观察CKD进展情况,回顾性验证两种检查方法对CKD残余肾功能判断的可靠性。结果 105例CKD患者中,肾脏病理显示肾小球硬化及肾小管间质慢性化程度,多数情况下(92%)与ECT对于CKD残余肾功能的判断是相符的,但8%的患者二者并不相符。根据形态学及功能学检查结果,所有2～5期的CKD患者共105例进行相应的治疗,随访2～3年,共35例进入透析。结论 对于各种CKD的诊断除病因诊断外,肾组织病理形态学诊断及肾脏功能诊断两者间既不能相互替代,又密不可分。仅根据CKD肾脏组织病理形态学判断CKD残余肾功能具有局限性。结合肾功能显像进行综合评价,正确评估保护CKD残余肾功能的治疗价值,对CKD治疗方案的确定具有重要临床指导意义。

Objective To evaluate the clinical significance of renal pathology combining with functional imaging on evaluating the residual renal function of patients with chronic kidney disease（CKD）.Methods 105 cases of chronic nephritis combining with chronic renal insufficiency were collected,and tested by renal needle biopsy and 99Tcm-DTPA renal dynamic imaging（ECT）,then we evaluated the CKD residual renal function,and determined the therapeutic regimen and observed the CKD progress dynamically,retrospective validated the reliability of the two inspection methods to the CKD residual renal function judgment.Results In the 105 cases of CKD,kidney pathology displayed glomerular sclerosis and renal tubulointerstitium chronic degree,in the most situations（92%）,it was conformity to the judgment of ECT evaluating the CKD residual renal function,but 8% of the cases were not conformity.According to the result of morphology and function study,all the 2-5 stage CKD,105 cases were treated proportionally,making a follow-up visit 2-3 years until now,35 cases underwent dialysis.Conclusion Besides of the etiological diagnosis of CKD,the pathological diagnosis of renal tissue and the diagnosis of kidney function can not substitute mutually,they are inseparable.Judging CKD residual renal function only by the pathological diagnosis of renal tissue has the limitation.Combined with the renal functional imaging,the correct evaluation on the treatment value of protecting the CKD residual kidney function has the important clinical guiding significance to decide the therapeutic regimen of CKD.