Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This m...Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR;the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney展开更多
Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by SPECT in 172 patients (192 times) with renal impairment due to various diseases and also in 18 normal controls. The results sugg...Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by SPECT in 172 patients (192 times) with renal impairment due to various diseases and also in 18 normal controls. The results suggest that GFR and ERPF are sensitive and efficient renal function indicators in monitoring the change of the disease and assessing therapeutic effect. However, they should be checked carefully because of many factors affect the resutls of the measurement.展开更多
Objective:To investigate the clinical usefulness in terms of estimation for glomerular filtration rate(GFR), we determined the serum cystatin C levels in 72 healthy adults , 63 children, and 109 patients with various ...Objective:To investigate the clinical usefulness in terms of estimation for glomerular filtration rate(GFR), we determined the serum cystatin C levels in 72 healthy adults , 63 children, and 109 patients with various renal diseases, and compared the serum cystatin C concentrations with serum creatinine levels. In addition, the renal function was evaluated in 5 adults receiving renal transplantations using cystatin C.Methods:Serum cystatin C levels were measured by a particle-enhanced nephelometric immunoassay on Dade Behring nephelometer system. Serum and urine creatinine concentrations were determined by use of Jaff’s kinetic assay.Results: The cystatin C concentration at birth was typically double that found in adults, then fell to a constant level after 1 year, a value that was maintained to about 60 years. The studies of cystatin C in the elderly showed that the circulation cystatin C levels rose gradually above 60 years. There was a significant positive correlation between serum cystatin C and creatinine level (r=0.921, P <0.01) in the patients with various renal diseases. Serum cystatin C was inversely and logarithmically correlated with creatinine clearance as shown in the equation lg cystatin C =-0.6061gCCr+1.209(r=-0.887, P <0.01). Serum cystatin C levels rose prior to creatinine concentrations and started to increase over normal range when creatinine clearance remained within normal range. After renal transplantation,cystatin C concentration significantly decreased during the first week(-43% vs -21% for creatinine) in patients without delayed graft function. In some cases of acute renal impairment, the increase in serum cystatin C values was more prominent than that of creatinine.Conclusion:Serum cystatin C is probably more attractive for estimation of renal function than serum creatinine and creatinine clearance especially for detection of the mild reduction of glomerular filtrate rate in patients with various kidney diseases. Serum cystatin C can also be used as an alternative marker of allograft function in adult transplant patients.展开更多
目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是...目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是否达成三连胜结局分为三连胜组(n=73)和非三连胜组(n=38),根据术前和术后24 h估计肾小球滤过率(eGFR)变化分为术后24 h eGFR下降≤10%组(n=85)和术后24 h eGFR下降>10%组(n=26)。分别比较2组患者年龄、性别、美国麻醉医师协会(ASA)评分、体质量指数(BMI)、高血压、糖尿病、术前eGFR、术后24 h eGFR变化百分率、肾门部肿瘤、肿瘤背腹侧位置、肿瘤最大径、手术路径、热缺血时间(WIT)、估计出血量(EBL)、肿瘤病理类型、肿瘤TNM分期、RENAL评分、PADUA评分、中心性指数(C-index)、肾脏肿瘤侵袭指数(RTII)和肿瘤接触面积(CSA)。多因素Logistic回归分析患者达成三连胜和术后24 h eGFR变化下降>10%的影响因素,多元线性回归分析影响患者术后24 h eGFR变化的影响因素。结果:111例患者中共73例患者达成三连胜结局。单因素分析,三连胜组和非三连胜组患者年龄、高血压、肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA和EBL比较差异有统计学意义(P<0.05)。多因素Logistic分析,EBL是RAPN术后患者未达成三连胜结局的独立影响因素(OR=1.006,95%CI=1.001-1.011,P=0.020)。术后24heGFR下降>10%组和术后24 h eGFR下降≤10%组患者肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL和肿瘤TNM分期比较差异有统计学意义(P<0.05)。多因素Logisitc回归分析,RTII是患者术后24 h eGFR下降>10%的独立影响因素(OR=4.442,95%CI=1.049-18.806,P=0.043)。肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL、肿瘤TNM分期与术后eGFR变化无明显关联,RTII与术后24 h eGFR变化呈负相关关系(B=-7.204,95%CI=-14.305--0.102,P=0.047)。结论:EBL是RAPN术后患者未能达成三连胜结局的独立影响因素,RTII与RAPN术后24 h eGFR变化呈负相关关系。展开更多
文摘Introduction: Tc-99m Di-ethylene Tri-amine Penta Acetic Acid (DTPA) renogram is an accepted method to measure Glomerular Filtration Rate (GFR) of the kidneys. The depth and position of ectopic kidneys may vary. This may lead to variation in tissue attenuation and error in the computed GFR and Differential Renal Function (DRF) of each kidney. Objective: The present study was undertaken in patients with ectopic kidneys to improve the accuracy of GFR and DRF calculation in a renogram with single injection of Tc-99m DTPA on a dual head gamma camera. Materials and Method: The study was conducted on 55 patients with ectopic kidneys. Images were acquired on a dual head gamma camera simultaneously in anterior and posterior views. Both anterior and posterior image datasets were used to compute the GFR of the ectopic kidney by Gates method. Depth correction of the ectopic kidney was done using the lateral view image. Total GFR was calculated as the sum of the anterior dataset ectopic kidney GFR and the posterior dataset normal kidney GFR. DRF was calculated again, by using the anterior dataset GFR of the ectopic kidney and posterior dataset for normal kidneys. The total GFR calculated by our method was compared to the patient’s eGFR (based on serum creatinine, age and sex). Result: The GFR calculated by anterior data set in the ectopic kidney was significantly higher than that calculated by posterior dataset (p 0.001). Similarly, the differential GFR of the ectopic kidney was higher when the anterior dataset was used (p 0.001). The ectopic kidney GFR of 34 (61.8%) of the 55 patients was greater than 35 ml/min, whereas in 21 patients (38.2%), it was less than 35 ml/min. The total GFR calculated by using both anterior and posterior data set was compared with the eGFR;the correlation coefficient was 0.74 in patients with ectopic kidney GFR of >35 ml/min and 0.83 in those with Conclusion: The GFR of ectopic kidney as calculated from the anterior data set was significantly higher in comparison to the GFR calculated from the posterior data set (p 0.001). Using the anterior dataset GFR, the DRF values for the ectopic kidneys was also significantly higher (p 0.001). This method improves the accuracy of the GFR and DRF values and helps to differentiate a normally functioning ectopic kidney from a poorly functioning one. Compared to the total GFR as calculated by the present method, the eGFR showed a better correlation in patients with ectopic kidney
文摘Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured by SPECT in 172 patients (192 times) with renal impairment due to various diseases and also in 18 normal controls. The results suggest that GFR and ERPF are sensitive and efficient renal function indicators in monitoring the change of the disease and assessing therapeutic effect. However, they should be checked carefully because of many factors affect the resutls of the measurement.
文摘Objective:To investigate the clinical usefulness in terms of estimation for glomerular filtration rate(GFR), we determined the serum cystatin C levels in 72 healthy adults , 63 children, and 109 patients with various renal diseases, and compared the serum cystatin C concentrations with serum creatinine levels. In addition, the renal function was evaluated in 5 adults receiving renal transplantations using cystatin C.Methods:Serum cystatin C levels were measured by a particle-enhanced nephelometric immunoassay on Dade Behring nephelometer system. Serum and urine creatinine concentrations were determined by use of Jaff’s kinetic assay.Results: The cystatin C concentration at birth was typically double that found in adults, then fell to a constant level after 1 year, a value that was maintained to about 60 years. The studies of cystatin C in the elderly showed that the circulation cystatin C levels rose gradually above 60 years. There was a significant positive correlation between serum cystatin C and creatinine level (r=0.921, P <0.01) in the patients with various renal diseases. Serum cystatin C was inversely and logarithmically correlated with creatinine clearance as shown in the equation lg cystatin C =-0.6061gCCr+1.209(r=-0.887, P <0.01). Serum cystatin C levels rose prior to creatinine concentrations and started to increase over normal range when creatinine clearance remained within normal range. After renal transplantation,cystatin C concentration significantly decreased during the first week(-43% vs -21% for creatinine) in patients without delayed graft function. In some cases of acute renal impairment, the increase in serum cystatin C values was more prominent than that of creatinine.Conclusion:Serum cystatin C is probably more attractive for estimation of renal function than serum creatinine and creatinine clearance especially for detection of the mild reduction of glomerular filtrate rate in patients with various kidney diseases. Serum cystatin C can also be used as an alternative marker of allograft function in adult transplant patients.
文摘目的:探讨机器人辅助下肾癌肾部分切除术(RAPN)后肾细胞癌(RCC)患者肾功能保留和达成三连胜结局的影响因素,为指导术前评估、术后治疗和远期随访提供依据。方法:回顾性分析行机器人辅助下肾部分切除术的111例RCC患者的临床资料,根据是否达成三连胜结局分为三连胜组(n=73)和非三连胜组(n=38),根据术前和术后24 h估计肾小球滤过率(eGFR)变化分为术后24 h eGFR下降≤10%组(n=85)和术后24 h eGFR下降>10%组(n=26)。分别比较2组患者年龄、性别、美国麻醉医师协会(ASA)评分、体质量指数(BMI)、高血压、糖尿病、术前eGFR、术后24 h eGFR变化百分率、肾门部肿瘤、肿瘤背腹侧位置、肿瘤最大径、手术路径、热缺血时间(WIT)、估计出血量(EBL)、肿瘤病理类型、肿瘤TNM分期、RENAL评分、PADUA评分、中心性指数(C-index)、肾脏肿瘤侵袭指数(RTII)和肿瘤接触面积(CSA)。多因素Logistic回归分析患者达成三连胜和术后24 h eGFR变化下降>10%的影响因素,多元线性回归分析影响患者术后24 h eGFR变化的影响因素。结果:111例患者中共73例患者达成三连胜结局。单因素分析,三连胜组和非三连胜组患者年龄、高血压、肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA和EBL比较差异有统计学意义(P<0.05)。多因素Logistic分析,EBL是RAPN术后患者未达成三连胜结局的独立影响因素(OR=1.006,95%CI=1.001-1.011,P=0.020)。术后24heGFR下降>10%组和术后24 h eGFR下降≤10%组患者肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL和肿瘤TNM分期比较差异有统计学意义(P<0.05)。多因素Logisitc回归分析,RTII是患者术后24 h eGFR下降>10%的独立影响因素(OR=4.442,95%CI=1.049-18.806,P=0.043)。肿瘤最大径、RENAL评分、PADUA评分、C-index、RTII、CSA、WIT、EBL、肿瘤TNM分期与术后eGFR变化无明显关联,RTII与术后24 h eGFR变化呈负相关关系(B=-7.204,95%CI=-14.305--0.102,P=0.047)。结论:EBL是RAPN术后患者未能达成三连胜结局的独立影响因素,RTII与RAPN术后24 h eGFR变化呈负相关关系。
