Comparison of clinical value of dynamic contrast-enhanced MRI and SPECT renal dynamic imaging of GFR measurement in the evaluation of renal function in renal transplantation

Objective:To compare the clinical value of dynamic contrast-enhanced MRI(DCE-MRI)and single-photon emission computed tomography(SPECT)renal dynamic imaging in the measurement of glomerular filtration rate(GFR)in the evaluation of renal function in renal transplantation.Methods:A total of 70 recipients who underwent renal transplantation in Baogang Hospital of Inner Mongolia from April of 2015 to April of 2018 were selected as research objects.GFR was measured in renal transplant recipients by use of DCE-MRI and SPECT(GFR-MRI and GFR-SPECT respectively),and was compared with creatinine clearance rate(Ccr).The safety of contrast media was evaluated in DCE-MRI detection.Results:The bias of GFR-MRI against Ccr value was higher than that of GFR-SPECT against Ccr value,with 30%and 50%accuracy of GFR-MRI higher than that of GFR-SPECT,and the difference was statistically significant(p<.05).Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated to Ccr(p<.05),and the correlation coefficient of GFR-MRI and Ccr was higher than that of GFR-SPECT and Ccr,with the difference statistically significant(p<.05).By Bland-Altman analysis,95%confidence interval of GFR-SPECT was 95.49 ml/(min·1.73 m^(2)),and 95%confidence interval of GFR-MRI was 62.35 ml/(min·1.73m^(2)),which was much narrower.Only 2 cases of patients developed mild rash among 70 cases of patients,and recovered spontaneously without any treatment.Conclusions:Compared with SPECT,the bias of GFR measured by DCE-MRI against Ccr is much greater.However,DCE-MRI has a higher accuracy,correlation and consistency in comparison with Ccr,and it has a narrower confidence interval.DCE-MRI can more accurately evaluate renal function in renal transplantation by measuring GFR,and it has a high safety.

Emergency department management of an occult renal laceration following a minor fall

We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.

Establishing the presence or absence of chronic kidney disease:Uses and limitations of formulas estimating the glomerular filtration rate

The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.

Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children

Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.

Relationship between Serum Uric Acid Levels and Kidney Arteriole Resistance in Patients with Type 2 Diabetes Associated with Hypertension

Objectives To investigate the relationship between serum uric acid levels and arteriole resistance detected with the color Doppler energy imaging (CDEI) and to explore the risks of impaired regulation of vascular tone by uric acid in kidneys of hypertension patients. Methods In 12 healthy control cases, 28 non-diabetic hypertension (nNIDDM +H) cases and 25 type 2 diabetic hypertension (NIDDM+H) cases, uric acid (UA) levels were measured with uricase-peroxidase method. Arteriole resistance index (RI) and pulsate index (PI) in separate sections of renal artery included MAR, SRA, IRA were detected using CDEI with 2.1~4.2 Hz Doppler transducer in kidneys. Results In comparison, UA was significantly higher in non-diabetic hyper- tension group and diabetic hypertension group than in control group (P<0.01, separately). UA levels was also significantly higher in NIDDM+H group than in nNIDDM+H, P < 0.029. RI in separate sections of renal artery was significantly higher in nNIDDM+H, or NIDDM+H group than in control group ( all P < 0.01) , and it was significantly higher in NIDDM +H than nNIDDM+H groups (P < 0.05 and P < 0.01). In nNIDDM +H and NIDDM +H groups UA levels and IRA-RI could be elevated significantly following with the impaired heart function being aggravated (χ2 = 13.028, P=0.005, χ2=13.29, P=0.004); the dosage of HCT being increased (χ2 =14.216, P=0.001, χ2 = 14.661, P=0.001); the levels of GHbA1 being excessed unnormally (P=0.000). The correlation between UA and IRA-RI in both hypertension groups were directly related, in nNIDDM+H group r=0.842, P=0.000, in NIDDM+H group, r=0.797, P=0.000. Conclusions Uric acid levels and IRA-RI in hyper-tension patients were directly related. Uric acid levels and IRA-RI could be partly dependent on the severity of heart dysfunction, diuretic dose, and serum glucose status of diabete patients in long-term. Uric acid and the xanthine oxidase metabolic pathway may contribute to impaired regulation of arteriole tone in hypertension patients.