Clinical evaluation of ^99mTc-DTPA renal dynamic scintigraphy and R.E.N.A.L. Scoring System in the Nephron-Sparing Surgery

Objectives: To investigate the application value of 99Tcm-DTPA renal dynamic scitigraphy and R.E.N.A.L. scoring system in the Nephron-sparing Surgery (NSS)

Methods: Patients who underwent 99Tcm-DTPA renal scans before and after Nephron-Sparing Surgery from January 2008 to January 2016 were identified retrospectively. R.E.N.A.L. scoring system based on anatomical imaging was adopted to describe the complexity of renal tumor and then the renal GFR (Glomerular Filtration Rate) was assessed on 99Tcm-DTPA renal scan before and after NSS. Uni-variate and multi-variate linear regression analysis was performed to determine the effectiveness of RENAL and other preoperative clinical variables on postoperative renal functional outcomes with interaction analysis. Associations between scoring systems and changes in GFRs were evaluated using a correlation coefficient

Results: Of the 45 patients, 37 with renal hydronephrosis underwent laparoscopic NSS and 8 underwent open NSS with averaged warm ischemia time of 20.5 min. On multivariate analysis, preoperative GFR and R.E.N.A.L. score were independent predictors of glomerular filtration functional decline of the affected kidney (all P&lt0.001), while only preoperative tumor size and ischemia time were significantly associated with the GFR reduction (all P&gt0.001). Preoperative GFR of patients with renal hydronephrosis was significantly lower than that measured 6 mo after NSS while it declined in patients without hydronephrosis.

Conclusion: Preoperative R.E.N.A.L. scoring and 99Tcm-DTPA renal dynamic scintigraphy could be used for prediction of GFR reduction of the operated kidney Research Support: National Natural Science Foundation of China (NSFC) projects (81301247), the Natural Science Foundation of Jiangsu Province (BK20130082) and the Nanjing Outstanding Youth Fund (JQX14009)