Abstract
251
Objectives: To evaluate renal function before and after interventional treatment of unilateral hydronephrosis with 99mTc-DTPA radionuclide dynamic imaging and a dual-plasma sample method GFR assay for guiding the selection of clinical treatment options and follow-up.
Methods: 80 patients with unilateral total obstructive hydronephrosis of the upper urinary tract were retrospective included in our hospital. Each pateintreceived interventional treatment to remove the obstruction. All patients were subjected to dynamic renal imaging of 99mTc-DTPA before and after treatment to obtain a dual-kidney renogram and determine GFR by Gates method (gGFR). In addition, a dual-plasma sample method was used determine GFR (dGFR) for each patient. The 80 patients were divided into 4 groups according to the dGFR of the affected kidney before interventional therapy based on the renal ratio of renogram: mild group GFR≥30 ml/(min.1.73 m2)(n=28), moderate group 30>GFR≥15 ml/(min.1.73m2) (n=12), severe group 15>GFR≥7.5 ml/(min.1.73 m2)(n=24); extremely severe group GFR <7.5 ml/(min.1.73 m2)(n=16). Dynamic renal imaging and dGFR were reexamined at 2-3 months after the operation to analyze the renal GFR before and after the interventional treatment and evaluate the efficacy.
Results: 1. In the mild group, preoperative dGFR was (35.30±3.55) ml/(min·1.73m2) and postoperative was (41.00±4.78) ml/(min·1.73m2), the difference was statistically significant (P <0.05). Whereas preoperative gGFR (38.94±11.78) ml/ (min·1.73m2) and postoperative (47.58±10.11) ml/(min·1.73m2) was not statistically significant (P >0.05). 2. The dGFR of patients in the middle, severe and extremely severe groups were (25.60±2.74), (14.90±2.89) and (6.50±2.67) ml/(min.1.73 m2)before operation and (20.00±0.79), (18.00±5.06) and (9.16±3.15) ml/ (min·1.73m2) after operation, there were not significant difference (P > 0.05, respectively). 3. In the renal dynamic gGFR, the gGFR of the mild, middle, severe and extremely severe groups were (38.94±11.78), (32.56±3.66), (18.05±8.12) and (7.50±4.23) ml/(min·1.73m2) before operation, and (47.58±10.11), (25.61±8.93), (21.06±7.42) and (9.39±2.35) ml/ (min·1.73m2) after operation, there were not significant difference (P > 0.05, respectively). 4. By Wilcoxon symbol rank sum test, comparison of dGFR and gGFR methods in 80 patients before and after interventional treatment of unilateral hydronephrosis, the difference was statistically significant (preoperative, P<0.05; postoperative, P<0.05).
Conclusions: For patients with unilateral obstructive hydronephrosis of the complete upper urinary tract, the dual-plasma sample method combined with renogram is suitable for GFR determination, while the Gates method of renal dynamic imaging has certain limitations. It is of certain value for interventional surgery for patients with unilateral mild hydrops, but of limited value for patients with moderate or above.