Application Of Radionuclide Renal Dynamic Imaging Combined With Double Plasma Method In Evaluation Of Split Renal GFR In Interventional Treatment Of Unilateral Hydronephrosis

Objective:To explore the value of ⁹⁹Tc^m-diethylenetriamine pentaacetic acid(⁹⁹Tc^m-DTPA)radionuclide renal dynamic imaging combined with double plasma glomerular filtration rate（GFR）in the evaluation of split renal function in adult patients with interventional therapy of unilateral hydronephrosis.Methods:A total of 79 patients with unilateral upper urinary tract obstructive hydronephrosis confirmed by imaging were retrospectively analyzed.All patients underwent ⁹⁹Tc^m-DTPA renal dynamic imaging before and after surgery to obtain bilateral nephrogram andGFR measured by Gates′method（marked as gGFR）,while GFR measured by double plasma method（marked as dGFR）.Based on the kidney ratio of renogram,79 patients were divided into three groups according to the dGFR of the affected kidney before interventional therapy:mild to moderate group（n=34）,with 40>dGFR≥20 ml·min^-1·1.73m^-2;severe group（n=24）,with 20>dGFR≥10 ml·min^-1·1.73m^-2;and extremely severe group（n=21）,with dGFR<10 ml·min^-1·1.73m^-2.Postoperative reexamination of renal dynamic imaging and dGFR,analysis of renal GFR recovery value（?gGFR,?dGFR）and curative effect after interventional operation.The data were analyzed by χ² test,paired sample t-test,one-way ANOVA,Pearson correlation analysis and Bland-Altman consistency test.Results:1.In the mild to moderate and extremely severe group,there were statistically significant difference in GFR between the Gates′method and the double plasma method after operation（Gates′method t:2.656,2.544;double plasma method t:2.418,3.335;all P value<0.05）;There was no significant difference between the two methods in the severe group after operation（Gates′method t:1.243;double plasma method t:1.270,all P value>0.05）.2.The recovery values of renal function in the three groups were gGFR（3.33±9.51）,（2.21±8.70）,（3.94±7.09）ml·min^-1·1.73m^-2,and the recovery values of renal dGFR were（3.07±7.41）,（2.08±8.03）,（3.82±5.25）ml·min^-1·1.73m^-2,respectively.There was no significant difference among the three groups（F:0.445,0.341,both P value>0.05）.Improvement was defined as a greater than 5%increase of the basal value,and the improvement rates of the three groups were 35.3%（12/34）、33.3%（8/24）、47.6%（10/21）,respectively,and the difference was not statistically significant（P value>0.05）.3.The results of correlation and consistency analysis showed that there was a good correlation between the two methods of GFR before and after operation in each group（pre-operation:r=0.628,0.675,0.819;post-operation:r=0.797,0.901,0.912,P value<0.0l）.The results of GFR measured by the two methods in mild to moderate and severe groups were not consistent,while those in extremely severe groups were better.4.The patients were divided into 3 groups according to the postoperative review time,the postoperative GFR recovery value and improvement rate were not statistically significant（F:0.563、2.322;χ²:2.092,P value>0.05）.Conclusion:1.Preoperative status of impaired renal function in patients with unilateral hydronephrosis cannot predict the recovery of postoperative renal function alone.2.Evaluation of renal GFR in patients with unilateral upper urinary tract obstructive hydronephrosis.Gates′method underestimatedGFR overall,and dual plasma method combined with renal dynamic imaging was more appropriate to determine renal function.3.The Gates′method has some limitations compared with the double plasma method for the determination of GFR,but it can be recommended for the evaluation of GFR before and after interventional operation in patients with extremely severe hydronephrosis and impaired renal function.