Correlation And Clinical Value Of Hydronephrosis With Renal Cortical Atrophy And Histologic Renal Function

Objective: Using CTU imaging technology,the measured cortical hydronephrous nephrolateral renal cortical thickness was compared with the GFR measured by SPECT renal dynamic imaging;the correlation between the two was studied,and the correlation equation was calculated.The use of CTU imaging techniques to measure the renal semi-quantitative early renal function before clinical SPECT renal dynamic imaging examination by measuring the thickness of cortical hydronephrosis renal cortical renal cortex,and for the treatment of hydronephrosis Selecting even the timing of surgery and the formulation of the plan provide a reference.Methods:In this study,a retrospective study was conducted.From June 2016 to March 2018,45 patients diagnosed with hydronephrosis were enrolled in the urology department of the Hospital Affiliated to Yan’an University.A 64-segment CTU was performed on the patient and the stagnant water was measured during the cortex.The mean thickness of renal cortex was measured.Renal dynamic imaging of SPECT was performed within 2 days.Using the ROI technique,the computer calculated the total renal GFR and renal GFR results automatically based on the Gate method.The correlation between cortical hydronephrosis renal cortical thickness and its renal GFR was analyzed.According to the SPECT renal dynamic imaging examination,the measured renal GFR and reference to its imaging characteristics,using the unilateral renal GFR normal value ≥ 34 ml/min,referring to the classification criteria of chronic renal insufficiency,90 kidneys(according to normal GFR≥34 ml/min)were divided into 3 groups: normal group,(GFR≥34 ml/min,34 个),mild renal impairment group(20 ml/min ≤ GFR<34 ml/min,32);renal function was severely affected Damage group(GFR < 20 ml/min,24).The 64-row CTU was used to measure the thickness of the renal cortex in the cortex of the three groups.One-way analysis of variance and two-sample t-test were used to compare the difference in renal cortical thickness between the two groups and whether there was statistical significance between the two groups;Pearson method was used.The correlation between unilateral renal cortical thickness and unilateral renal GFR was analyzed.The correlation between the renal cortical thickness in the cortex hydronephrosis and its subrenal GFR was analyzed.The 64-item CTU examination was used to measure the renal cortical thickness of the cortex hydronephrosis renal function and its clinical value.Results:1.The dialysis stage scan showed that all patients with ureteral obstruction had a diagnosis rate of 100% compared with clinical results including surgery and ureteroscopy.In the 45 patients in this study,obstructive ureters were fully demonstrated in the first single-dose CT urography,and 97% of cases had good continuity.The remaining 3% of patients successfully identified ureteral obstruction after a second CT scan of the voiding period.In 45 patients with urinary calculi,9 cases were diagnosed by CT scan during excretion,6 cases were stones in the middle segment,8 cases were stones in the lower segment,16 cases were kidney stones,and 3 cases were stones with pelvis stones and ureter stones.Eight of them had bilateral renal pelvis or/and ureteral stones.A total of 50 kidneys have hydronephrosis.2.The cortical thickness of the kidney in 90 patients was(0.59 ± 0.08)cm in the normal renal function group,(0.38 ± 0.06)cm in the mildly impaired group,and(0.25 ± 0.06)cm in the severely impaired group,respectively.3.The mean thickness of renal cortex in the normal renal function group,mild renal impairment group and severe renal impairment group were statistically significant(P<0.05).The difference in cortical thickness between each group was also statistically significant.The cortical thickness was compared.The t values of the normal group and mildly impaired renal function group,mildly impaired renal function group,and severely impaired renal function group,normal group,and severely impaired renal function group were 11.59,20.09,and 8.17,respectively.P value was <0.01;P value was 0.00(P<0.05)between the three groups;between the three groups,the P-value of renal cortex between group a and group B was 0.000(P<0.05);The P value of cortical thickness was 0.000(P<0.05);the P value of renal cortex in group a and C was 0.000(P<0.05).4.The coincidence rate of RI and cortical CT enhancement values with GFR(see Table 2): RI> 0.5cm,0.3-0.5cm,<0.3cm were used as criteria for judging renal function status,and were compared with the renal function status GFR(See Table 2).The coincidence rate of the two grouping methods is 86%.5.Correlation between renal cortical thickness and GFR: There was a positive correlation between unilateral GFR and unilateral renal cortical thickness,and the correlation coefficient was r=0.96(P<0.01).The regression equation of unilateral renal GFR to unilateral renal cortical thickness was Y.=140.84x-20.63(t=33.75,P<0.01).Conclusion:1.Urinary tract CT scan + three-dimensional imaging has a high diagnostic value for urinary tract obstruction.2.CTU measurement of enhanced renal cortical thickness from the morphological and anatomical level of the entire urinary tract intuitive understanding of the side of the kidney filtration function can be semi-quantitative response,so for hydronephrosis patients CTU imaging examination Techniques are useful indicators for evaluating kidney function(GFR).3.Excluding age-related factors,when the thickness of the cortical renal cortex became thin,the renal filtration function of the flank was decreased.The thinner the thickness of the renal cortex,the more severe the renal filtration function was.4.The measurement of renal cortical thickness may be more accurate for evaluating renal filtration function.The renal function can be quantitatively analyzed based on the renal cortical thickness through a linear regression equation.5.The SPECT renal dynamic imaging has accurate evaluation of the renal function of the hydronephrosis kidney,and the sensitivity is high.At the same time,the CTU measurement of the renal cortex thickness in the enhanced phase is an effective index to evaluate the single renal function,and is unconditional for the nuclear medicine examination.In primary hospitals or in the early stages of patients with hydronephrosis,the renal glomerular GFR value can be obtained by measuring the thickness of renal cortex and using the linear regression equation,so that the renal function can be assessed semi-quantitatively in the early stage of hydronephrosis diagnosis.The choice of treatment plan or even surgical plan has clinical practical value.