Study Of ^99mTc-DTPA Renal Dynamic Imaging On Compensatory Capacity Of Contralateral Kidney In Patients With Unilateral Hydronephrosis

Objective To investigate the value of ^99mTc-DTPA renal dynamic imaging in pa-tients with unilateral hydronephrosis,and to observe the compensatory function and influencing factors of the contralateral kidney.To better evaluate the renal function of patients with unilateral hydronephrosis,and provide assistance for the selection of clinical treatment options and evaluation of prognosis.Methods Retrospective analysis of 231 patients who underwent unilateral hydro-nephrosis in the Department of Nuclear Medicine of the Second Hospital of Tianjin Medical University?from January 1,2016 to November 26,2018?,recorded as ob-servation group.64 healthy subjects in our hospital were selected and recorded as a control group.All of the above patients underwent abdominal ultrasonography,se-rum renal function tests,and radionuclide renal dynamic imaging within one week.All patients didn't have acute or chronic diseases which affect renal function such as diabetes,hypertension,or tumors.And in a short period of time,it has not used Chi-nese herbal medicines,antibiotics,sulfonamides and iodine-containing contrast agents and other nephrotoxic drugs which may affect kidney function.The gender,age,location of affected kidney,degree of water accumulation,serum creatinine?Scr?,urea nitrogen?BUN?and glomerular filtration rate?GFR?were compared in all observation groups and control groups.According to the abdominal ultrasound im-ages,the patients in the observation group were divided into three groups:a.mild hy-dronephrosis group:no abnormalities in renal morphology,normal renal parenchyma thickness and echo,2³ cm in renal collecting system;b.moderate renal accumula-tion Water group:The kidney volume is slightly increased,the shape is full,the body is slightly thin,the renal column is not clear,the renal pelvis and renal pelvis are ob-viously dilated,the renal collecting system is separated by 3⁴cm;c.severe hydro-nephrosis group:the kidney is increased in volume.Large,morphologically abnormal,substantially thin or not visible,the entire kidney area is a liquid dark area.According to the GFR value of the affected side of the observation group,they were divided into5 groups:a.near-no functional group:GFR<10 ml/min;b.severe injury group:10ml/min?GFR<20 ml/min;c.moderate injury group:20 ml/min?GFR<30 ml/min;d.mild injury group:30 ml/min?GFR<40 ml/min;e.normal group:GFR?40ml/min.According to the patient's age,they were divided into 4 groups:a.youth group:age?30 years old;b.middle-aged group:30 years old<age?40 years old;c.middle-aged group:40 years old<age?50 years old;d.elderly group:age>50 years old.To analyze the compensation situation of the control group,compare the GFR of the healthy side with the normal GFR upper limit of the corresponding age group in the Nuclear Medicine Diagnostic and Therapeutic Specifications,and calculate the GFR compensation rate of the healthy kidney according to the formula:the GFR compensation rate of the healthy kidney?%?=?constant side GFR-normal upper limit GFR?/normal upper limit GFR×100.All the above data were analyzed by SPSS23.0 statistical software.The measurement data and the count data were expressed by?mean±standard deviation?and percentage?%?respectively.The two data were re-spectively subjected to T test and?² test.The measured data of the skewed distribu-tion is represented by the median?interquartile range?and a nonparametric rank sum test is performed.Pearson analysis was used to analyze the correlation between total GFR and age,Scr and BUN in the observation group and the control group.A The difference was considered statistically significant at P<0.05.Results?1?The mean age of the observation group was?55.46±12.18?years old.After radionuclide renal dynamic imaging measured,the GFR of the affected side was?28.46±15.06?ml/min,the GFR of the healthy side was?61.26±15.07?ml/min,and the total GFR was?89.34±22.29?ml/min.The GFR of the affected side was sig-nificantly lower than that of the healthy side GFR?t=23.39,P=0.00?.The mean age of the control group was?57.48±9.57?years old.Measured by radionuclide renal dynamic imaging,the left renal GFR was?52.49±8.02?ml/min,the right renal GFR was?52.14±8.09?ml/min,and the total GFR was?104.62±15.44?ml/min.There was no significant difference between the left kidney and the right kidney?t=0.251,P=0.802?.The total GFR of the control group was significantly higher than that of the observation group?t=6.303,P<0.001?.?2?The Scr values of the observation group and the control group were?88.77±29.29??mol/L and?75.8±19.38??mol/L.The BUN values of the two groups were?6.1±3.60?mmol/L and?5.4±1.25?mmol/L.The Scr and BUN levels in the observation group were higher than those in the control group,and the difference was statistically significant?t=?4,19,P=0.00;t=2.46,P=0.015?.?3?According to statistics,the positive rate of radionuclide renal dynamic imaging results was 79.22%,and the positive rate of blood and kidney func-tion was 16.45%.The positive rate of radionuclide renal dynamic imaging test was higher than that of blood and kidney function test,and the difference was statistically significant??²=11.93,P=0.001?.?4?The total GFR of the observation group was negatively correlated with age,Scr and BUN?r=?0.47,P<0.001;r=?0.42,P=<0.001;r=?0.23,P=0.001?;The total GFR of the patients was negatively corre-lated with age,and had no correlation with Scr and BUN?r=?0.57,P<0.001;r=?0.22,P=0.075;r=?0.17,P=0.170?.?5?The GFR compensation rate of the healthy kidney was as follows:the GFR compensation rate of the healthy kidney in the young,middle-aged,middle-elderly-aged,and elderly groups was 19.19%??2.68%,23.74%?,9.36%??4.89%,17.91%?,5.17%??16.15%,21.28%?and4.03%??10.47%,19.94%?.The GFR compensatory rate of 231 patients in the ob-servation group was 5.93%??11.39%,20.21%?.?6?There was no significant dif-ference in the compensation rate of the healthy kidney between patients of different ages,gender,location of affected kidney and degree of kidney damage??²=3.120,P=0.373;Z=?0.763,P=0.446;Z=?1.831,P=0.067;?²=8.424,P=0.077?.Different levels of water accumulation have an effect on the GFR compensation rate of the healthy kidney??²=16.976,P<0.001?.Conclusions?1?Patients in the observation group had different degrees of reduc-tion in renal GFR or total renal GFR compared with healthy subjects,and their Scr and BUN were also higher than those of control group.?2?The positive rate of radio-nuclide renal dynamic imaging in observation group was significantly higher than that in blood and kidney function.?3?The GFR of the observation group was nega-tively correlated with the age,Scr and BUN of the patients.The GFR of the control group was negatively correlated with the age of the patients,and had no correlation with Scr and BUN.?4?There is obvious compensatory phenomenon in the healthy kidney of patients with unilateral hydronephrosis.The compensatory ability is related to the degree of hydronephrosis.Compensatory ability has no correlation with age,gender,the location of the affected kidney and the degree of kidney damage.?5?Although renal dynamic imaging has important clinical value in the diagnosis and treatment of patients whose suffering unilateral hydronephrosis.In order to compre-hensively evaluate the obstruction and renal function of patients with unilateral hy-dronephrosis,choose the appropriate treatment plan,it is necessary to comprehen-sively evaluate the results of renal dynamic imaging and other related examination results.