螺旋CT双期增强扫描测定肾小球滤过率

目的 研究螺旋CT双期增强扫描测定肾小球滤过率(GFR)的方法及其准确性,评估UroCARE软件计算GFR的可靠性.方法 选择25例无急性肾功能障碍的成年患者,CT检查包括腹部平扫和双期增强扫描(动脉期、门静脉期),同时在动脉期前与两期之间各插入一组同层动态扫描.应用UroCARE软件计算GFR,以血清半胱氨酸蛋白酶抑制剂C(Cystatin C)测定的GFR作为对照指标.结果 两种方法测定的GFR相关性良好,r=0.799,y=39.0977+0.6083x.结论 螺旋CT双期增强扫描并应用UroCARE软件可以较准确地测定GFR,具有一定的临床应用前景.     

多层螺旋CT扫描对尿路梗阻性疾病的诊断价值

目的 探讨多层螺旋CT扫描对尿路梗阻性疾病的诊断价值.方法 对36例经超声或静脉尿路造影(IVU)检查,肾脏及输尿管显影效果差,不能达到临床诊断要求,未明确梗阻原因者行CT平扫加增强扫描检查.结果 36例均获得明确诊断,其中输尿管结石26例.肾结核、肾脏萎缩、膀胱肿瘤累及输尿管、异位肾、肾盂肿瘤累及盂管处致尿路梗阻、肾脏肿瘤导致肾脏不显影等共10例.结论 对尿路梗阻类疾病,当超声和IVU未能显示梗阻原因,需进一步明确诊断时,行尿路CT平扫加增强检查对判断梗阻部位、梗阻原因、梗阻程度、梗阻部位及邻近关系时CT检查具有很高的价值.     

16层螺旋CT在肾癌术前诊断中的价值

目的 探讨肾癌的16层螺旋CT影像特征.方法 回顾性分析86例经病理证实的肾癌在螺旋CT多期扫描的表现.结果 86例中,多数肾癌突出肾轮廓外,平扫多数表现为低或等密度,少数表现为高密度.增强扫描大多数皮质期明显强化,实质期迅速消退,排泄期病灶呈低密度影.CT分期总的准确率为87.2%.结论 16层螺旋CT扫描能清晰显示肾癌的影像学特征,可为肾癌诊断和分期、指导手术方案制定及估计患者预后等各方面提供可靠依据.     

多层螺旋CT增强扫描对慢性肾盂肾炎的诊断价值

目的：探讨多层螺旋CT增强扫描在诊断慢性肾盂肾炎的应用价值。方法：回顾分析16例慢性肾盂肾炎患者的螺旋CT增强扫描图像。结果：本组16例中肾盂积水扩张10例,占62.5%;肾盂壁增厚、强化8例,占50.0%;肾盏变形10例,占62.5%;肾盏裸露征9例,占56.3%;肾实质凹陷征16例,占100.0%;肾功能减退13例,占81.3%;肾盂肾盏结石5例,占31.3%。肾盂肾盏形态改变、肾实质凹陷征、肾盏裸露征、肾功能减退和肾盂积水,肾盂壁增厚是慢性肾盂肾炎的特征性的CT表现。结论：多层螺旋CT增强扫描能准确显示慢性肾盂肾炎的影像特征,为临床的诊断和治疗提供依据。     

螺旋CT动态增强扫描在肾细胞癌亚型鉴别中的应用

目的评价螺旋CT动态增强扫描对肾细胞癌(RCC)亚型中的鉴别意义。方法选取该院2010年9月至2015年1月收治的RCC患者66例,其中肾透明细胞癌(CCRCC)42例,乳头状肾细胞癌(PRCC)19例,肾嫌色细胞癌(CRCC)5例,分别行CT平扫和二期增强扫描,测量肿瘤、邻近正常肾实质CT值,并计算相应的相对强度,比较不同亚型各期CT值和相对强度。结果平扫期,PRCC的CT值显著高于CCRCC及CRCC,皮髓期、实质期CCRCC的CT值显著高于CRCC及PRCC,差异有统计学意义。但PRCC及CRCC在皮髓期、实质期的CT值比较差异无统计学意义。结论螺旋CT增强扫描对RCC病理亚型的鉴别诊断有重要价值,尤其是鉴别CCRCC,对于PRCC及CRCC的鉴别有待进一步研究。     

99mTc-DTPA肾动态显像评价急、慢性肾功能衰竭

目的 探讨99mTc-DTPA肾动态显像对急、慢性肾功能衰竭患者评价.方法 采用99mTc-DTPA肾动态显像,应用Gates法计算急性肾功能衰竭11例、慢性肾功能衰竭14例.在设定全肾ROI及肾皮质ROI时的GFR值,均采用99mTc-DTPA肾动态显像,分别测两组肾脏与腹主动脉的平均放射性计数比值(K/A)、功能相肾脏摄取高峰值(KP)、肾小球滤过率(GFR).结果 经统计学分析两组间K/A、KP、GFR等各参数均有显著差异(P＜0.05).结论 由肾皮质ROI计算GFR值可更灵敏、更准确地反映急、慢性肾功能衰竭患者肾功能改变.     

~(99)Tc~m-DTPA肾动态显像肾小球滤过率的临床应用

目的探讨放射性核素99Tcm-DTPA肾动态显像肾小球滤过率对上尿路结石患者诊断和治疗的临床应用价值。方法收集平顶山第二人民医院2006年1月至2010年12月间上尿路结石患者60例,患病肾脏共71个,对患者进行99Tcm-DTPA肾动态显像,计算患肾的肾小球滤过率(GFR)。结果 99Tcm-DTPA肾动态显像共提示上尿路梗阻或不完全梗阻肾脏67个,诊断阳性率为94.4%(67/71),解除梗阻后3个月时对患者进行随访,解除梗阻前肾功能差者其GFR恢复差。结论上尿路结石患者及时进行99Tcm-DTPA肾动态显像,能及时通过肾小球滤过率了解患肾功能,便于及时采取有效措施保护患肾功能。     

急性上尿路梗阻性肾及肾周的多层螺旋CT研究

目的：研究各种原因所致上尿路梗阻时肾及肾周间隙的CT表现。方法对21例上尿路梗时肾脏及肾周间隙异常影像学多层螺旋CT表现进行观察和分析。结果患者主要表现为肾被膜增厚、肾边界毛糙、肾脂肪囊内絮状及斑片状高密度影、肾筋膜增厚。结论急性上尿路梗阻及慢性梗阻急性发作严重梗阻时，除发现结石、肿瘤、狭窄、肾盂及输尿管扩张积水等直接征象外，肾脏及肾周间隙在多层螺旋CT下间接征象可作为其有力补充。     

多层螺旋CT对成人型多囊肾体积测量的价值

目的探讨采用多层螺旋CT对成人型多囊肾进行体积测量的诊断价值。方法对收治的16例APKD患者的CT图像进行分析,并对每位患者两侧肾脏三条最大径线的长度进行测量,采用多田公式:体积=1/6π×a(长径)×b(宽径)×m(层厚)×c(层数)计算出肾脏的体积(近似值)。同时随机选取16例健康成人的肾脏测量体积作为对照组,比较两组之间肾脏体积的差异,分析肾脏体积大小与肾功能指标之间是否存在相关性。结果 16例APKD患者的CT图像呈现出复杂的伴随征象,肾脏体积与健康成人比较明显增大,差异有统计学意义(P<0.05);肾脏的体积大小与肾脏功能的指标之间成负相关。结论多层螺旋CT能可靠地对肾脏进行体积测量,并能够对成人型多囊肾及其伴随征象作出较准确的诊断。     

磁共振扩散成像在尿路梗阻后肾功能评价中的应用

目的:探讨磁共振弥散加权成像技术在尿路梗阻-肾脏积水肾脏功能评价中的价值。方法:对10名健康志愿者(对照组)和临床申请MRU检查的19例患者进行研究,先行常规磁共振T1WI和T2WI扫描,随后进行磁共振弥散加权成像,最后进行增强扫描。对双肾ADC值测量,对病肾肾实质厚度进行测量,对数据进行统计学分析。结果:肾积水患者梗阻侧肾脏各个b值下的ADC值均低于对侧,也均低于正常对照组;肾积水患者梗阻对侧肾脏各个b值下的ADC值与正常对照组各b值下的ADC值经统计学分析差异无显著性;梗阻侧肾实质厚度与其所测ADC值呈线性相关,且相关关系较为密切。结论:磁共振弥散加权成像可以通过测量ADC值来反映肾积水后病肾的功能情况,其技术的进一步完善有望对临床治疗方案的选择提供较为可靠的帮助。     

Angiotensin II type 1 receptor blockade prevents decrease in adult stem-like cells in kidney after ureteral obstruction

Infusion of renal side population (SP) cells, enriched with adult stem-like cells, can ameliorate acute renal failure. We investigated the effects of an angiotensin II type 1 (AT(1)) receptor antagonist, valsartan on SP cell changes in renal injury by ureteral obstruction. Renal SP fraction was reduced by 38%, and the number of cells expressing CD45, a marker of hematopoietic system, in renal SP cells was increased in obstructed kidneys. Valsartan attenuated renal injury and the associated SP profile changes. Angiotensin AT(1) receptor blockade may exert regenerative effect by preserving adult stem-like cells such as SP cells in the kidney.     

Renal oxygen delivery: matching delivery to metabolic demand

The kidneys are second only to the heart in terms of O2 consumption; however, relative to other organs, the kidneys receive a very high blood flow and oxygen extraction in the healthy kidney is low. Despite low arterial-venous O2 extraction, the kidneys are particularly susceptible to hypoxic injury and much interest surrounds the role of renal hypoxia in the development and progression of both acute and chronic renal disease. Numerous regulatory mechanisms have been identified that act to maintain renal parenchymal oxygenation within homeostatic limits in the in vivo kidney. However, the processes by which many of these mechanisms act to modulate renal oxygenation and the factors that influence these processes remain poorly understood. A number of such mechanisms specific to the kidney are reviewed herein, including the relationship between renal blood flow and O2 consumption, pre- and post-glomerular arterial-venous O2 shunting, tubulovascular cross-talk, the differential control of regional kidney blood flow and the tubuloglomerular feedback mechanism. The roles of these mechanisms in the control of renal oxygenation, as well as how dysfunction of these mechanisms may lead to renal hypoxia, are discussed.     

Effects of acute exposures to gentamicin on renal handling of proteins

The polycationic aminoglycoside gentamicin has been reported to compete with other aminoglycosides and cationic compounds for uptake into renal tubular cells at brush border membranes and during subsequent endocytosis. Gentamicin has also been reported to decrease the activity of lysosomal proteolytic enzymes in the rat kidney.In vivo and in vitro experiments were carried out to determine the effect of acute exposure to gentamicine on renal handling of the cationic low molecular weight protein, lysozyme. Thirty or 60 mg/kg of gentamicin was given to male Wistar rats (250–300 g) intravenously or isolated rat kidneys were perfused with gentamicin concentrations of 0.25, 0.50, 1.0 and 2.5 mg/ml. Subsequently, clearances of lysozyme (C_LY) and inulin (GFR, glomerular filtration rate) were measured in the intact rat and in the isolated perfused rat kidney. The glomerular sieving coefficient of lysozyme was determined in control and gentamicin perfused kidneys after complete inhibition of tubular lysozyme reabsorption by sodium iodoacetate. Renal degradation of ¹²⁵I-labelled lysozyme was quantified in control and gentamicin perfused kidneys by measuring the release [¹²⁵I] monoiodotyrosine to the perfusate.The glomerular sieving coefficient of lysozyme increased in kidneys perfused with gentamicin from a control value of 0.8-1.0. A dose-dependent increase of the ratio C_LY/GFR in intact rats treated with gentamicin and dose-dependent decrease of percentage reabsorption of lysozyme in the isolated perfused kidneys demonstrate inhibition of renal reabsorption of lysozyme by gentamicin. Perfusion of kidneys with 0.25 mg/ml gentamicin reduced renal degradation of lysozyme to about 50% after 2h perfusion; at gentamicin concentrations of 0.5 mg/ml and higher almost all degradation of lysozyme was inhibited.Thus acute exposure to gentamicin causes impairment of filtration, tubular reabsorption and catabolism of the protein lysozyme, effects which are due to pharmacological interactions between the molecules of the 2 cations gentamicin and lysozyme.     

慢性肾衰竭与血浆胃泌素、胃动素的相关性分析

目的 探讨慢性肾衰竭与血浆胃泌素、胃动素的相关性.方法 选择本院2013年1～12月收治的90例慢性肾衰竭患者与9例正常健康者,以肾小球滤过率分组并与血浆胃泌素、胃动素进行相关性统计分析.结果 慢性肾衰竭组测定的血浆胃泌素、胃动素的指标均高于对照组;慢性肾衰竭五组的胃泌素与对照组比较差异有统计学意义（P＜0.01）;除GFR3、GFR4组胃动素与对照组比较差异有统计学意义（P＜0.01）,其余3组胃动素均差异无统计学意义（P＞0.05）;GFR1、GFR2、GFR3、GFR4、GFR5组及对照组的GFR与胃泌素呈正相关;GFR1、GFR2、GFR5组及对照组的GFR与胃动素呈正相关,GFR3、GFR4组的GFR与胃动素呈负相关.结论 肾脏损害可能会导致胃泌素和胃动素的升高,但是并不能证明胃泌素和胃动素的升高就是肾脏损害的严重征兆,胃泌素和胃动素是消化道疾病的测定指标,可以衡量消化系统功能的损害程度,虽然它们的分泌与肾脏损害有一定程度的相关性,但不能单纯用胃泌素与胃动素的测定指标来衡量肾脏实质的损伤.     

螺旋CT在小肾癌诊断中的临床应用

目的：评价螺旋CT多期扫描在小肾癌诊断中的价值。方法：分析20例小肾癌的螺旋CT表现及其病理基础。结果：小实性肾癌17例，增强扫描皮质期13例呈明显强化，4例呈轻中度强化；小囊性肾癌3例，增强后皮质期囊壁、壁结节、囊内分隔明显强化。实质期及肾孟期强化迅速减退，呈“快进快退”改变。病理上所有病例血窦丰富(3例小囊性肾癌囊变明显，但实性部分血窦丰富)。结论：螺旋CT多期扫描在小肾癌的诊断中较常规CT有明显优越性；多数小肾癌皮质期强化明显、实质期强化迅速减退，呈“快进快退”表现，这一强化形式有定性意义；皮质期扫描应纳入小肾癌CT检查的常规步骤。     

Renal interaction between itraconazole and cimetidine

Renal drug interactions can result from competitive inhibition between drugs that undergo extensive renal tubular secretion by transporters such as P-glycoprotein (P-gp). The purpose of this study was to evaluate the effect of itraconazole, a known P-gp inhibitor, on the renal tubular secretion of cimetidine in healthy volunteers who received intravenous cimetidine alone and following 3 days of oral itraconazole (400 mg/day) administration. Glomerular filtration rate (GFR) was measured continuously during each study visit using iothalamate clearance. Iothalamate, cimetidine, and itraconazole concentrations in plasma and urine were determined using high-performance liquid chromatography/ultraviolet (HPLC/UV) methods. Renal tubular secretion (CL(sec)) of cimetidine was calculated as the difference between renal clearance (CL(r)) and GFR (CL(ioth)) on days 1 and 5. Cimetidine pharmacokinetic estimates were obtained for total clearance (CL(T)), volume of distribution (Vd), elimination rate constant (K(el)), area under the plasma concentration-time curve (AUC(0-240 min)), and average plasma concentration (Cp(ave)) before and after itraconazole administration. Plasma itraconazole concentrations following oral dosing ranged from 0.41 to 0.92 microg/mL. The cimetidine AUC(0-240 min) increased by 25% (p < 0.01) following itraconazole administration. The GFR and Vd remained unchanged, but significant reductions in CL(T) (655 vs. 486 mL/min, p < 0.001) and CL(sec) (410 vs. 311 mL/min, p = 0.001) were observed. The increased systemic exposure of cimetidine during coadministration with itraconazole was likely due to inhibition of P-gp-mediated renal tubular secretion. Further evaluation of renal P-gp-modulating drugs such as itraconazole that may alter the renal excretion of coadministered drugs is warranted.     

肾囊性病变100例的影像学诊断分析

目的探讨影像学对肾囊性病变的诊断和鉴别诊断的价值。方法回顾性分析100例部分经皮穿刺抽吸证实或手术证实的肾囊性病变影像学资料（CT/MRI）。结果肾实质囊肿90例,肾盂旁囊肿6例,囊性肾癌3例,肾盏憩室1例。结论认识各种肾囊性病变的影像学表现,有利于诊断和鉴别诊断,对肾囊性病变的临床治疗具有指导意义。     

RENAL EXTRACTION OF ATRIAL NATRIURETIC PEPTIDE IN UNILATERAL RENAL ARTERY STENOSIS

1. Elevated peripheral atrial natriuretic peptide (ANP) levels were observed in 12 patients with unilateral renal artery stenosis (U-RAS). 2. Renal extraction of ANP was higher across the affected than the unaffected kidney in U-RAS, provided the glomerular filtration rate in the affected kidney was not severely reduced (> 12 mL/min). As ANP is a high clearance compound, reduced flow on the affected side may result in increased renal extraction of ANP. 3. When glomerular filtration rate (GFR) in the affected kidney was severely reduced (<12 mL/min), renal extraction of ANP was also reduced, possibly contributing to increased circulating ANP levels in this subgroup. 4. Overall, renal extraction of ANP was inversely correlated to peripheral ANP levels in patients with U-RAS. This might be explained by progressive sodium retention as GFR falls leading to volume expansion and increased ANP secretion.     

Effects of gentamicin on the recovery of renal function after unilateral hydronephrosis

BACKGROUND: Urinary tract infection is a complication of hydronephrosis and antibiotics such as gentamicin are indicated for treatment. However, gentamicin can cause drug-induced nephropathy in dehydrated patients. We used a rat kidney model to investigate the effects of gentamicin administration on functional recovery from unilateral hydronephrosis. MATERIALS AND METHODS: Gentamicin was intraperitoneally injected twice for 48 hours following the release of a unilateral ureteral obstruction. The function of both kidneys was separately quantified by Technetium-99mDMSA renoscintigraphy. We examined morphological changes in renal tubular cells by electron microscopy and by in situ DNA 3'-end labeling. RESULTS: Renal function in the contralateral, but not the obstructed, kidney was significantly damaged by gentamicin administration under our conditions and electron microscopy confirmed the presence of myeloid bodies in renal tubular cells. In situ DNA 3'-end labeling revealed characteristic damage to the renal tubules. CONCLUSION: These results suggest that damage to each kidney should be considered individually after gentamicin administration during recovery from hydronephrosis.     

Preventive effects and mechanisms of rhein on renal interstitial fibrosis in obstructive nephropathy

Renal interstitial fibrosis is a common outcome of a variety of chronic renal diseases. Here we evaluated the therapeutic efficacy of rhein on renal interstitial fibrosis induced by unilateral ureteral obstruction (UUO) and investigated the potential mechanisms. Mice underwent UUO, followed by orally administrated rhein (150 mg/kg/d) or control vehicle. Renal interstitial injury and the degree of fibrosis were evaluated by pathological staining and Western blot. The possible mechanisms were studied by Western blot, indirect immune-fluorescence and enzyme-linked immunosorbent assay. Our results showed that rhein therapy markedly ameliorated renal interstitial fibrotic lesions, reduced α-smooth muscle actin (α-SMA) expression, attenuated deposition of fibronectin (FN). Rhein also suppressed transforming growth factor-β1 (TGF-β1) and its type I receptor expression in obstructed kidneys. In vitro, rhein abolished the α-SMA and fibronectin expression of rat kidney interstitial fibroblasts cells (NRK-49F) induced by TGF-β1. These observations strongly suggest that rhein is a potent inhibitor of renal interstitial fibrosis, and its therapeutic mechanism is, at least in part, blocking interstitial fibroblasts cells activation.