High renal activity on bone scintigrams. A sign of hypercalcaemia?

Various abnormalities of the renal tract can be detected from the renal images seen on 99Tcm methylene diphosphonate (MDP) bone scintigrams. Diffusely increased renal parenchymal activity has been associated with cytotoxic and other drug therapy, radiation nephritis, iron overload and cirrhosis. A further association--with hypercalcaemia--is reported here. In a retrospective study, 1950 bone scintigrams were reviewed and a significant relationship between high renal activity and hypercalcaemia was found. This was subsequently confirmed by a small prospective study. None of the patients whose bone scintigrams showed this association had evidence of nephrocalcinosis on X rays. It is postulated that in these hypercalcaemic patients there may be high tissue calcium in the kidneys which results in the high uptake of MDP, and it is suggested that serum calcium be measured in patients with previously unsuspected hypercalcaemia whose bone scintigrams exhibit the finding of high parenchymal renal activity.     

CT demonstration of hyperdense renal carcinoma

Sharply demarcated homogeneously hyperdense renal lesions have been found to be benign renal cysts, with hemorrhage or a high protein content the most common etiology of the high density. A similar hyperdense renal lesion is presented that was found to be a renal adenocarcinoma. This lesion showed mild contrast enhancement on CT and was found by ultrasound to be a solid mass. The malignant nature of this lesion suggests that further evaluation, such as ultrasound, fine needle aspiration biopsy, or surgery may be needed.     

Renal transplant hypertension caused by iliac artery stenosis.

A captopril renal study performed with both radiohippuran and 99mTc-MAG3 demonstrated the typical changes of a hemodynamically significant renal artery stenosis in a hypertensive renal allograft recipient. Arteriography demonstrated high grade stenosis not of the renal artery but of the iliac artery. After successful angioplasty, the patient's hypertension resolved.     

High-dose renal pharmacoangiography in the assessment of hypovascular renal neoplasms.

From 6% to 25% of primary renal carcinomas are either hypovascular or avascular and are the major source of false negative angiography. High-dose renal pharmacoangiography, a valuable adjunct to conventional angiography, combines a renal vasodilator, acetylcholine, with a high dose of contrast medium. High-dose renal pharmacoangiography improves the diagnosis of hypovascular mass by enhancement of tumor vessels, increase of tumor stain, and better opacification of main and collateral renal veins. During a 4 year period, 20 hypovascular renal neoplasms were studied and successfully diagnosed preoperatively by this method.     

The specificity of renal vein thrombosis.

Clinical and roentgenographic features of renal vein thrombosis are discussed. The authors' experience with 17 cases is presented. The roentgenologist with a high degree of suspicion can, by correlation of clinical and urographic findings, make the specific diagnosis of renal vein thrombosis in a high percentage of cases.     

MR imaging of acute renal cortical necrosis. A case report.

MR imaging of a patient with acute renal cortical necrosis secondary to massive bleeding following an abortion is presented. The kidneys were enlarged with a high signal intensity observed in the renal cortex on both T1- and T2-weighted images. Follow-up MR imaging showed thinned renal cortex of low signal intensity on both pulse sequences representing renal cortical calcification which was confirmed on conventional radiography and CT.     

髓质海绵肾的影像学诊断

目的　结合文献复习进一步探讨髓质海绵肾各种影像学检查方法的临床应用价值。方法　回顾分析了 11例髓质海绵肾腹部平片 ( 1例 )、静脉肾盂造影 (IVP) ( 2例 )、B超 ( 3例 )及CT( 9例 )表现。结果　X线平片 1例 1肾见肾乳头、髓质区成簇排列的圆形、椭圆形高密度影。IVP 2例 3肾显示收集管呈线状、刷子状、囊状扩张。B超 3例 5肾见肾髓质内有散在密丛状排列的强回声光点 ,后方伴有声影 ,2例 3肾集合管呈囊样扩张。CT 9例 16肾有沿肾髓质分布的海绵肾结石 ,3例 5肾增强CT扫描后见结石被造影剂覆盖 ,同时有增强的条纹状高密度影从乳头伸向髓质。结论　平片、IVP、B超、CT均可用于诊断髓质海绵肾 ,X线平片、IVP仍是首选检查方法 ,IVP对集合管的扩张显示较为特异、直观 ,B超特别是CT对海绵肾结石显示率高 ,对集合管的扩张也能做出一定评价     

频谱多普勒技术在慢性肾功能损害定量分析中的意义

目的 研究主肾动脉峰值血流速度及阻力指数在慢性肾功能衰竭病人中的变化规律。方法 采集52例104个肾数不同病程的慢性肾功能衰竭病例，与155例310个正常肾数样本，利用彩色多普勒血流显像里的频谱多普勒技术，于二维灰阶B超显像的基础上加彩，在清晰显示主肾动脉血流时采样，测量主肾动脉的血流参数。结果 肾功能代偿期主肾动脉呈高速低阻频谱与正常主肾动脉血流参数接近；肾功能衰竭期呈低速高阻频谱。主肾动脉峰值血流速度随肾功能损害程度加重而减慢，阻力指数随肾功能损害程度加重而升高。结论 频谱多普勒技术能较定量地反映慢性肾病肾功能损害的程度，客观地分析病变进展的情况，为临床诊治提供帮助。     

输尿管结石肾绞痛期行体外冲击波碎石术并发肾内感染的探讨

 目的 探讨输尿管结石患者行体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)并发肾内感染的相关因素.方法 选择2006-06至2009-06于我院行ESWL的输尿管结石278例,根据行ESWL前是否有肾绞痛分为绞痛组128例及非绞痛组150例.对两组行ESWL后发生肾内感染的情况进行比较.结果 绞痛组行ESWL后发生肾内感染率与非绞痛组比较,差异有统计学意义(P<0.01);绞痛组中、下段结石与上段及中段结石行ESWL后发生肾内感染率相比差异有统计学意义(P=0.02).结论 行ESWL前有肾绞痛的输尿管结石患者术后并发肾内感染率高.输尿管下段结石的肾绞痛患者行ESWL后发生肾内感染率较高.     

肾损伤的螺旋CT诊断分级方法及临床意义

目的 探讨肾损伤严重程度的螺旋CT诊断分级方法及其临床指导意义.方法 回顾性分析46例肾损伤CT表现及临床资料.结果 肾挫伤:肾包膜下血肿、肾表浅裂伤15例(33％),肾内小血肿9例(20％),共24例;肾轻度裂伤:肾撕裂伤(未累及集合系统)、肾周血肿9例(20％);肾全层裂伤:肾深度撕裂伤(累及集合系统)5例(11％)、肾碎裂8例(17％),其中合并肾蒂伤1例(2％),共13例.结论 螺旋CT检查具有快速、分类准确率高、无创等特点,可为肾损伤的诊断提供直观的形态学依据,且能提示是否有合并伤,对肾损伤的诊断有着十分重要,对其临床治疗方案及预后具有重要意义.     

The pre-operative diagnosis of renal hamartoma.

The characteristic angiographic findings in renal hamartoma consist of: a large dilated feeding vessel passing through the mass, multiple multisacculated aneurvsmal dilatations (bunch of grapes), a delicate discrete discrete neovascularity without A-V shunting, and 'onion peeling' on the venous phase. In addition radiolucent areas within the renal mass indicate a high fat content. When these findings are present renal hamartoma can be diagnosed confidently. Racial nephrectomy and needless sacrifice of a whole kidney for a benign lesion can be avoided. Heminephrectomy may be sufficient, thus saving the patient valuable renal tissue. Four cases of renal hamartoma are presented. Plain film and angiographic studies are shown. All four showed the characteristic angiographic findings of renal hamartoma and were diagnosed pre-operatively.     

卡托普利介入99mTc-双半胱氨酸肾动态显像对肾血管性高血压患者的价值

目的研究卡托普利介入^99mTc-双半胱氨酸（^99mTc-EC）肾动态显像对高血压患者的肾血管性原因的诊断准确性,并评价其对肾血管性高血压（RVH）患者血管成型术后肾功能改善的预测价值。方法55例临床疑似RVH的患者,口服卡托普利50mg,60min后进行^99mTc-EC肾动态显像,结果异常患者次日再进行基线水平肾动态显像。按照显像结果将RVH的诊断分为高度可能组、不确定组和低度可能组。结果高度可能组的22例患者中20例有肾动脉狭窄（RAS）;不确定组10例中的5例有RAS;低度可能组23例均证实没有RAS。如果将不确定诊断组和低度可能组归为阴性,诊断RAS的灵敏度为80%,特异度为93.3%,阳性预测值为90.9%,阴性预测值为84.8%;如果将高度可能组和不确定诊断组归为阳性,则灵敏度、特异度、阳性预测值和阴性预测值分别为100%、77.7%、78.7%、100%。22例RVH患者进行介入治疗,高度可能组的18例患者中16例治疗有效,不确定组中3例无效、1例有效。结论卡托普利介入^99mTc-EC肾动态显像是诊断RVH的有效手段,同时能预测患者血管成形术治疗效果。     

Protective effect of erythropoietin on renal injury induced by acute exhaustive exercise in the rat

We investigated the protective effect of Erythropoietin (EPO) analogue rHuEPO on renal injury induced by acute exhaustive exercise in the rat. Rats were randomly allocated to one of 3 groups: normal control (C), exhaustive exercise test (ET) and EPO pre-treatment (rHuEPO 2 000 U/kg) plus ET (EPO+ET). Compared with controls, animals in the ET group had increased serum urea nitrogen, serum creatinine, urine protein, and renal tissue malondialdehyde (MDA) and decreased renal tissue nitric oxide (NO), nitric oxide synthase (NOS) and superoxide dismutase (SOD) activities. There was severe damage in renal tubular epithelial cells with a lot of cell apoptosis, and TUNEL assay revealed a remarkably high apoptotic index (p<0.01). Changes in renal function and kidney tissue were much less in the EPO+ET group (p<0.05) and the apoptotic index was much lower than in the ET group (18.45±0.32 vs. 27.55±0.49, p<0.05). EPO pretreatment thus significantly prevented renal cell apoptosis, and counteracted high MDA and low NO and NOS renal contents induced by exhaustive exercise. The data point to a potential value of EPO in preventing the acute renal injury after exhaustive exercise.     

高原和平原慢性肾衰竭患者红细胞相关指标比较分析

目的:探讨高原和平原慢性肾衰竭患者血红蛋白的差异,为高原慢性肾衰竭诊治提供参考依据。方法:同期检测西藏军区总医院(高原组,n=80)和重庆新桥医院肾内科(平原组,n=80)慢性肾衰竭患者血红蛋白(Hb)、血细胞比容(HCT)、红细胞计数(RBC)、红细胞平均体积(MCV)及红细胞平均血红蛋白浓度(MCHC)等指标。根据血清肌酐浓度将患者分为4期。结果:两组各期患者均为20例。随肾功能不全程度加重,高原患者和平原患者一样,Hb、HCT及RBC均逐渐降低。高原组代偿期、氮质血症期和肾功能衰竭期患者Hb、HCT及RBC均高于同期平原组,但在尿毒症期两组患者无明显差异。高原组患者MCV明显高于平原组,呈现大细胞性贫血。结论:高原慢性肾衰竭早中期贫血程度要轻于平原患者,终末期无明显差别;且为大细胞性贫血。     

Results and significance of angiography in potential kidney donors.

Multiple renal arteries originating from the aortoiliac vessels were identified angiographically in 44% of 444 prospective renal donors. Bilateral multiple renal arteries were identified in 12%. With good immunological donor-recipient matching, 17 kidneys with multiple renal arteries were transplanted with excellent results; therefore, presence of multiple renal arteries should not be considered a contraindication to kidney transplantation. A high proportion (17%) of the prospective donors, acceptable by all other means of evaluation, had abnormmal angiographic findings that led to reconsideration of their acceptance. In addition to multiple renal arteries, neither renovascular atherosclerosis nor fibromuscular dysplasia proved to be an absolute contraindication to transplantation.     

Renal tolerance of iodinated low osmolality contrast agents. Clinical and experimental aspects

The low osmolality iodinated contrast agents (ICA), ionic or non ionic are now suggested too replace the usual high osmolality ICA. The main arguments are the better clinical tolerance and a lower renal toxicity. Recent experimental studies have clearly demonstrated that the low osmolality ICA presents a lower renal toxicity. On the rat, we have confirmed that the in vivo renal toxicity of low osmolality ICA, is lower than the high osmolality ICA toxicity. It is clearly demonstrated on man than the enzyme urinary excretion and proteinuria are little or not modified by the low osmolality ICA, but both are increased by high osmolality ICA. These changes are found with a normal glomerular filtration flow. No difference are noted in the creatinine concentration and clearance follow-up. However it is possible that the necessary population of patient to get statistically significative differences between both agents can be superior to the number of patients studied. In clinical practice, we think, that low osmolality ICA must be used for patients presenting one or several risk factors of acute renal failure.     

糖尿病患者肾阈测定的临床意义

本文对65例糖尿病人进行了肾糖阈测定,结果发现44.6％的糖尿病患者肾糖阈异常,其中15例肾糖阈降低,占23.1％,血糖在2.8—5.9mmol/L时仍有糖尿排出(+—(?)),14例肾糖阈升高,占21.5％,血糖在11.2—14.5mmol/L时尿糖仍阴性。糖尿病人肾糖阈改变与患者年龄,病程、上糖值无关,P>0.05。 糖尿病人有肾糖阈异常,尿糖测定就不能正确反映其血糖水平,肾糖阈降低的患者,临床上会呈现控制不良假象。肾糖阈升高的患者,又会造成用药量偏小,使血糖不能及时得到满意控制。因此用尿糖作为糖尿病患者的病情监测并指导合理用药时,有必要对糖尿病人进行肾糖阀定。     

Exertional rhabdomyolysis and acute renal failure in marathon runners

Strenuous exercise, including marathon running, can result in damage to skeletal muscle cells, a process known as exertional rhabdomyolysis. In most cases, this damage is resolved without consequence. However, when the damage is profound, there is a release of muscle proteins into the blood; one of these proteins, myoglobin, in high concentrations and under certain conditions (such as dehydration and heat stress) can precipitate in the kidneys, thereby resulting in acute renal failure. Although the marathon is a gruelling physiological challenge, with races sometimes run in hot and humid weather, acute renal failure is relatively infrequent. From case reports, a high proportion of marathon runners who developed acute renal failure had taken analgesics, had a viral or bacterial infection, or a pre-existing condition. The rare cases of acute renal failure in marathon runners may be a situation of the 'perfect storm' where there are several factors (heat stress, dehydration, latent myopathy, non-steroidal anti-inflammatory or other drug/analgesic use, and viral/bacterial infection) that, in some combination, come together to result in acute renal failure.     

Peripheral renal vascular disease in essential hypertension: Hemodynamic,angiographic, and endocrine assessment

Renal hemodynamic (¹³³Xe-washout) and angiographic studies were performed in 46 patients with essential hypertension to demonstrate a possible correlation between graded renal small vessel disease and changes in renal blood flow. In addition, influence of the effects of duration of hypertension, diastolic blood pressure values and renal vein renin activity on hemodynamic and arteriographic findings were evaluated. Our results demonstrate that in patients with accelerated or severe renal small vessel disease the mean and cortical renal blood flow is significantly reduced (P<0.001). Furthermore, renal arteriosclerosis becomes evident in patients with long-standing hypertension, high diastolic blood pressure values, and elevated renal vein renin levels. Correlations between renal blood flow and renal vein renin activity (r=0.45) apparently are governed by severity of the renal arteriosclerosis.     

Value of captopril renal scintigraphy in hypertensive patients with renal failure.

The aims of this study were to show the value of captopril renal scintigraphy for detecting a renovascular cause in hypertensive patients with renal failure and to assess the ability to predict the beneficial effect of revascularization on renal function. METHODS: Thirty-eight patients with renal failure (mean glomerular filtration rate = 35 mL/min) underwent renal scintigraphy after injection of 99mTc-mercaptoacetyltriglycine. Baseline scintigraphy was performed, and the test was repeated 24 h later after oral administration of 50 mg captopril given 60 min before the test. RESULTS: In 5 of 6 patients with a renovascular cause for renal failure, and 2 of 3 patients with a probable arterial pathology, scintigraphy had a high probability. The result was indeterminate in the other 2 patients. In 5 of 11 patients with negative arteriography and 14 of 18 patients with probable absence of renovascular pathology, we found a low probability of functional renal artery stenosis. Six revascularization procedures were performed and were predictive of a beneficial effect in 5 patients. Time of peak activity was an effective predictor in each case. CONCLUSION: In hypertensive patients with renal failure, captopril renal scintigraphy can detect hemodynamic dysfunction downstream from a renal artery stenosis and can predict the beneficial effect of revascularization in some cases.