肾积水对轻中度肾损伤者Gates法GFR的影响

目的了解轻中度肾积水对肾动态显像GFR的影响。方法回顾2010年1～12月51例双血浆法GFR(tGFR)在30～90ml/(1.73m2.min)范围内的肾积水患者的肾动态显像,按照tGFR的大小并结合肾脏疾病的分期标准分成正常对照组90ml(1.73m2.min)≤tGFR<120ml/(1.73m2.min)],轻度60ml/(1.73m2.min)≤tGFR<90ml/(1.73m2.min)]和中度30ml/(1.73m2.min)≤tGFR<60ml/(1.73m2.min)]肾损伤3组,并比较体表面积标准化前后Gates法GFR(gGFR)和tGFR间差异和相关性。结果大多数情况下,gGFR均高于tGFR,二者差值范围-35.1～26.1ml/(1.73m2.min);tGFRBSA和gGFRBSA间差值范围-38.3～26.8ml/(1.73m2.min)。无论轻度和中度肾损伤组,还是整体患者中,BSA标准化均可改善tGFR和gGFR间的相关性。BSA标准化后,中度肾损伤组的相关系数可达到0.634(P=0.020),而轻度肾损伤组和整体患者中仅为0.298(P=0.229)和0.543(P=0.002)。结论体表面积标准化Gates法GFR可提高其与双血浆法间的相关性,但评估肾积水伴轻中度肾损伤患者GFR价值有限,应参考双血浆法的定量结果。

Influence of Hydronephrosis on GFR Among Patients with Mild and Moderate Renal Injury

Objective To explore the influence of hydronephrosis on the GFR quantification in dynamic renal scans.Methods Form January 2010 to November 2010,the GFR of 51 patients who underwent dynamic renal scans were in the range of 30 to 90ml/(1.73m2·min) that quantified by dual sample serum method(tGFR).Patients were divided into normal90ml(1.73m2·min)≤tGFR<120ml/(1.73m2·min)],mild 60ml(1.73m2·min)≤tGFR<90ml/(1.73m2·min)] and moderate 30ml(1.73m2·min)≤tGFR<60ml/(1.73m2·min)] injury group based on their tGFR and DOQI.To determine the difference and correlation between Gates method(gGFR) and tGFR,the comparison was conducted with or without body surface area(BSA) normalization respectively.ResultsIn most cases,gGFR was higher than tGFR.The difference between tGFRBSA and gGFRBSA was-35.1~26.1ml/(1.73m2·min).Either in mild and moderate injury groups or in all enrolled patients,BSA normalization could improve the correlation between tGFR and gGFR.After the BSA normalization,the correlation coefficient of moderate injury group was up to 0.634(P=0.020).In the mild and all enrolled group,the correlation coefficient were 0.298(P=0.229)and 0.543(P=0.002).Conclusion The BSA normalization can improve the correlation between Gates and dual sample serum method.However,Gates method has limited value in evaluating GFR in mild and moderate kidney injury patients who suffered from hydronephrosis.Especially for mild injury patients,the correlation was very poor and should refer to the results of tGFR.