Piepsz Amy, Prigent Alain, Hall Michèle, Ismaili Khalid, Collier Frank, Ham Hamphrey
Department of Nuclear Medicine, Centre Hospitalo-Universitaire St Pierre, Brussels, Belgium.
Pediatr Nephrol. 2005 Nov;20(11):1593-8. doi: 10.1007/s00467-005-1974-x. Epub 2005 Aug 4.
Functional compensation occurs in a kidney when the function of the contralateral kidney is decreased or absent. What is, however, not documented is the level of unilateral renal impairment at which functional compensation occurs. Split function, as obtained from a radionuclide renogram, can only show the asymmetry between both kidneys. The aim of the present work was to evaluate at what level of unilateral impairment a functional compensation can be observed in the contralateral normal kidney. From a large database, 180 children over 2 years of age with unilateral pathology were retrospectively selected. All of them underwent a radionuclide study, combining a technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renogram associated with a chromium-51 ethylenediaminetetraacetic acid (Cr-51 EDTA) overall clearance, allowing a precise estimation of single-kidney glomerular filtration rate (SKGFR). Below 30-35 ml/min/1.73 m2, there was a significant inverse correlation between SKGFR on the normal and the abnormal side. Above this level, no such correlation was observed, the mean SKGFR on the normal side remaining around 58 ml/min/1.73 m2, whatever the value of SKGFR on the abnormal side. In pediatric patients, hyperfunction occurs when SKGFR of the diseased kidney is below 30-35 ml/min/1.73 m2.
当对侧肾脏功能减退或丧失时，患侧肾脏会发生功能代偿。然而，目前尚无文献记载发生功能代偿时单侧肾损伤的程度。放射性核素肾图所测得的分肾功能，只能显示两侧肾脏之间的不对称性。本研究的目的是评估在单侧损伤达到何种程度时，对侧正常肾脏会出现功能代偿。从一个大型数据库中，回顾性选取了180例2岁以上患有单侧病变的儿童。他们均接受了放射性核素检查，包括锝-99m巯基乙酰三甘氨酸（Tc-99m MAG3）肾图检查及铬-51乙二胺四乙酸（Cr-51 EDTA）总清除率检查，从而精确估算单肾肾小球滤过率（SKGFR）。当SKGFR低于30 - 35 ml/min/1.73 m2时，正常侧与异常侧的SKGFR之间存在显著的负相关。高于此水平时，未观察到这种相关性，无论异常侧SKGFR的值如何，正常侧的平均SKGFR保持在58 ml/min/1.73 m2左右。在儿科患者中，当患病肾脏的SKGFR低于30 - 35 ml/min/1.73 m2时，会出现肾功能亢进。
