Itoh K, Kakizaki H, Kato C, Tsukamoto E, Nakada K, Nagao K, Togashi M, Furudate M
Department of Nuclear Medicine, Hokkaido University School of Medicine.
Kaku Igaku. 1990 Apr;27(4):363-71.
Dynamic renal scintigraphy with 99mTc-DTPA before (baseline renography: BS-RG) and 1 hour after administration of 25 mg to 50 mg of captopril (captopril-enhanced renography: CP-RG) was performed in a selected series of 18 patients suspected of having renovascular hypertension. Final diagnosis was made by angiography and further clinical follow-up. Eight patients were considered as renovascular hypertension (RVH), 6 with bilateral renal artery stenosis (BRAS) and 2 with unilateral renal artery stenosis (URAS). The remaining 10 patients were non-renovascular (non-RVH). Two criteria were prospectively employed for evaluating positive response induced by captopril. Glomerular filtration rate (GFR) on BS-RG (GFRbase) and on CP-RG (GFRcap) was estimated by early (120-180 seconds) DTPA uptake by the kidney, and then captopril response rate (CRR) was calculated in the following: CRR = (GFRcap-GFRbase)/GFRbase X 100 (%). CP-RG was considered positive when it was less than 20%. Renogram shape was also independently evaluated. CP-RG was also considered positive when either a delay of time to peak activity of more than 5 min or conversion of renogram shape to an obstructive or non-functioning pattern was observed. The sensitivity and specificity of CRR and change in renogram were 50% and 80%, 63% and 100%, respectively. In BRAS, positive response was observed in the unilateral kidney alone which maintained relatively a good renal function. CP-RG could not differentiate RVH with URAS from that with BRAS. Four patients were followed after the surgical or angioplastic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
对18例疑似肾血管性高血压的患者进行了动态肾闪烁扫描，分别在服用25毫克至50毫克卡托普利前（基线肾图：BS-RG）和服用后1小时（卡托普利增强肾图：CP-RG）使用99mTc-DTPA。最终诊断通过血管造影和进一步的临床随访确定。8例患者被诊断为肾血管性高血压（RVH），其中6例为双侧肾动脉狭窄（BRAS），2例为单侧肾动脉狭窄（URAS）。其余10例患者为非肾血管性（非RVH）。前瞻性地采用了两个标准来评估卡托普利诱导的阳性反应。通过肾脏早期（120 - 180秒）摄取DTPA来估计BS-RG（GFRbase）和CP-RG（GFRcap）时的肾小球滤过率（GFR），然后按以下公式计算卡托普利反应率（CRR）：CRR = (GFRcap - GFRbase)/GFRbase × 100 (%)。当CRR小于20%时，CP-RG被认为是阳性。还对肾图形态进行了独立评估。当观察到峰值活动时间延迟超过5分钟或肾图形态转变为梗阻或无功能模式时，CP-RG也被认为是阳性。CRR和肾图变化的敏感性和特异性分别为50%和80%、63%和100%。在BRAS中，仅在单侧肾脏观察到阳性反应，该侧肾脏保持相对良好的肾功能。CP-RG无法区分URAS和BRAS引起的RVH。4例患者在接受手术或血管成形治疗后进行了随访。（摘要截断于250字）
