肾皮质体积：与活体供肾者术前术后肾功能的高度相关性。

Renal cortical volume: High correlation with pre- and post-operative renal function in living kidney donors.

机构信息

Radiology Department, CHU, Nantes, France.

Nephrology Department, CHU, Nantes, France; Centre de recherche en Transplantation et Immunologie (CRTI) UMR 1064, INSERM, Université de Nantes, France; Institut de Transplantation Urologie et Néphrologie (ITUN), CHU, Nantes, France.

出版信息

Eur J Radiol. 2018 Feb;99:118-123. doi: 10.1016/j.ejrad.2017.12.013. Epub 2017 Dec 21.

DOI:10.1016/j.ejrad.2017.12.013

PMID:29362141

Abstract

BACKGROUND

CT volumetry has previously been proposed as an alternative to scintigraphy for the evaluation of pre-donation split renal function and the prediction of post-donation renal function in living kidney donors. The aim of our study was to retrospectively assess the relevance of three CT volumetry techniques for estimating pre-donation kidney function and predicting the risk for chronic kidney disease (CKD) at 1-year post-nephrectomy in a French cohort of living donors using isotopic measures of kidney function.

METHODS

Kidney volume was quantified pre-donation for 105 donors using three methods total parenchymal three-dimensional renal volume (3DRV), total parenchymal renal volume contouring (RVCt), and renal cortical volume (RCoV). Subjects also had a 51Cr-EDTA scintigraphy to measure glomerular filtration rate (mGFR) pre-donation and 1-year after donation. For each volume, we tested for association with mGFR using univariate regression models, and computed receiver operating characteristics analyses to assess their predictive potential of post-donation CKD.

RESULTS

Our population was composed of healthy subjects, who were predominantly female (69%) with a median age at donation of 51yo. Median mGFR was 102 mL/min/1.73 m at pre-donation and 66 mL/min/1.73 m 1-year after nephrectomy. The pre-donation median volume of the preserved kidney was 156 cm, 163 cm and 99 cm for the 3DRV, RVCt and RCoV methods respectively, with a high correlation observed between each technique (R > 0.84). For all methods, total kidney volume was significantly associated with pre-donation mGFR (P < 0.001). Preserved kidney volume was also strongly correlated with post-donation mGFR (P < 0.0001), with the strongest correlation observed for RCoV (R = 0.60 vs. R = 0.39 and R = 0.51 for 3DRV and RVCt, respectively). Finally, the RCoV method yielded the best predictive value of 1-year post-donation CKD (AUC = 0.80 vs. AUC = 0.76 and 0.70 for RVCt and 3DRV, respectively).

CONCLUSIONS

In our cohort of healthy donors with measured kidney function, cortical volumetry (RCoV) appears as the best volumetric technique to use as a surrogate to scintigraphy for estimating pre-donation split renal function and predicting post-donation renal outcomes.

摘要

背景

CT 容积测量法此前已被提议作为闪烁扫描法的替代方法，用于评估活体供肾者的供肾前分肾功能，并预测供肾后的肾功能。我们的研究目的是使用同位素测量的肾功能，回顾性评估三种 CT 容积测量技术在评估法国活体供者的供肾前肾功能和预测 1 年后肾切除术后慢性肾脏病（CKD）风险方面的相关性。

方法

对 105 名供者在供肾前使用三种方法（全肾实质三维容积（3DRV）、全肾实质容积轮廓（RVCt）和肾皮质容积（RCoV））对肾体积进行定量。受检者还进行了 51Cr-EDTA 闪烁扫描以测量供肾前和供肾后 1 年的肾小球滤过率（mGFR）。使用单变量回归模型对每种容积与 mGFR 进行关联检验，并计算了受试者工作特征分析以评估其对肾切除术后 CKD 的预测潜力。

结果

我们的研究人群由健康受试者组成，其中女性占主导地位（69%），供肾时的中位年龄为 51 岁。供肾前 mGFR 中位数为 102 mL/min/1.73 m，肾切除术后 1 年为 66 mL/min/1.73 m。供肾前保留肾的中位体积分别为 3DRV、RVCt 和 RCoV 方法的 156 cm、163 cm 和 99 cm，各技术之间具有高度相关性（R > 0.84）。对于所有方法，全肾体积与供肾前 mGFR 显著相关（P < 0.001）。保留肾体积与供肾后 mGFR 也呈强相关性（P < 0.0001），其中 RCoV 相关性最强（R = 0.60，而 3DRV 和 RVCt 的 R 值分别为 0.39 和 0.51）。最后，RCoV 方法对 1 年后的 CKD 预测具有最佳的预测价值（AUC = 0.80，而 AUC = 0.76 和 0.70 分别为 RVCt 和 3DRV）。