Elseviers M M, De Schepper A, Corthouts R, Bosmans J L, Cosyn L, Lins R L, Lornoy W, Matthys E, Roose R, Van Caesbroeck D
Department of Nephrology, Universitair Ziekenhuis Antwerpen, Belgium.
Kidney Int. 1995 Oct;48(4):1316-23. doi: 10.1038/ki.1995.416.
Recently, well performing diagnostic criteria for analgesic nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 analgesic abusers (defined as daily use of analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of analgesic nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of analgesic nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of analgesic nephropathy.
最近，通过证实肾体积双侧减小并伴有凹凸不平的轮廓或乳头钙化，确定了终末期肾衰竭（ESRF）患者镇痛剂肾病的良好诊断标准。在本研究中，将计算机断层扫描（CT）的诊断价值与先前使用的肾脏成像技术（超声检查和传统断层扫描）进行了比较。在第一项研究中，对40名镇痛剂滥用者（定义为至少5年每日使用镇痛剂混合物）和40名对照者（均为无明确肾脏诊断的ESRF患者）进行了超声检查、断层扫描和不注射碘化造影剂的CT扫描，以寻找镇痛剂肾病的成像征象。使用CT扫描、超声检查和断层扫描，可以得到可比的肾脏大小评估结果，而CT扫描在检测乳头钙化方面更具优势（敏感性87%，特异性97%）。在第二项对照研究中，对53名血清肌酐在1.5至4mg/dl之间且无明确肾脏诊断的镇痛剂滥用者进行了CT扫描，并对肾体积减小、轮廓凹凸不平和乳头钙化的存在进行了评分。结果发现，肾衰竭早期CT扫描显示的镇痛剂肾病肾脏图像与ESRF患者的观察结果相似。特别是乳头钙化的显示对镇痛剂肾病的早期诊断具有92%的高敏感性和100%的特异性。
