• Title/Summary/Keyword: 신기능

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Guideline in the Management of Antenatally Diagnosed Unilateral Hydronephrosis (산전 초음파로 발견된 수신증의 치료 방침)

  • Hahn Hye-Won;Jun Nu-Lee;Kim Kun-Seok;Moon Dae-Hyuk;Yoon Chong-Hyun;Park Young-Seo
    • Childhood Kidney Diseases
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    • v.7 no.1
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    • pp.60-66
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    • 2003
  • Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis. Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol. Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant. Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.

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Clinical Analysis of Postoperative Acute Renal Failure in the Patients undergoing Cardiovascular Operation with CPB (개심술 후 발생한 급성 신부전의 임상적 고찰)

  • 편승환;노재욱;방정희;조광조;성시찬;우종수
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.494-501
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    • 1998
  • From May 1, 1993 to May 31 1995, the authers studied retrospectively 211 patients who underwent cardiovascular operation with cardiopulmonary bypass(CPB). Because we were interested in new development of ARF(prevalence, mortality rate, and main risk factors), we performed a multivariate statistical analysis about data of patients with preoperative serum creatinine values of less than 1.5 mg/dL. Normal renal function before operation(serum creatinine level less than 1.5 mg/dL) was registered in 198(74%) patients. Of these, 27(14%) patients showed postoperative renal complication, including 20(10%) patients classified as renal dysfunction(serum creatinine level between 1.5 and 2.5 mg/dL) and 7(4%) patients as acute renal failure(serum creatinine level higher than 2.5 mg/dL). The mortality rate was 5.8% in normal patients, 5% in patients with renal dysfunction, and 43% when acute renal failure developed(p=0.036). Indeed, the renal impairment proved to be an independent predictor of mortality(odd ratio 2.52∼11.25), along with cardiovascular(odd ratio 4.20) and respiratory(odd ratio 2.18) complications. Multivariate analysis identified the following variables as independent risk factors for postoperative renal impairment : advanced age(odd ratio 1), need for emergency operation(odd ratio 3.78), low-output syndrome(odd ratio 3.66), respiratory complication(odd ratio 1.30), need for deep hypothermic circulatory arrest(odd ratio 1.4). The 13 patients(7%) with preoperative renal failure showed a significantly higher morbidity and mortality rate than those without renal complications before operation. We concluded that the likelihood of severe renal complications is resonably low in the patients undergoing cardiac operation without preexisting renal dysfunction, but associated mortality remains high. A prominant role of hemodynamic factor in the development of postoperative acute renal failure must be recognized during preoperative, intraoperative, and postoperative periods.

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$^{99m}Tc$-DMSA Scintigram for Renal Function Recovery after Therapy in Infants and Children (유소아 신질환에서 치료후 신기능회복에 대한 $^{99m}Tc$-DMSA 신티그램의 임상적 고찰)

  • Moon, Tae-Yong;Son, Hyun-Ju;Kim, In-Ju;Yoon, Chong-Byung;Lee, Suck-Hong;Kim, Byung-Soo
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.1
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    • pp.69-74
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    • 1994
  • Authors retrospectively analysed 20 cases of follow-up $^{99m}Tc$-DMSA renal scans to evaluate renal function recovery after treatment in urologic disorders of infants and children. There were 20 cases with both $^{99m}Tc$-DMSA renal scans prior to and after therapy in 15 patients below 9 years old. Among them, 10 patients underwent ureteroneocystostomy under the diagnosis of vesicoureteral reflux, two patients pyeloplasty because of obstructive uropathy and one was treated with antibiotics even diagnosis of UPJ stricture. We have got the quantified uptake rate of $^{99m}Tc$-DMSA renal scan by using the regression equation as "y=0.591x-2.105" (y=the quantified uptake rate, x=the simple uptake rate). The number of kidneys performed proper therapy were 29, and the cases with more increased radiotracer uptake rate in the follow-up $^{99m}Tc$-DMSA renal scans were 20 in number as 69% in frequency. 19 cases with improved renal function on $^{99m}Tc$-DMSA renal scans didn't show any significant difference related to aging or recovery duration after therapy. The $^{99m}Tc$-DMSA renal scans were not useful to evaluate renal function recovery in infants and children, but could be good tests to assess residual renal function prior to or after treatment.

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