Japanese
TitleCaptopril負荷腎シンチグラフィによる腎血管性高血圧症の診断
Subtitle原著
Authors伊藤和夫*, 柿崎秀宏**, 加藤千恵次*, 塚本江利子*, 中駄邦博*, 永尾一彦*, 富樫正樹**, 古舘正従*
Authors(kana)
Organization*北海道大学医学部核医学講座, **泌尿器科学講座
Journal核医学
Volume27
Number4
Page363-371
Year/Month1990/4
Article原著
Publisher日本核医学会
Abstract「要旨」 Captopril負荷99mTc-DTPA腎シンチグラフィ (CP-RG) による腎血管性高血圧症 (RVH) の診断に関して検討した. 対象18例中8例が最終的にRVHと診断され, 10例はnon-RVHと診断された. 腎摂取率の変化 (Captopril Response Rate, CRR≦-20%) を診断基準とした場合のsensitivityおよびspecificityはそれぞれ50%と80%で, 偽陽性例は紫斑病腎炎と腎移植の各1例であった. また, レノグラムパターンの変化 (Tmaxが5分以上延長, あるいはレノグラムが閉塞あるいは無機能型に変化) を診断基準とした場合のsensitivityおよびspecificityはそれぞれ63%と100%であった. 両側腎動脈狭窄 (BRAS) 6例中4例の陽性例では, 反応はいずれも腎機能が比較的保持されている一個腎にしか観察されなかった. CP-RGによるBRASとURASとの鑑別は困難であったが, 本検査の副作用はなく, RVHの術後あるいは血管形成術後の腎機能の経過観察にきわめて有用である.
Practice臨床医学：一般
KeywordsRenovascular hypertension, Renal scintigraphy, Captopril, 99mTc-DTPA
English
TitleCaptopril-Enhanced Renography Using 99mTc-DTPA in Renovascular Hypertensive Patients
Subtitle
AuthorsKazuo ITOH*, Hidehiro KAKIZAKI**, Chietsugu KATO*, Eriko TSUKAMOTO*, Kunihiro NAKADA*, Kazuhiko NAGAO*, Masaki TOGASHI**, Masayori FURUDATE*
Authors(kana)
Organization*Department of Nuclear Medicine, Hokkaido University School of Medicine, **Department of Urology, Hokkaido University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume27
Number4
Page363-371
Year/Month1990/4
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] Dynamic renal scintigraphy with 99mTc-DTPA before (baseline renography ; BS-RG) and 1 hour after administration of 25mg to 50mg 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×100 (%) . CPRG 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. Captopril-enhanced renography is a useful means for evaluating functional renin-dependency of the kidney with RAS in renovascular hypertension and its follow-up after operation or angioplasty.
PracticeClinical medicine
KeywordsRenovascular hypertension, Renal scintigraphy, Captopril, 99mTc-DTPA

【全文PDF】