遊走腎におけるPAH血中濃度下降曲線と半減期値

Abstract

When nephroptosis patients are in upright posit i o n, frequently, excretory time from the renal pelvis to the bladder is delayed. It is caused by retention of urine in the renal pelvis as a result of renal ptosis, torsion of the renal pedicle or kink of the ureter. Therefore, there exists a time discrepancy between plasma concentration and urine concentration of clearance substances. In order to find out the difference in the renal function between standing up and laying down position, the author tried to use exponential function curve in blood concentration of PAH and half crest value time on each of the following groups of patients : 15 persons with normal kidneys as a control group, 15 persons with unilateral nephroptosis, 15 persons with bilateral nephroptosis, 5 persons with remaining normal kidney as a control group, and 5 persons with nephroptosis of the remaining kidney. In addition to these, 4 persons who had nephropexy for unilaterl nephroptosis were examined pre and postoperatively. The results are summarized as fol l ows: 1) In normal persons, eliminatin g constant (K) is almost equal in both upright and supine position. There also are no remarkable difference of average (K) between upright and supine position in both normal and nephroptosis patients unilaterally. or bilaterally, for the first half an hour following injection. After that, however, the difference becomes larger in order of normal persons, unilateral nephroptosis patients and bilateral nephroptosis patients. In the cases of remaining kidney with nephroptosis, the difference average of (K) between upright and supine position is most remarkable for the first half an hour following injection. 2) The characteristic distribution area is seen in each of the exponential function curve of different groups. 3) In normal a d ults, half crest value time is 19.3±2.44 min. in supine position and 22.4±1.89 min. in upright position. In upright position, the arevage half crest value time is almost equal in both normal and nephroptosis cases unilaterally or bilaterally. The discrepancy of the half crest value time between upright and supine position is 3.1 min. in normal persons, 6.8 min. in unilateral nephroptosis, 1.7 min. in control remainin g NOTES 1) Exponential Function Curve (Exponentielle Funktionskurve) 2) Half Crest Value Time (Halbwertszeit) kidney, 4.8 min. in remaining kidney with nephroptosis, 12.5 min. pre-nephropexy and 2.3 min. post-nephropexy. 4) In bilateral nephroptosis, if the renal descending ratio in either side of the kidneys goes over 2nd or 3rd degree, the half crest value time tends to become longer. 5) In bilateral nephroptosis patients, the cases with prolonged half crest value time shows remarkable changes in the kidney position in the upright x-ray films. Particularly, it is accorded with the degree of the renal torsion. 6) In the cases of nephropexy, the average half crest value time and the .upright x-ray findings have improved after nephropexy. 7) Comparing direct clearance v a lue with indirect clearance value which was calculated with half crest value time, the value with Niissigensts formula gives the most approximate value to that of the direct clearance.