腎クリアランスに関する研究 第1篇: 泌尿器科領域に於ける腎クリアランス

Abstract

1) Renal clearance study was performed in 109 patients w ith various urological diseases, 20 patients who had undergone upper urinary tract surgery and in 35 with spinal cord injury . In some of them split renal clearance test was also studied. Clearance test values were compared with other renal function tests values and also grouped according to diseases. 2) Renal tuberculosis . GFR, RPF and RBF were low in parallel with ea c h other. In tuberculosis of both kidneys and solitary kidney after nephrectomy these clearance test values were markedly lowered. 3) Upper urinary c a lculus . In general, RPF and RBF were low, whereas GFR was not so much affected. Many of cases showed elevated FF. In nephrolithiasis group, clearance test values were diminished more remarkably than in ureteral stone group. Site of stone, period since onset of disease, presence or absence of associated infection : - those are probably determinative factors of clearance test values. 4) Prostatic enlargement . No mark e d change was observed. RPF and RBF were slightly dropped probably due to the senile change of kidney in this aged group. 5) Ureterovaginal fistula (4 cases) . Split renal clearance w as studied with the result of remarkable drop on the diseased side and compensatory increase on the healthy side. On the diseased side RPF and RBF were diminished more than GFR. 6) In comparison with PSP and Indigocarmin test, renal clearance test was proved to be quite sensitive and accurate. Simultaneous and parallel decrease in diluting power and clearance values, especially GFR, suggested the correlation between glomerular and tubular function. 7) After surgical invasion upon the upper urinary tract, such as nephrectomy and nephro-or ureterolithotomy, renal clearance .values became lowest within 3 to 7 postoperative days and returned normal or more than it in 3 to 4 weeks. 8) Clearance values in patients with cord inju r y were not low as expected. Some of them actually showed diminished values probably as a result of ureteral reflux, urinary infection, or urinary calculus. Site of cord injury, grade of paralysis, period since trauma : those seem to have less to do with renal function. 9) Renal clearance tests were prove d to be useful to establish the clinical judgment if performed together with other renal function examinations.