신장 질환이 있는 소아에서 99mTechnetium-mercaptoacetyltriglycine (99mTc-MAG3) 신장 스캔에 의한 사구체 여과율 측정
Glomerular Filtration Rate Measurements Using 99mTechnetium-mercaptoacetyltriglycine Dynamic Renal Scintigraphy in Children with Renal Disease
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목적: 소아에서 24시간 소변 수집의 단점을 대체하기 위해 99mTc-MAG3 신장 스캔을 통한 신기능을 측정하여, 크레아티닌 청소율과 혈청 cystatin C과 크레아티닌에 의한사구체 여과율 추정식을 비교하여 연관성을 확인하였다. 방법: 2011년 7월부터 2012년 8월까지 101명의 18세 미만의 환자들을 대상으로 의무기록 후향적 조사로 실시하였고 99mTc-MAG3 신장 스캔을 시행하여 사구체 여과율을측정하였다. 24시간 소변과 혈액을 체취하여 크레아티닌 청소율을 측정하였고 5개의 추정식을 통해 사구체 여과율을측정하였다. 결과: 크레아티닌 청소율과 99mTc-MAG3 신장 스캔을 이용한 사구체 여과율의 Pearson 상관 계수는 0.389(P<0.001)이었다. 99mTc-MAG3 신장 스캔과 Schwartz 식,Counahan-Barratt 식, MDRD 식, Cockcroft-Gault 식,Filler and Lepage 식, Bokencamp 식에 의한 사구체 여과율의 Pearson 상관 계수는 각각 0.265 (P=0.007), 0.128(P=0.044), 0.216 (P=0.030), 0.230 (P=0.021), 0.356 (P<0.001), 0.355 (P<0.001) 로 확인되었다. 사구체 및 비사구체신질환의 비교에서 99mTc-MAG3 신장 스캔에 의한 사구체여과율은 모두 유의한 상관성을 가졌고, 신기능의 저하 유무에 상관없이 99mTc-MAG3 신장 스캔에 의한 사구체 여과율은 크레아티닌 청소율과 유의한 연관성을 보였다. 결론: 크레아티닌 청소율과 99mTc-MAG3 신장 스캔에 의한 사구체 여과율 간에는 유의한 상관성이 있으며 99mTc-MAG3 신장 스캔에 의한 사구체 여과율은 신질환의 기원과 신기능의 정상 여부 모두에서 크레아티닌 청소율을 대체할 수 있는 방법임을 확인할 수 있었다. 99mTc-MAG3 신장 스캔 이용 시 정확하고 빠른 결과를 얻을 수 있으리라 생각된다.
Abstract
Purpose: In children, 24-hour urine collections are unreliable for evaluating glomerular filtration rate (GFR) because of the difficulty of regulating voiding and the daily variation of urinary creatinine up to 25%. Additionally, creatinine clearance (Ccr) based on urinary creatinine is considered inaccurate. The purpose of this study was to compare estimated GFR determined using Ccr, formulas with serum cystatin C and creatinine, and 99mTc-mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy. Methods: This retrospective study included 101 patients (age, <18 years) who visited Chung-Ang University Hospital between July 2011 and August 2012. GFR was estimated using 24-hour urinary creatinine, five formulas with serum creatinine and cystatin C, and 99mTc-MAG3 renal scan. Results: Of the 101 patients, glomerular renal diseases were present in 60 patients (59.4%) and non-glomerular diseases were present in 41 patients (40.6%). There was a significant correlation between estimated GFR determined using 99mTc-MAG3 renal scan and Ccr (r=0.389, P <0.001). The correlation values between estimated GFR determined using 99mTc-MAG3 renal scan and each formula of Schwartz, Counahan-Barratt, Cockcroft-Gault, Filler and Lepage, and Bokencamp were 0.265 (P=0.007), 0.128 (P=0.044), 0.230 (P=0.021), 0.356 (P<0.001), and 0.355(P <0.001), respectively. 99mTc-MAG3 renal scan was correlated with estimated-GFR by all formulas in decreased renal function. Conclusion: Estimated GFRs determined using serum creatinine and cystatin C, and 99mTc-MAG3 renal scan correlated well with estimated GFR determined using Ccr. 99mTc-MAG3 renal scan may be replaced for evaluation of renal function with convenience in patients with renal disease and decreased renal function in childhood.
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