泌尿器科領域に於ける分担腎クリアランスの研究

抄録

Not a few cases of urologic diseases encountered demand us more precise analysis of individual renal function, when ICT and IVP are the only means available at the present time for this purpose. Various renal clearance tests with their appreciation of total kidney function have been thought to apply to serve to evalute individual renal function only to fail because of the difficulty in obtaining separate urine. There are some reports concerning the study of unilateral renal function using Garceau or Woodruff catheter and others.
Here I introduce now method, balloon catheter I have devised and named to solve the problem obtaining pure separate urine, and present the results of renal clearances measured on normal and diseased kidneys with the aid of this catheter,
1) The average values of individual renal clearance on normal kidney are CSTS R. 49.6ccm/min. L. 53.1ccm/min., C creatinin R. 45.7ccm/min. L. 49.8ccm/min., CPAH R. 255.4ccm/min. L. 269.9ccm/min., CPSP R. 245.9ccm/min. L. 252.5ccm/min. and F.F. 0.19 in both side, in adult male, CSTS R. 45.2ccm/min. L. 46.7ccm/min., C creatinin R. 44.7ccm/min., L. 46.8ccm/min., CPAH R. 230.6ccm/min. L. 235.1ccm/min., CPSP R. 224.4cc/min. L. 230.5ccm/min. and F.F. 0.19 in both side, in adult female.
In the urinary tract obstruction, RPF and CPSP are often decreased greater than GFR, and they decreased in parallel to each other when urinary infection was complicated. Elimination of passage disturbances was usually followed by recovery of clearance especially RPF and CPSP, although the recovery of GFR was less rapid in the passage impairement at the upper urinary tract than at the lower portion.
3) In the cases of the upper urinary tract calculi, the clearance of healthy kidney suffered little iufluences from the diseased kidney and the decrement of GFR was greater in ureteral stone than in renal stone.
4) Staghorn stone caused a significant decrease in clearance especially of RPF and CPSP except GFR in which the degree of decrease was not as great.
5) Post operative recovery of clearance in pyeloplastied hydronephrosis was more or less under influence of compensatory function by the healthy kidney, however, Hinmann's theory on renal counter balance should not be placed too great an emphasis preoperatively.
6) Parenchymal damage of the kidney manifested in general decrease of clearance, and in case of renal tuberculosis its decrease was in parallel with the extent of the lesion, and the clearance of the healthy kidney was influenced by the condition of the diseased kidney.
7) Movable kidney revealed lowering in clearance especially the values of RPF and CPSP. Essential renal bleeding showed a decrease in RPF.
8) Renogram of the separate kidney showed a high correlationship between RPF and 15min. value of PSP, RPF and TmPAH, TmG and Fishberg's urine concentration test, a relative correlationship between RPF and TmG, and TmPHA and TmG, no correlationship between RPF and 60min. value of PSP.
9) Individual renal clearance test was more sensitive than ICT and IVP, and enough information was obtained by our method to establish accurate diagnosis and management.