畢柳鶯Bi, Liu-Ying蔡素如Cai, Su-RuSu-RuCai醫學研究所2026-10-289999-12-31https://handle.ncl.edu.tw/11296/uq2k39https://scholars.csmu.edu.tw/handle/123456789/34852Diagnosis of the presence of obstructive nephropathy with hydronephrosis is the single most important determination to be made during the periodic urologic surveillance of spinal cord injured patients. We performed the prospective study to determine the screening yield and the diagnostic agreement of renal ultrasonography (RU) and radioisotope renography (RS) for detection of obstructive nephropathy. A second purpose was to determine the influence of bladder fullness on the diagnostic yield of RU. A third purpose was to identify the risk factors associated with a decrease in renal function.At the time of periodic IVP, RU, RS, VCUG and laboratory tests were done on 170 patients between January, 1993 and June, 1996. Findings at RU and RS were compared with the final results by IVP and clinical diagnosis. The sensitivity of RU was 0.92 with a negative predictive value (NPV) of 0.98. The RS reached a sensitivity of 0.89 with a NPV of 0.97. Both RU and RS achieved the significant agreement on the diagnosis of obstructive nephropathy (Kappa coefficient=0.584, p<0.001). Physiological filled-bladder may improve the screening ability (0.90) of RU in comparison to a lower sensitivity (0.74) after voided. Factors associated with a statistically significant reduction in effective renal plasma flow (ERPF) included the duration of injury, presence of vesicoureteral reflux and a history of pyelonephritis. Other factors examined but not found to be statistically significant included age, gender, quadriplegia, level of injury, long-term catheterization and complete injuries.It is recommended that both renal ultrasonography, especially in filled-bladder status, and radioisotope renography may be used for screening upper urinary tract obstruction in the long-term follow-up program. The renal function usually can be preserved if the treatable risk factors are managed properly.醫學MEDICINEthesis