Aim To study the additional utility of pre‐nephrectomy whole and cortical kidney volumes (WKV, CKV) in predicting long‐term post‐nephrectomy kidney function in Indian living kidney donors (LKDs). Methods This retrospective cohort study included all LKDs who underwent nephrectomy between 1 January 2006 and 31 December 2015 at our centre, had pre‐nephrectomy height, weight and computed tomography (CT) angiography with arterial and nephrographic phase documented, and 5‐year post‐nephrectomy creatinine values measured. Correlation between body surface area (BSA) adjusted pre‐nephrectomy total CKV, WKV and pre‐nephrectomy CKD EPI eGFR; BSA‐adjusted remnant pre‐nephrectomy CKV (rCKV), WKV (rWKV) and 5‐year post‐nephrectomy CKD EPI creatinine eGFR (5yeGFRCr); predictors of 5yeGFRCr < 70% of pre‐nephrectomy CKD EPI creatinine eGFR (pre‐eGFRCr), and an equation to predict 5yeGFRCr from pre‐nephrectomy variables were calculated. Results A total of 196 LKDs (74% female, mean age 41.7 ± 11.0 years) were included in the study. Total WKV showed higher correlation with pre‐nephrectomy eGFR than CKV, the highest with CKD EPI cystatin eGFR. Remnant WKV showed higher correlation than rCKV with post‐nephrectomy eGFRCr and this increased over time. Older age, lower rWKV or rCKV, higher BSA, and higher pre‐eGFRCr identified LKDs with 5yeGFRCr < 70% of pre‐eGFRCr, with rCKV identifying a higher proportion (4.5%) of such LKDs. A model including rWKV or rCKV predicted 5yeGFRCr better than one including age, gender, BSA and pre‐eGFRCr alone. Conclusion Inclusion of pre‐nephrectomy remnant CKV and WKV into models for 5yeGFRCr and sub‐optimal post‐nephrectomy adaptation in Indian LKDs improves their accuracy. CKD EPI cystatin eGFR correlates better with functional renal mass.
Context: Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) for treatment monitoring in patients with lymphoma is one of the most well-developed clinical applications. Deauville five-point score (DS) is recommended for response assessment in international guidelines. DS gives the threshold for adequate or inadequate response to be adapted according to the clinical context or research question. Aims: We aimed to validate DS in Hodgkin's lymphoma (HL) by retrospectively assigning this score to F-18 FDG PET-computed tomography (CT) studies done before 2016 and analyzing its concordance with the line of management. The secondary aim was to assess the reproducibility of DS in the interpretation of PET-CT scans. Subjects and Methods: A total of 100 eligible consecutive patients underwent F-18 FDG PET-CT scans between January 2014 and December 2015. Their interim, end of treatment, and follow-up PET scans were retrospectively visually analyzed and assigned DS by three nuclear medicine physicians. Concordance was defined as agreement between the DS assigned and the line of treatment. Interobserver variability was calculated using weighted Kappa and presented with 95% confidence interval. Results: Among 212 scans assigned DS, 165 scans showed agreement between the DS and line of treatment. Of these, 95.2% of scans scored DS 1–3 were kept on following or the same treatment plan was continued and patients did well. Among the scans that showed discordance, 24 scans scored DS 4/5 were continued on the same treatment regimen and the next assessment showed disease progression. Conclusions: Our study confirmed that DS is a useful tool to aid in reporting F-18 FDG PET-CT in the management of HL with good positive and negative predictive values. This study also demonstrated good interobserver agreement.
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