RU2198400C2 - Method for diagnosing hypoxic and ischemic renal lesions - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves examining 0.04 ml of urine under microscope with 0.01 ml of 8-12% albumin solution added and after drying the sample on transparent plastic surface during 16-18 h as drop at 20-30 C temperature. Dot cracks being observed, hypoxic and ischemic renal lesion is to be diagnosed. Dot cracks pattern is interpreted in terms of renal lesion severity degree. The dot cracks being found in peripheral zone as ones branching from a broad main crack located near the dried drop boundary, hypoxic and ischemic renal lesion of interstitial nephritis type is to be diagnosed. The dot cracks being found in peripheral zone as complex structures like combs with localized formations located in central zone, hypoxic and ischemic renal lesion of acute renal insufficiency type is to be diagnosed. The dot cracks in peripheral zone and rounded amorphous formations located in central zone being found, hypoxic and ischemic state of kidneys of renal infarction type is to be diagnosed. EFFECT: accelerated non-invasive diagnosis method; small quantity of material required for study. 5 cl, 10 dwg

Description

 The invention relates to medicine, namely to laboratory research.

 Laboratory methods are known for detecting hypoxic-ischemic kidney damage, which are based on determining the activity of urine enzymes (alkaline phosphatase, lactate dehydrogenase, cholinesterase, etc.), since the main source of fermentation is nephrothelial cells (F.K. Mostofi, D.E. Smith. Kidneys. - M.: Medicine, 1972, pp. 62-68).

 However, the diagnosis of this renal lesion is difficult due to the low symptom of clinical manifestations and the lack of specificity of laboratory and functional research methods. As a rule, the hypoxic-ischemic state of the kidneys develops against the background of an existing disease or lesion, and the main attention of specialists is aimed at restoring the impaired functions of other vital organs and systems (respiratory, cardiovascular, central nervous system). As a result of a prolonged hypoxic-ischemic state of the kidneys, the degree of tissue damage from the reversible stage (for example, hypoxic nephropathy) can turn into irreversible - with the development of interstitial nephritis, acute renal failure, kidney infarction, often ending in the death of a patient or lifelong disability (F.K. Mostofi , D.E. Smith, Kidneys .-- M .: Medicine, 1972, pp. 73-83).

 Closest to the claimed method is a microscopic method for the study of urine sediment, which allows to determine a small increase in the number of red blood cells with a normal or slight increase in the number of leukocytes, hyaline or granular cylinders (V.I. Verbitsky, O.L. Chugunova. Diagnosis of nephropathy in newborns. Mat. 1-st Congress "Modern methods for the diagnosis and treatment of nephro-urological diseases in children. - M., 1998, pp. 41-44). This picture is caused by a violation of microcirculation in the kidneys and the development of stasis of red blood cells in the capillaries (with arterial hypertension, poisoning with barbiturates, a pronounced metabolic disorder in the body, "compression" syndrome and other conditions).

 However, the method has the disadvantage that the listed indicators are not specific for kidney damage and can occur during the occurrence and development of various pathological processes in other organs and systems. At the same time, the diagnosis of hypoxic-ischemic lesions of the kidneys is very important, since timely treatment for minor injuries, such as hypoxic nephropathy, leads to the complete restoration of damaged structures and the preservation of the functional activity of the organs of the urinary system.

 The task was to eliminate these shortcomings and create such a diagnostic method that would allow quickly and objectively when testing urine to establish the hypoxic-ischemic state of the kidneys and the degree of damage.

To do this, in a method for diagnosing hypoxic-ischemic kidney damage, including microscopic examination of urine, it is proposed to add 0.01 ml of 8-12% albumin solution in 0.04 ml of urine, dry it on a transparent surface of the plastic for 16-18 hours in the form of a drop at a temperature of 20-30 ^o C and in the presence of dashed cracks to diagnose hypoxic-ischemic damage to the kidneys.

In addition, it is proposed to determine the degree of damage to the kidneys by the nature of the arrangement of dashed cracks:
- when detecting dashed cracks in the marginal zone, extending from a wide main crack located along the edge of the dried drop, diagnose the hypoxic-ischemic state of the kidneys by the type of hypoxic nephropathy;
- when detecting dashed cracks in the marginal zone, forming areas bounded by cracks on all sides, diagnose the hypoxic-ischemic state of the kidneys according to the type of interstitial nephritis;
- when detecting dashed cracks in the marginal zone in the form of complex structures - scallops and the presence of focal formations in the central and marginal zones, diagnose the hypoxic-ischemic state of the kidneys by the type of acute renal failure (ARF);
- when detecting dashed cracks in the marginal zone and rounded forms of amorphized formations in the marginal and central zone, diagnose a hypoxic-ischemic state of the kidneys according to the type of renal infarction.

Figure 1 shows a fragment of a dried drop of urine with dashed cracks extending from a wide main, characterizing hypoxic nephropathy;
figure 2 is a fragment of figure 1, an increase in x65;
figure 3 shows a fragment of a dried drop of urine with dashed cracks forming areas bounded by cracks on all sides, characterizing interstitial nephritis;
figure 4 is a fragment of figure 3, an increase in x65;
figure 5 shows a fragment of a dried drop of urine with dashed cracks in the form of complex structures - scallops and locus formations in the central and regional zones, characteristic of acute renal failure;
in Fig.6, 7 is a fragment of Fig.5, an increase in x65 scallop and locus formation, respectively;
in FIG. 8 - a fragment of a dried drop of urine with dashed cracks and rounded forms of amorphized formations in the central and regional zone, characteristic of kidney infarction;
Fig.9 is a fragment of Fig.8, an increase in x65;
figure 10 is a fragment of a dried drop of urine at normal.

 It is known that hypoxic-ischemic damage to kidney tissue is caused by impaired microcirculation and spasm of larger arterioles. At the same time, numerous stases of red blood cells are observed in the capillaries, their sizing (formation of coin columns) and sometimes loss of certain sections of the renal tissue from the blood supply system. As a result of such damage, the functional activity of the kidneys is impaired, the kidneys work with great stress, which is manifested in the characteristic features of samples of a mixture of urine with an albumin solution, namely, the appearance of dashed cracks (impaired blood circulation in the capillaries), “scallops” - spasms of arterioles extending from a wide main crack along the very edge of a dehydrated drop. With normal functional activity of the kidneys, the separation of a sample of a mixture of urine with albumin occurs without the formation of dashed cracks (figure 10).

 The method is as follows.

Take 0.04 ml of urine into the tube, add 0.01 ml of an 8-12% albumin solution, mix the contents of the tube, apply the mixture to the surface of a transparent plastic in the form of a drop, dry at a temperature of 20-30 ^o C for 16-18 hours. The use of plastic as a substrate is necessary, since this provides a hydrophobic bond of the test material with the substrate.

 The type of cracks is determined in the marginal zone of the dried drop and, in the presence of dashed cracks, hypoxic-ischemic damage to the kidneys is established. Moreover, the more complex the structure of the drop as a whole, the higher the degree of damage to the kidney tissue. So, the appearance of small parts in the central zone of the drop, limited on all sides by cracks, indicates the development of deeper damage to the kidneys - interstitial nephritis. With the spread of locus formations (dashed cracks form in the form of radially symmetric structures) to the marginal and central zone of the droplet and in the form of scallops in the marginal zone to acute renal failure. The appearance of structureless rounded formations against the background of dashed cracks indicates kidney infarction. The last two conditions (acute renal failure and renal infarction) are often accompanied by the death of the patient.

 The severity of hypoxic-ischemic damage to the renal tissue is presented by specific clinical examples.

 Example 1

 Patient V., 47 years old. Diagnosis: urolithiasis, stage of remission.

 Optical examination of urine by the proposed method: dashed cracks were revealed, extending from the wide main mixture along the edge of the dried drop of drops (Fig. 1, 2).

 Conclusion: the hypoxic-ischemic state of the kidneys according to the type of hypoxic nephropathy that developed as a result of increased water load and the use of diuretic herbs.

 Recommendations: stop taking diuretic herbs, switch to normal water regimen, repeat urinalysis after 7 days.

 After 7 days, the patient in the dried drop of the mixture had no dashed cracks, the normal state was diagnosed (Fig. 5).

 Example 2

 Patient K., 66 years old. Diagnosis: Multiple myeloma.

 Optical examination of urine by the proposed method: dashed cracks were detected that emanated from the mixture radial along the edge of the dried drop of the drop. In the central zone, areas are defined that are bounded by cracks on all sides (Figs. 3, 4).

 Conclusion: hypoxic-ischemic condition of the kidneys as an interstitial nephritis.

 Conducted in accordance with this conclusion, an ultrasound of the kidneys showed a densification of her parenchyma, which corresponds to morphological changes in interstitial nephritis. Interstitial nephritis was caused by the chronic course of multiple myeloma, which "flooded" the kidney with paraproteins.

 Example 3

 Patient A., 32 years old. Diagnosis: Poisoning with barbiturates. Acute renal failure. Anuria

 Optical examination of urine by the proposed method: a complex type of structures was discovered in the form of dashed cracks - scallops in the marginal zone of the drop, in the central and marginal zones there are independent small sections bounded by cracks on all sides (Figs. 5, 6, 7).

 Conclusion: the hypoxic-ischemic state of the kidneys as an acute renal failure.

 The conclusion is confirmed by renal autopsy data.

 Example 4

 Newborn L., the 17th day of life. Diagnosis: Severe asphyxia during childbirth. Intraventricular hemorrhage of 3 degrees.

 Optical examination of urine by the proposed method: a complex type of structures was revealed in the form of dashed cracks in the marginal zone of the droplet; in the marginal and central zone there are round-shaped amorphized formations (Figs. 8, 9).

 Conclusion: hypoxic-ischemic state of the kidneys according to the type of renal infarction.

 Conducted in accordance with this conclusion, an ultrasound of the kidneys revealed strong echo-positive signals of irregular shape in the projection of the pyramids, which corresponds to morphological changes in renal infarction.

 The proposed method allows you to quickly diagnose the hypoxic-ischemic nature of the lesion of the kidney tissue, as well as the degree of damage. For the first time in the practice of clinicians, it becomes possible to objectively fix hypoxic-ischemic damage to the kidneys, timely correct treatment and prevent the development of formidable complications. The study is non-invasive, the amount of material for analysis is minimal, which is of particular importance for the early diagnosis of newborn pathology.

Claims (5)

1. A method for the diagnosis of hypoxic-ischemic kidney damage, including a microscopic examination of urine, characterized in that they take 0.04 ml of urine, add 0.01 ml of an 8-12% albumin solution, dry on a transparent plastic surface for 16-18 hours in drop form at 20-30 ^o C and in the presence of dashed cracks diagnose hypoxic-ischemic damage to the kidneys.  2. The method according to claim 1, characterized in that when detecting dashed cracks in the marginal zone, extending from a wide main crack located along the edge of the dried drop, a hypoxic-ischemic state of the kidneys is diagnosed as hypoxic nephropathy.  3. The method according to claim 1, characterized in that when detecting dashed cracks in the marginal zone, forming areas bounded by cracks on all sides, the hypoxic-ischemic state of the kidneys is diagnosed as interstitial nephritis.  4. The method according to claim 1, characterized in that when detecting dashed cracks in the marginal zone in the form of complex structures - scallops and the presence of locus formations in the central and marginal zones, the hypoxic-ischemic state of the kidneys is diagnosed as acute renal failure.  5. The method according to p. 1, characterized in that when detecting in the regional and central zone of rounded forms of amorphized formations, a hypoxic-ischemic condition of the kidneys is diagnosed as a kidney infarction.

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