RU2237435C1 - Differential diagnosis method for diagnosing the cases of simple renal cyst and hydronephrotic transformation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out transcutaneous puncture of liquid-filled lump under ultrasonic control and sucking the content. Protein concentration is determined in the collected liquid. The protein concentration being found greater than 3 g/l, simple renal cyst is to be diagnosed. The value being lower than 1 g/l, hydronephrotic transformation is to be diagnosed.

EFFECT: high accuracy and information capacity of the diagnosis method.

Description

The invention relates to medicine, to urology, to methods for differential diagnosis of a simple kidney cyst and hydronephrotic transformation.

A simple cyst is the most common of all benign volumetric formations of the kidneys. Difficulties in the differential diagnosis of kidney cysts with hydronephrosis arise with far advanced hydronephrotic transformation - at 3 stages, when the kidney is a “bag” filled with urine. The second situation is stage 3 hydronephrosis of one of the halves of the doubled kidney, when the hydronephrotic transformation of half of the kidney is taken as a simple cyst.

Most often, the diagnosis and differential diagnosis of a simple kidney cyst is carried out on the basis of ultrasound, excretory urography, radioisotope examination of the kidneys, X-ray computed tomography of the kidneys, renal arteriography, cystography. However, the implementation of all these modern diagnostic methods in rare cases does not allow an unambiguous diagnosis to be made before an open surgery is performed [1].

Even 20-30 years ago, this issue was not fundamental, since in any case there was only one treatment method - an operative one, in which the diagnosis was finally established and the necessary surgical manual was performed.

The situation has now changed. Various minimally invasive interventions for kidney cysts have been introduced into widespread practice: percutaneous puncture of cysts under ultrasound guidance with or without sclerotizing agents [1], laparoscopic excision of kidney cysts [2], excision of cysts from mini-accesses during retroperitoneoscopy [3]. With these interventions, accurate diagnosis is especially important.

Closest to the proposed one is a method for differential diagnosis of simple kidney cysts and hydronephrotic transformation, which consists in percutaneous puncture of fluid formation under ultrasound control and cystography and subsequent study of radiographs with visualized volumetric formation [4]. However, this method has the following disadvantages: when conducting cystography, the radiation load on the patient increases, there is a need for additional administration of a contrast drug, and there appears a dependence of the diagnostic accuracy on the subjective interpretation by the doctor of the results of cystography.

A new technical task is to increase accuracy and information content. The problem is solved by a new method for differential diagnosis of a simple kidney cyst and hydronephrotic transformation, including transdermal puncture of a liquid formation under ultrasound control and aspiration of the contents, moreover, the protein concentration is determined in the obtained liquid and a simple kidney cyst is determined at a protein concentration of more than 3 g / l, and protein concentrations less than 1 g / l hydronephrotic transformation.

The method is as follows. As an apparatus for ultrasound examination of the kidney and monitoring the progress of the puncture, you can use, for example, the Panthera 2002 ADI apparatus manufactured by B&K Medical A / S (Denmark).

Puncture of fluid formation in the kidney is performed in the operating room, with all the rules of asepsis and antiseptics. The patient is placed on the operating table, on a healthy side or on the stomach. Process the surgical field. An ultrasound probe examines the kidney and fluid formation, outlines the course of the puncture channel. In the course of the proposed puncture, local infiltration anesthesia is performed with a local anesthetic (novocaine 0.25-0.5%, lidocaine 0.25-0.5%). Under ultrasound control, a needle is inserted into the cyst cavity, through which a string is inserted, and then a drainage tube is inserted along the string. Aspirate the contents of the cyst and send it to the laboratory to determine the concentration of the protein, for example, by photoelectrocolometric method. At a protein concentration of more than 3 g / l, a simple kidney cyst is determined, and at a protein concentration of less than 1 g / l, a hydronephrotic transformation.

The proposed criteria are determined based on the interpretation of the results of clinical observations.

In the urology department of the hospital clinic of the Siberian State Medical University for the period from 1999 to 2003, puncture treatment of simple kidney cysts was performed in 43 patients. Diagnosis was based on all of the modern research methods listed above (ultrasound, excretory urography, radioisotope examination of the kidneys, cystography). In addition, after cyst puncture, its contents were examined for protein content. In all patients with simple renal cysts (41 patients), the protein content ranged from 3.3 to 3.5 g / L. In two patients who were subsequently diagnosed with hydronephrotic transformation of stage 3 of the lower half of the doubled kidney, the protein content was 0.033 and 0.034 g / l. Both of these patients were observed by a urologist at a polyclinic for simple kidney cysts for 5 and 8 years.

Example. Patient M., 58 years old (medical history No. 337), was admitted to the urology department of hospital clinics of the SSMU on 04.21.2003 with a diagnosis of a simple cyst of the lower pole of the right kidney. Complaints of periodic dull pain in the lumbar region on the right. History: eight years ago, during an ultrasound examination during a routine examination, a cyst of the lower pole of the right kidney was detected up to 15 cm in diameter. At the time of examination, ultrasound revealed the presence of a cyst in the lower pole of the right kidney up to 17 cm in diameter. Excretory urography was performed: the excretory function of the kidneys was timely, symmetrical, the pyelocaliceal system was expanded, a volumetric formation adjoining the lower pole of the right kidney was up to 17 cm in diameter. Conclusion: cyst of the lower pole of the right kidney? Hydronephrosis 3 stages of the lower half of the doubled right kidney?

Puncture of fluid formation of the right kidney under ultrasound control was performed on April 23, 2003. The liquid was aspirated, the protein concentration was determined, which turned out to be 0.033 g / l. The diagnosis of hydronephrotic transformation of the 3rd stage of the lower half of the doubled right kidney was established. Given the exact diagnosis, an open operation was performed on April 25, 2003 — lumbotomy, revision of the retroperitoneal space, resection of the lower pole of the doubled right kidney, which was hydronephrotic and was a “bag” filled with urine. Determining the concentration of protein in the aspirated liquid made it possible to timely diagnose and perform the necessary operation.

Perhaps the huge difference in the protein content in simple kidney cysts and during hydronephrotic transformation is revealed to be explained by different ways of fluid formation in these diseases. With cysts, the fluid is a blood plasma filtrate, i.e. primary urine is high in protein, with no protein reabsorption in the tubules of the nephron. With hydronephrosis, the liquid is the final, secondary urine, which has gone all the way from the glomerulus of the nephron to the cavity system of the kidney, and therefore the protein content corresponds to its level in the general analysis of urine.

Thus, the proposed method for differential diagnosis of a simple kidney cyst and hydronephrotic transformation has the following advantages:

- reduction of radiation exposure to the patient,

- harmlessness and safety for the patient,

- ease of diagnosis,

- reducing the cost of diagnosis and differential diagnosis,

- the absence of a “subjective factor” in the interpretation of cystography data,

- accurate diagnosis, which allows you to immediately change the tactics of treatment, choose a more effective method in the most optimal time.

Sourse of information

1. Ignashin N.S. Ultrasonography in the diagnosis and treatment of urological diseases. - M .: Vidar, 1997, 112 p.

2. Hinman F. Operational Urology: Atlas: Trans. from English - M.: GEOTAR-MED, 2001, 1192 p.

3. Rublevsky V.P., Rublevsky B.V., Ilyinskaya E.V., Likhachev A.G. Minimally invasive retroperitoneal surgery using a retroperitoneoscope. Materials of the scientific-practical conference “Actual issues of urology”, Kemerovo, InSEPZ, 2002, p.129-132.

4. Trapeznikova MF, Urenkov SB, Ba U.R. Diagnosis and treatment of simple kidney cysts. - M., 1997, 132 p.

Claims (1)

The method of differential diagnosis of a simple kidney cyst and hydronephrotic transformation, which consists in conducting percutaneous puncture of a liquid formation under ultrasound control and aspiration of the contents, characterized in that the protein concentration is determined in the obtained liquid and a simple kidney cyst is determined at a protein concentration of more than 3 g / l, and protein concentration less than 1 g / l hydronephrotic transformation.