RU2252707C1 - Method for diagnosing secondary kidney shrinkage in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic triplex scanning comprising renal hemodynamic speed and resistance parameters study with maximum blood circulation velocity in stem artery and pulsation index in arcuate artery being determined before and after protein load. Maximum blood circulation rate being unchanged and pulsation index increased by 20% and more, secondary kidney shrinkage is diagnosed.

EFFECT: high accuracy of diagnosis; no radiation load applied to organism.

Description

The invention relates to medicine, namely to pediatric nephrology, and can be used to diagnose a secondary-wrinkled kidney in children.

There are various methods for diagnosing a secondary wrinkled kidney in children: clinical anamnestic, x-ray urological (excretory urography), radioisotope (angiorenoscintigraphy), ultrasound (conventional ultrasound in B mode and duplex scanning with color Doppler mapping of blood flow) (Olkhova E.B. Sonographic aspects of nephrosclerosis in children // J. Ultrasound Diagnostics in Obstetrics, Gynecology and Pediatrics, 2000, 2, pp. 136-142).

It is noteworthy that none of the above methods has 100% specificity, sensitivity and information content. Usually, a set of research results is used to make a diagnosis. A correctly diagnosed diagnosis determines the prognosis, tactics of dynamic monitoring of the patient and the possibility of timely administration of drugs that prevent the progression of secondary wrinkling of the kidney, which can lead to the development of complications such as arterial hypertension and renal failure.

The objective of the invention is to expand the arsenal of diagnostic tools, namely the creation of a method that allows the diagnosis of a secondary-wrinkled kidney and has its advantages, such as: accessibility, ease of implementation, non-invasiveness, lack of radiation exposure.

The problem is solved in that in the known method for the diagnosis of a secondary-wrinkled kidney in children by ultrasonic triplex scanning (ultrasonic duplex scanning with color Doppler blood flow mapping), which includes determining the speed and resistive parameters of renal hemodynamics, according to the invention, the maximum blood flow velocity of the stem artery and pulsation are determined arc artery index before and after protein loading and while maintaining the initial level of maximum speed increase blood flow and pulsatile index by 20% and more are diagnosed with secondary contracted kidney.

For the first time, a protein load has been proposed to determine the response of the vessels of the renal parenchyma specific for a secondary shriveled kidney. Features of the reaction to protein load for a secondary-wrinkled kidney can be used in the diagnosis.

As a protein load, vegetable protein was used - soy protein in a standard dose.

Ultrasonic investigations were carried out on an ACUSON 128 XP 10 device (USA) using a convex sensor with a frequency of 3.5-5 MHz, a sector-vector sensor with a frequency of 2.5-4 MHz according to the generally accepted method. During duplex scanning, a sequential location of the renal artery was performed in the region of the renal sinus (stem artery) and at the level of the artery artery. The maximum blood flow velocity (Vmax) and the pulsation index (PI) were estimated, which was calculated automatically according to the program of the ultrasound apparatus with a manual stroke of the Doppler blood flow curve. Statistical processing of the results was carried out using the methods of parametric and nonparametric statistics. Statistical processing of the material was carried out using the program Statistica for Windows v.6.0.

We examined 20 children aged 8 to 17 years with a diagnosis of secondary wrinkling of the kidney as a result of vesicoureteral-pelvis reflux.

The research data are presented in table 1

Table 1
Dynamics of parameters of renal hemodynamics of a secondary-wrinkled kidney before and after protein loading Hemodynamic parameter To load After loading Diagnostic criterion V max stem artery, m / s 0.45 ± 0.04 0.52 ± 0.05 No significant increase p≥0.05 PI arc artery 0.77 ± 0.07 0.94 ± 0.07 20% or more increase P = 0.009

From table 1 it can be seen that a significant increase in the average maximum blood flow velocity in the trunk of the renal artery of a shrunken kidney after exercise is not observed, which is apparently due to the lack of reserve capacity of the organ, but increases by 20% or more initially low pulsating index of the artery artery after stimulation, which, apparently, is associated with blocking the mechanism of arteriovenous blood shunting with nephrosclerosis under load conditions and reflects the functional state of the renal parenchyma.

The method can be carried out as follows.

The first ultrasound examination of the patient is performed on an empty stomach, then the patient receives soy protein in a standard dose of 1 g of protein / kg of weight. A second study is carried out 2 hours after oral administration of soy isolate.

The method is illustrated by the following examples.

Example 1. Patient M., 14 years old. Diagnosis: secondary chronic pyelonephritis with a violation of tubular functions, bilateral vesicoureteral reflux (right 4 degrees, left 2 degrees). Secondary wrinkling of the right kidney.

Anamnesis of the disease: from an early age, the pyelonephritis clinic recurred. Ultrasound showed a decrease in the size of the right kidney. It was first examined at the age of 14, when bilateral cystic-ureteral reflux (PMR) was recorded on cystography - 4 degrees on the right, 2 degrees on the left.

Ultrasound: RD 6.2 × 3.1 cm, S = 17.5 sq.cm.

RS 9.6 × 3.8 cm, S = 30.6 sq.cm.

The right kidney is much smaller than the left. The contour is deformed to the right, the parenchyma in the upper and lower third is thinned, and the renal index is reduced. In the upper pole, cicatricial changes in the capsule, poor cortico-medullary differentiation (almost absent in the areas of the upper pole of the parenchyma and middle sections).

Angiorenoscintigraphy: the right kidney is reduced in size, the time of maximum accumulation and the half-life of the radiopharmaceutical are slowed, the volume of blood filling and the functional power of the right kidney are reduced by 70%. Duplex of the renal arteries: on the right, the intrarenal blood flow is diffusely weakened, a sharp dilution of the vascular pattern up to the complete absence in the upper pole, laterally and medially. The blood flow in the trunk of the renal artery is reduced in amplitude. Subcapsular blood flow is sharply depleted. On the left, the intrarenal vascular pattern is not changed. The diameter of the right renal artery is 3.5 mm, the left is 4.2 mm. The results of the protein load test are presented in table.2.

table 2
Dynamics of renal hemodynamics parameters before and after protein loading Hemodynamic parameter To load After loading Vmax of the stem artery, m / s 0.48 0.48 PI arc artery 0.60 0.73

From table 2 it can be seen that by changing the indicators of renal hemodynamics in accordance with the proposed method, we can judge the secondary-wrinkled kidney: after loading, the level of maximum blood flow velocity in the trunk of the renal artery of the secondary-wrinkled kidney remained unchanged, but an increase in the initially low pulsation index of the arc was noted arteries by 21%.

Example 2. M., 9 years old. Diagnosis: small right kidney. Anamnesis of the disease: accidentally, an ultrasound revealed a decrease in the size of the right kidney. There were no pathologies in the analysis of urine, clinical manifestations of a urinary tract infection. Cystography: vesicoureteral reflux (PMR) is not detected.

Ultrasound: RD 6.4 + 2.1 + 2.0 cm, S 12.8 cm, anteroposterior size of the pelvis 0.7 cm

RS 8.0 + 2.4 + 2.6 cm, S 20.7 cm, anteroposterior size of the pelvis 0.5 cm

On the right, the contour is uneven, deformation of the pyelocaliceal system on the right. The bladder is of normal shape, the contours are clear.

Angiorenoscintigraphy 2251: RD Tmax 8 min T1 / 2 29.5 min

RS Tmax 8 min T1 / 2 13.5 min

The right kidney is reduced in size. The glomerular filtration rate of both kidneys is normal. The right kidney is reduced in size, its functional power is reduced by 46%.

Duplex examination: on the left, the nature of the blood flow is normal. On the right, a deformed, depleted vascular pattern is defined, subcapsularly there is no location of small branches. For all branches of the renal artery, low PI.

From the results of the examination it was seen that there is a decrease in the size of the kidney. Deformation of the contour could be considered as a sign of kidney dysplasia. Due to the absence of manifestations of chronic pyelonephritis, which leads to wrinkling of the kidney, and an indication of a decrease in the indices of peripheral vascular resistance of the kidney, it was decided to conduct a protein stress test to determine the reaction of the renal parenchyma and to clarify the diagnosis. The results of the study are presented in table.3.

From the table. Figure 3 shows that the blood flow of this kidney was characterized by initially low speed and resistive indicators. After loading, the pulsation index of the artery artery PI significantly increased (by 25%), reflecting the response of the parenchyma to the load. The level of maximum blood flow velocity in the trunk of the renal artery did not significantly change. Thus, this kidney had the character of a shriveled kidney response to a load.

Table 3
Dynamics of renal hemodynamics parameters before and after protein loading Hemodynamic index To load After loading Vmax, stem artery m / s 0.31 0.37 PI arc artery 0.76 0.95

In this case, the use of methods for assessing renal blood flow under conditions of functional load made it possible to verify the diagnosis.

The proposed method extends the arsenal of tools for the diagnosis of secondary-wrinkled kidneys in children.

Claims (1)

A method for diagnosing a secondary shriveled kidney in children by means of ultrasonic triplex scanning, including determining the speed and resistive parameters of renal hemodynamics, characterized in that the maximum blood flow velocity of the stem artery and the pulsation index of the artery artery before and after protein loading and while maintaining the level of maximum blood flow velocity and an increase in the pulsation index by 20% or more is diagnosed as a secondary-wrinkled kidney.