SU1706561A1 - Method for diagnosis of renal hematuria source - Google Patents

Description

D, o v vascular o - d (lrter: Yalni or venous; ch d sd t. Jr irvect py

G. ZNDr: LC, EXECUTIVE.1. The PpJCDOTfi is a POCRESE Fu Vase ;; Another RPP SHOYYUT is in the projection D of the kidney, which is more severe in the lumbar region D. Connect the electrodes to rsogps-fu. register curves, read n; The walking golos calculate the coefficient of the hay eye. Similar m.v; e: .u.i by -.-. while finding the electrode in the contralateral. renal vessel and a in the lumbar region on the protisopoal, ocher side. With a reliable increase in the background coefficient of a potential outflow from an interested party (by 30% or more), the cause and source of | -..-; the place of renal hemorrhage with ree /, rffic signs of renal hypertension on this same side, i.e. the source of renal hematuria is located on the sides with an increased venous outflow rate.

Example. Ill B., 45 years old, was in the urological clinic since 01/23/84. on 03/26/84. with a diagnosis of hematuria not of a clear genesis. Complaints of pain in the right lumbar region and a microscopic admixture of blood about urine. Sick for two years, when, after suffering a sore throat, there was a nagging pain in the right lumbar region and microhematomas. When examining blood pressure 120/90 mm Hg The kidneys are not palpable, their area is painless, Pasternack symptom is negative on both sides, the bladder is empty. On the review radiograph of the urinary system shadows concrement. Comrade no. On the series of urethral ucrograms, the normal structure of the lateral-hillock systems on both sides, the contrast of the ureteral material is not disturbed by the ureters. There are no filling defects in the projection of the cup-pelvis systems. The npaur-l kidney is located higher than the left: the lower pole is scored at the level of the transverse process L}, the left kidney - the lateral process Lg. On the urogramme of the layer, the lower sang was os lrizo. ; kidney ne level lz. No abnormal changes were found in the most intensive examination of the kidneys. In dynamic nephrssscintigraphy, the function is poorly impaired.

When hromotsiskoskopii indmgokarmin ne 7 min allocated on both sides, pathologically; formations on the mucous there. The source of hematuria during cystoscopy is not highlighted.

On the retrograde ureterspielofamme with sergozin cap, in., - changes in the structure of the MSI; with ns-lxs: ohmol does not surround the t: o. On ni .cnorpSM -.e with hydrogen peroxide

Software K / 1 T MM g "TS-MI ir. 3i l P POSITION KIDNEY NA

obtained by the lead of the intensity of the blood of persecution.

Crozine analysis: lie; Otsit P thousand, HB 13

r, i. err.: trots1; gsv g.Z million. ESR l mm / h, g, .- lschko5%; s; g 1.i &%,tro; 231 thousand. Protein 7.2 g%, lumbum 3.9 g% .. ole-crei / HH 210 mg / o. glucose 110 mg%. urea g.logo b /, mg%, bi / n; RuOin 0.3 mg%, urine0 DHr.d 21 mg%, cancer 0.6 mg%.

Immuno; o (lobulin norm, rheumatic; negative; on coagulation, activation of the blood coagulation system (RCFM-0.840).

5 Analysis of urine total: protein 0.09%, lei.:; cytes 1-3, erythrocyte leaching, 20-50 c. Urine analysis according to Nechyporenko: 275 thousand red blood cells (after exercise). Prsb-e ZU.MNITSKOY 1005-1031 with a diuresis of 950 ml. Rn mpmm

0 4.8-6.2, the excretion of uric acid 0.38 g in su.ki.

Pharmacoproteinuric test with lazix: increase in protein excretion about the polyuria period, indicating

F edema inerstication (penna induration) of the kidney. The glomerular protoninuria was not identified.

At the observational aortogram, the kidney is supplied with blood by one artery, at the intersection with the XII rib, it is divided into two branches that enter the kidney. The left renal artery is not changed. The nefterographic effect is satisfactory on both sides. Rights kidney bean-shaped, left

5 bud - humpback. There is a vein 3 cm in length on the right kidney, with suspected her torsion along the axis. Pedunkulite (). orterio- nszny conflict of the right kidney (). Pressure p renal vein 120 mm water column, chgo not

0 allows you to speak with confidence about venous renal hypertension.

T -: in this way, the study by a known method did not allow to establish the source of renal hematurni and choose

5 adequate treatment for this disease

A study was carried out on the proposed method.

The venous probe is equipped with a metallic mandrel, which functions as an electrode in the lumen of the right renal BG. Another plate-shaped electrode was placed in a wound in the lumbar region in the projection of the kidney. Electrode locations

5 was checked with fluoroscopy. Z / k.ktoody connected to / yes to the scanner and registered reograficch kry.g.ye. In the analysis of descending waves, the coefficient of osseous outflow from the kidney was calculated, which is equal to 0.45 ± 0.04 ed-electoo, /: g; L.O.MI G: g: s :: / O ps. : y: oh him, and n;: l--. spin:; i th ohm r genus;, ::: g. left in the lynical sylgzst; L-. pp; : and i / pok1 / and proizg. / a:. p ,,;, ;;:, о г .-. 1; some | pk and Ј g. and g- "; fi: -, .-: o; i j. The coefficient is calculated for the rate of distinct maternal swelling from the left kidney, which is C G 5 ± C, 02. So ooozom.poiog y KC3v. L i. sonosis outflow from s.: / ntereso and - | ; right side dssu. R.HZHZS, than with the grotto-left left side of the k1 Ripe-, -; e by 30%, p 0.05). This would indicate the cause of renal hematuria with unilateral venous hyperemia, a recurring symptom. which is a significant increase in the rate of venous outflow from the interested party, and consider the right kidney to be the source of renal hemturia.

At the same time, 500 mg (7 mg / kg of body weight) were applied to the croropy troxesazine current and a regimen was performed along the left and right side of the Pschsk for 5 min after administration. The coefficient of the venous flask from the left gyuchka became equal to 0.20 ± 0.02, and from the right one, almost 0.31 ± 0.03, i.e. the repeated coefficient of venous outflow from the right kidney was significantly lower than the background indicator of the same side (more than 20%, p 0.05). On the opposite side of the disinterested party, the decrease in the repeated venous outflow rate is not statically statistically significant (less than 20%, p 0.05). The results of the frmopacter testify to the reversible nature of the impaired venous outflow from the interested party and the usefulness of the prescription of therapy with phlebotonic agents.

Further, in order to monitor the reliability of the findings, a right kidney was reographised by inserting one of the electrodes embedded in the ureteral catheter, during cystoscopy into the right ureter to the pelvis, and placing the other electrode on the skin of the right lumbar area of the kidney projection. Regographic curves were recorded, and the analyzes of the descending part of the reference waves were recorded, and the venous outflow coefficient merged, which turned out to be 0.50 ± 0.05, which was significantly higher than the CWO 0.20-0.25. obtained in a study of 30 patients suffering from diseases of the kidney ooz signs of venous renal disease: disease. Then, trokseg was intrafinely drunk;) o.; N 500 MI (7 mg / kg body weight) and, ixryl rheography after 5 minutes

posgs Gg -jo. iCHi-rr. W .. C ---; .,: f.-: t g ,, ggo from- TOi- from nprf but whether; p him 0.33:. : C, SC, O eC ib DG.TO .. (, .-: H) (-; G ,,, e: g,. Telg with: .a nt:;. Especially Las, b b cheg: nor 20 . r - (, 0 ..

Takpgl obratom, D pe y / ytots take ft m is not p / ;. the floodplain of the Roastrütz: -and f;. р LoKSrTsG rDG / M RECEIVED PPDTG; o | . KDOI (G, S

Dos yermoe yfieKbmjHiio on-tsr ;: his cogofi fi gentl.:; but outflow from the sgd: 1; tsross-right side, that sssnoyet choice of therapies - the appointment of phleootropic agents.

The patient was prescribed therapy / n securuta on 300 mg 2 times a day in those -. 25 days, as a result of which micro-hemguri stopped. After the break gnoulagor- f; o courses lochenich glevenol and doxyium. At the control of the follow-up

0 after six months, no data was obtained for the DSMT.

The advantage of the proposed method in comparison with the ghost is in enhancing the relationship between the resurgent symptoms of venous renal hypertension and the source of renal hematuria. In addition, the advantage of sposoPz in reducing trapmatichnost and raising the information content for the estimates of combining techniques.

0 The positive effect of the method is the possibility of establishing the side - the source of renal hematuria after stopping the bleeding, about the early diagnosis of late diagnosis

5 in the course of the disease, in reducing the therapeutic rate due to an adequate choice of conservative therapy, as well as in the effectiveness of the pathogenetically substantiated prescribed treatment.

0

Claims (1)

Claim method for diagnosing a source of renal hematuria, including cystoscopy with insertion of a catheter into the renal pelvis and zones of renal vessels with antigraphography and phlebotonometry, characterized in that, in order to improve the accuracy of the method by detecting the source of hematuria after its termination, it is necessary to tons of rheography with the placement of electrodes in the renal vessels on both sides and in the lochsna, the coefficients of venous outflow from the kidneys and with one-sided uplich55 coefficients 30% and more diagnose the source of renal hematuria on the side of increasing coefficients.