SU957855A1 - Method of diagnostics of kidney hemodynamics distortion at chronic pielonephritis - Google Patents

Description

The invention relates to medicine, namely urology.

A known method for diagnosing renal hemodynamic disorders in chronic pyelonephritis, including reoci nephrography, before and after intravenous administration of the drug Gu.

However, the known method does not provide complete information about the state of renal hemodynamics, in particular, the venous circulation of the kidney: about the availability of reserve possibilities for increasing the venous outflow, about the functional or organic nature of the disorders, about the reversibility of the venous circulation of the kidney.

The aim of the invention is to determine the reversibility of the venous circulation of the kidney. .

This goal is achieved by the fact that, when carrying out a method for diagnosing a renal hemodynamic disorder in chronic pyelonephritis, including reonephrography before and after intravenous administration of a drug, venorutone is administered intravenously in a dose of 10-15 mg / kg body weight for 15-30 minutes and an increase in the rheographic index by 13-72% and at the same time a decrease

diastolic index by 18-60%, peripheral resistance index by 25-50%, and venous outflow ratio by 25-77% diagnose a reversible violation of the venous circulation of the kidney, and while maintaining these parmeters at the same level as in Background or reducing rheographic in10 dex with a simultaneous increase in the diastolic index, the index of peripheral resistance and the venous outflow ratio, a diagnosis is made of irreversible damage to the venous part of the vascular bed of the kidney.

The method is carried out in a suitable manner.

Neonography of the kidneys,

20 on the basis of indications for a particular intervention, kidney reonephrography during cystoscopy and ureteral catheterization, rheonphrography during kidney angiography, 25 nodular kidney reflux during surgery, intervention.  Reefing programs are subjected to qualitative and quantitative analysis.  When detecting a reonephrographic 30 signs of impaired venous circulation in the kidney: the appearance of a domed catacrotic part, a pre-sys- tic wave, a decrease in the rheographic index, an increase in the diastolic index, and a dex of peripheral vascular resistance, an increase in the venous outflow rate — enter intravenous veno-ruton based on / kg of body weight and continue the registration of rheonophrograms for 30 minutes with their subsequent analysis.  The appearance of a concave catacrotic part, the disappearance of a presistopic wave, a decrease in the diastolic index and an index of peripheral vascular resistance, a decrease in the venous outflow rate indicate an improvement in the functional state and the availability of reserve capabilities of the renal hemodynamic knee.  The opposite orientation of the above parameters indicates the irreversibility of changes in the impossible knee of the vascular bed of the kidney, the lack of reserve possibilities for improving renal hemodynamics and the futility of conservative therapy with venorrutone.  Example 1  Venorutic effect on rabbit renal hemodynamics in experimental pyelonephritis A model of chronic pyelonephritis is created by injecting hormonal preparations into the rabbit and culture of a non-pathogenic strain of E. coli.  Then, under hexenal anesthesia, laparotomy is performed.  Install two-channel electrons in the exposed left kidney.  Register the reeonofrogram.  Introduce intravenously venoruton at the rate of 15 mg / kg body weight.  Record rheo-nephrograms every 5 min for 30 MIR.  The rabbit is slaughtered on trivenndm by the rapid introduction of 0.3 g of hexenal.  Examine the removed buds by morphological methods.  In chronic experimental gelonephritis, a characteristic redistribution of blood filling and the alto-tonic properties of blood vessels in the cortex and medulla of the kidney occurs.  Note the decrease eographically index RI cortical substance, t. e of the pulse volume of this zone by more than 2 times (by 52%), an increase in the diastolic D index by 2 times, t. e.  the difficulty of outflow to & a from the arteries into the veins and an increase in the tone of the veins, an increase in the peripheral vascular resistance index of IPA, t. e.  tonus in the arteriole system, more than 2 times; an increase in the venous outflow ratio of the QUO, indicating the last difficulty, is 3 times.  In the medulla of the kidney, where large vascular shunts pass, an increase in RI is noted, t. e.  pulse blood volume, 2.3 times and increase in QUO, t. e.  difficulty of venous outflow, 1.5 times.  After venoruton is administered in a dose of about 15 mg / kg of body weight, the following biphasic changes occur within 30 minutes of observation.  In the first 5 minutes, an increase in the RI (pulse volume) of the cortical substance by 1.3 times is noted; decrease in DI and IPS (relief of blood flow from arteries to veins and decrease in). vein tonus, normalization of arteriole tone (significant. , more than 2 ra. behind; decrease in CWE) relief of venous outflow (by 39%).  In the medulla of the kidney, in the first 5 minutes after the injection of venoruton, the RI increases even more compared to the norm - by 2.6 times, the CI and the IPS - decrease by 45% and 25%, respectively.  The difficulty of venous outflow remains at the same level - KRO 0 ,. 41 + 0.05.  In the vicinity of the 10th minute after the administration of venoruton, a short-term depression of the rheogram indices occurs, reflecting the process of adapting the blood flow to new conditions in the vascular bed of the kidney.  In the vicinity of 15 minutes and up to 30 minutes after the administration of venoruton, a gradual increase in RI in the cortical substance and a decrease in RI in the medulla of the kidney almost to the norm are noted.  At the same time, DI, IPA and CEP are progressively reduced in both the cortical and the medulla of the test kidney.  This indicates the normalization of the distribution of blood filling, the decrease in vascular tone, and the relief of venous outflow in the studied morpho-functional structures of the kidney.  Conclusion: in experimental pyelonephritis, there is a pronounced redistribution of the pulse blood filling of the cortical and medulla of the kidney, the fiapSiiieHHe elasto-tonic properties of the vessels of various morpho-functional structures of the kidney under study, the difficulty of venous outflow from the kidney.  The introduction of venorouton has a pronounced hemodynamic effect in the area of the damaged bloodstream of the kidney.  The observed changes in the pharmacorefunction programs are biphasic, According to the indices of intrarenal hemodynamics and according to this characteristic reaction of the renal vessels, in response to the introduction of venorrout, the availability of reserve capabilities of the venous circulation of the kidney is made, it is concluded that the venous outflow from the kidney improves when exposed to venorrutons, p and me 2.  Sick L, 27 years old diagnosis: chronic pyelonephritis on the left.  Complaints at admission to pain in the left lumbar region of a dull character, elevation of temperature to subfebrile numbers without chills, exercise of turbid urine, headache, periodic increase in blood pressure.  Suffer in the past two years.  In spite of the ongoing therapy with anti-inflammatory and heparin-like agents (trental), the disease is exacerbated periodically.  During examination: AD-140 / lOO mm Hg. Art.  The region of the left kidney is more painful.  Symptom of Pasternack left positive.  Ai blood: leukocytes. 10,000, Hb 10 g%, ESR of 20 mm / h.  An.  urine according to Nechyporenko: 20,000 leukocytes, 3: 1 leukocyte activity, 4,000 erythrocytes, no bacteria.  On the left extracorporeal urogram series, there is a decrease in the nephrographic effect, positive symptoms of Fuchs and Frole, which makes it suspected that hemodynamics is impaired in the left kidney.  To clarify the condition of renal hemodynamics, to determine indications for therapeutic use of hepar-like drugs, or to explain the reasons for the ineffectiveness of the therapy carried out, indirect pharmacoreonephrography with trental during cystoscopy and catheterization of the left ureter is performed.  After selectively collecting urine and recording a direct rheogram of the left kidney, 100 mg of trental are injected intravenously and pharmaco-nephrograms are recorded for 15 minutes.  A qualitative analysis of pharmacoreograms indicates a dramatic difficulty in venous outflow from the kidney in response to an increase in arterial blood flow caused by trental.  A pharmacoreonephrography with venorrutone is used to clarify the nature of the disorders of the venous outflow from the kidney and the availability of reserve possibilities for compensating for them. Venoruton is administered intravenously at a dose of 15 mg / kg body weight and the regulative is recorded for 15 minutes.  The initial rheographic indicators:. reduced RI, an increase in MDI and IPA and QUO of the kidney are characteristic of chronic pyelonephritis.  These figures indicate that the initial pulse volume of the kidney is reduced, the elasticity of the vessels is reduced, mainly in the arteriole system, the peripheral resistance of the renal vessels is increased, the kidney vein tone is high, the outflow of blood from the arteries and the kidney from the venous collector of the kidney is difficult.  In the vicinity of 5 minutes after the introduction of trental, the pulse volume of the kidney increases by 35%, the peripheral resistance of the renal vessels moderately decreases, the tone of the kidney veins remains high, and the venous outflow from the kidney is even more difficult.  In the neighborhood from 10 minutes to the 15th minute.  after the introduction of trental, an increase in pulse blood volume by 8–15% is observed, compared with the initial one, a peripheral decrease. The resistance of the renal vessels by 15-35%, the tone of the veins increases by 15%, the difficulty of the venous outflow from the kidney increases by 30-50%.  Thus, in the vicinity of the 10th to the 15th minute after the introduction of trental as a drug that improves the rheological properties of the blood flowing through the kidneys, a decrease in peripheral vascular resistance and an increase in the kidney pulse volume is noted.  At the same time, hypertonicity of the blood vessels and the progressive obstruction of venous outflow from the test kidney are noted.  This suggests that the venous wheel of the bloodstream of the kidney does not cope with such an increased volume of blood flowing into the kidney with improved rheological properties.  To clarify the nature of the insufficiency of the venous circulation of the kidney, venorutone is administered and the obtained eographic indicators are compared.  In the vicinity of the 5th min after its introduction, against the background of the continuing effect of trental, a further increase in the kidney pulse volume was noted by 35% compared with the baseline, a further decrease in the peripheral resistance of the renal vessels by a 40% decrease in DI, t. e.  vascular tone, by 25% compared with the previous measurement, a decrease in the QUO to the level of the initial indicator, t. e.  significant reduction in obstructed venous outflow from the kidney.  In the vicinity of the 10th to the 15th minute after the injection of venorutone, an increase in the pulse period is noted. kidney blood supply to normal, peripheral vascular resistance drop by 30% below normal, normalization of outflow of blood from arteries into veins and venous tone.  Venous outflow from the kidney is not difficult.  Thus, the use of trental as a means of improving the rheological properties of blood as a form-test causes a significant increase in arterial inflow into the kidney, a decrease in peripheral resistance of the kidney.  At the same time, there comes a dystoleosulist with a predominance of hypertonus of the arterioles and veins and the difficulty of venous outflow from the kidney increases.  The assumption that the venous knee of the renal blood circulation does not cope with such an increased arterial inflow into the kidney is checked during pharmaco-neurography with venorrutone.  Intravenous administration of venoruton within 15 minutes eliminates the difficulty of venous outflow from the kidney, increases the blood supply to the kidney, reduces vascular tone, and decreases the peripheral resistance of the kidney vessels.  So, the proposed method for diagnosing the state of renal hemo-dynamics shows that the difficulty of venous outflow from the kidney in this case is functional and.  reversible character.  There are potential for normalization of venous circulation in the kidney by conservative therapy with venorutine.  The patient was given a conservative treatment with venorrutone with effect.  Recovery.  At the control inpatient examination after a year of data for pyelonephritis is not received.  Froze  Patient B. , 37 le diagnosis: the structure of the left ureteropelvic segment, the stone of the lower calyx of the left kidney, the name of the lower pole of the left kidney, chronic pyelonephritis.  Complaints at admission to constant dull pain in the left lumbar region, periodic attacks of left-sided renal colic.  Suffering from paroxysmal pains periodically for 20 years.  During examination: Hell 135/75 mm Hg. Art.  The region of the left kidney is painful.  Symptom Pasternac who is negative on both sides.  An.  blood: leukocytes 6800, HB 14 g% ESR 2 mm / hour.  An. Nechiporenko urine: 17,500 leukocytes, 4,000 erythrocytes, 2: 1 leukocyte activity, no bacteria, no growth.  Trial. Zimnitskogo 1005-1017, On a series of excretory. the urogram on the right is the norm, on the left the cup-pelvis system the calculus 1.1X1.0 cm in size is located in the lower calyx, the suspicion of wrinkling of the lower pole of the left kidney, the pelvic-ureteral segment on the left is narrowed.  Pa aortogram right vascular pattern of the kidney is normal, on the left vascular pattern of the lower pole of the kidney is depleted. Nephrographic effect is weakened there.  On the phlebograms of the left kidney, intraorganic varicose dilatation of the small renal eyelids, ring-shaped anastomosis between them was found.  According to a vascular examination of the left kidney, there is a suspicion of impaired renal hemodynamics, in particular of the venous circulation in the kidney.  To confirm the fact of impaired renal disease, clarify the nature and extent of damage: organic or functional, reversible or irreversible, which is necessary to develop tactics for further treatment of the patient: conservative therapy or surgical treatment, organ preservation or organ-carrying out, as well as to clarify the condition hemodynamics of the right kidney, which is necessary to determine the type of conservative therapy in the postoperative period and the judgment of the prognosis for the patient, pharmacore Hepathography with venorruton administration during kidney phlebography.  The active probe electrode is introduced sequentially into the right and left renal veins before and after the internal administration of venoruton in a dose of 15 mg / kg of body weight and the rheograms of the kidneys are recorded within 10 minutes from the moment of administration.  Eographical index, t. e.  pulse blood filling of the right kidney, - normally, left kidney - reduced by 4 times.  Diastolic index, t. e.  the state of outflow of blood from the arteries into the veins and the tone of the veins on the right, - - increased by 1/3, to the left increased by 3 times compared with the norm.  Peripheral resistance index of the right kidney, t. e.  arteriole tone is almost normal, and on the left it is increased by 1.85 times compared with the right kidney IPA.  The coefficient of obstruction of the venous outflow on the right is increased by 0.6, and on the left is increased by 4.5 times compared with the norm.  10 minutes after intravenous administration of venoruton in a dose of 15 mg / kg body weight, an increase in the pulse volume of the left kidney by 1.6 times, a decrease in the diastolic index and peripheral resistance index to the norm, 5 times the venous outflow coefficient by 3 times, indicating that Improved hemodynamics of the left kidney.  At the same time, there is a slight decrease in the blood volume of the right healthy kidney by 31%, an increase in the peripheral vascular resistance index by 14.5% compared to the norm. the kidneys. .  At the same time, a 16% decrease in diastolic index and a decrease in the ratio of the venous outflow of the right kidney to the norm are noted.  Thus, impaired venous circulation in the right kidney is functional in nature, conservative therapy with venorrutone of these disorders is prognostically favorable.  The impairment of venous blood circulation in the left kidney is organic, but to a certain extent reversible. An organ-preserving operation on the left kidney is shown to the patient.  The patient underwent surgery: Extrapleural.  on extraperitone is applied to the thoracotomy in the XI intercostal space on the left.  Resection of the pelvis-scapular segment. Pi lolitotomi.  Ureteropieloanastomosis Biopsy kidney.  In the operation code, there was a question about the safety of a functioning parenchyma at the lower pole of the kidney, t. e.  on the feasibility of resection of the lower pole of the kidney and on the demarcation line of resection.  To solve these questions, the proposed method of diagnosing impaired renal hemodynamics of the upper and lower poles has been applied.  Two-channel needle electrodes are installed in pairs in the region of the upper and lower poles of the operated kidney.  The recording of rheograms of the cortical and cerebral substance of the upper and lower pole of the point was made.  Then, venorutone was administered intravenously at a dose of 15 mg / kg of body weight and the recording of pharmacoreograms was continued for 30 minutes from the moment of administration of the drug.  In pharmacoreography of the lower pole, the border of resection of the latter was established due to the absence of positive dynamics of the re-refrogram indicators on the administration of venoruton.  The lower pole of the kidney was resected according to the established demarcation zone.  The results of intraoperative rheography of the cortex and medulla of the upper healthy and lower stern poles of the operated kidney before and 30 minutes after the injection of venorouton show that the rheographic parameters of the so-called healthy upper pole of the kidney are different from normal. In the cortex: RI, t. e.  the value of pulse blood volume, by 5-35%. less than norm, DI, t.  the state of outflow from arteries to veins in venous tone, increased by 9-52%, IPS, t. e.  peripheral vascular resistance, increased on average by 20%, QUO, tons e.  difficulty of venous outflow, increased by an average of 1.8 times.  These indicators suggest that in the cortex of the healthy upper pole there is an increase in vascular tone, a decrease in elasticity, an increase in resistance to blood flow in the capillaries and, as a consequence, a decrease in blood supply.  At the same time, the following changes in intraorginal hemodynamics are observed in the medulla of the upper pole: RI increases by 3060%, which is evidently due to the redistribution of blood supply and blood flow through the shunt of the medullary substance, IPA on average decreases by 16%, however.  DI and QUO increase on average by 20% and 30%, respectively, indicating a compensatory temporary increase in the blood filling of the medulla, as the latter is achieved by increasing the vascular tone.  Rheographic indicators of the affected lower pole differ significantly from both normal values and the upper pole indicators.  Thus, in the cortical substance, the RI is significantly reduced: 3.0–4.3 times, DK is 38–68% increased, IPA is increased 1.6–2.1 times, the QUO is increased by 2.78, 0.  In the medulla of the lower pole, the IPA is reduced sharply: by an average of 53%, while DI and QUO are increased by an average of 53%, and DI and QUO are increased on average by 50% and 85%, respectively. e.  even more significantly than the same indicators of the upper pole, RI increased dramatically: 2.84, 1 times.  Thus, the difference between the above indicators of the cortical and medulla of the upper healthy and lower affected poles of the test kidney is highly reliable, indicating a different functional state of the vessels of the structures of these zones.  in the cortex of the upper pole, RI increases by 18–62%, DI decreases by 40%, t. e.  almost to normal.  IPS drops 1.5-2.7 times.  CWO is reduced by an average of 1.8 times, t. e.  normalized.  In the medulla of the upper pole: the RI does not statically reliably change.  DI is reduced by 5-25%, t. e.  normalized.  The IPA is not statistically significantly changed, as is the RI, with which it is not conjugated.  In the lower cortex cortical substance: RI, on the contrary, decreases even more: by 19-100%, and DI increases even more: by 36%, IPA increases even more - by an average of 12%, CEP decreases slightly, remaining above normal .  In the medulla of the lower pole: RI increases by 12-59%, CI increases even more: by 13%, IPA and QUO are not statistically significantly changed.  In this way.  It follows that the reaction of the blood filling and the elasto-tonic properties of the vessels of the renal tissue with different degrees of damage in response to the introduction of venorouton is different.  This is due to the unique properties of the drug to act in the region of the capillary tus-la, experiencing hypoxia and functional acidosis.  The redistribution of blood filling between the various morpho-functional structures of the kidney is due to the properties of the drug to increase cortical blood flow by reducing the medullary one, which is a reflection of Robin Hood's simpton and occurs due to the spastic increase in the tone of the right kidney vessels.  The biphasicity of the action of venorouton is manifested in the case when the vascular bed of the kidney has not lost its elasto-tonic properties and is a prognostic good symptom.  An increase in the medullary blood flow due to a decrease in the cortical flow, as well as the lack of response of the renal vessels to the introduction of the venora, is a prognostic unfavorable symptom.  The absence of a reaction to the administration of the drug indicates the futility of long-term therapy with venorrutone.  The border of the kidney resection is established by changing the directionality of the eographical indicators in the demarcation zone. Thus, the diagnosis of renal hemodynamics is based on different directivity of the cortical and medulla of the healthy and damaged renal vascular bed before and after the introduction of venoruton and on their comparative analysis.  Based on the analysis of indicators of intraoperative rheograms of patient B.  The following conclusions are made in general, the blood supply of the upper pole of yiviepeHHo is reduced, and peripheral resistance is increased. .  Venous outflow is difficult.  The introduction of venorutone causes an increase in pulse volume by increasing the capillary phase of the blood flow, reducing peripheral resistance of the renal vessels.  Normalization of the venous outflow from the upper pole of the kidney occurs.  The blood supply to the lower pole of the kidney is significantly reduced, the peripheral vascular resistance to high fever.  Significant difficulty of venous outflow.  The introduction of venorouton does not cause positive changes in hemodynamics. : the blood supply does not increase, the difficulty of the venous outflow increases.  This serves as an additional rationale for resection of the lower pole of the kidney, helps to detect the border of resection of the organ.  Histological, histoenzymatic and electropho-microscopic studies of the biopsy specimens of the upper and lower regiments of the kidney before and after the injection of venorouton confirm the reographic data on the integrity of the vascular structures and parenchyma of the upper pole of the kidney and their irreversible changes in the lower pole of the kidney, which confirms retroactively confirms the evidence of the kidney and confirms the irreversible changes in the lower pole of the kidney, which confirms retroactively confirms the evidence of the kidney and confirms the irreversible changes in the lower pole of the kidney, which is confirmed by retroactive evidence of a well-developed kidney and the irreversible changes in the lower pole of the kidney. and provides a fairly favorable prediction of the function of the rest of the kidney.  Thus, brl B. With chronic local pyelonephritis, according to vascular examination, a difficulty in venous outflow from the left kidney was found, the nature and extent of which were not dreamed of.  Conducting pharmacoangioreonephrography indicated the organic, but to a certain extent reversible nature of the disorder and the presence of reserve possibilities for improving the venous circulation of the left kidney, which confirmed the expediency of organ preservation for the operation.  The use of intraoperative pharmacoreonephrography of the upper and lower poles of the kidney according to the proposed method indicates a positive dynamics of venous outflow in the upper pole and the absence of such in the lower pole of the kidney. This confirms the correctness of the operational tactics and helps to determine the extent of kidney resection.  Normalization of venous outflow in the upper pole in response to the introduction of venoruton justifies the feasibility of pharmacotherapy with this drug in the postoperative period and a rather favorable prediction of the function of the remaining part of the kidney.  Morphological methods for the study of renal biopsy specimens confirm the objectivity of the proposed diagnostic method.  The proposed method was applied in an experiment on 30 rabbits and in clinical conditions on 10 patients.  It was found that the proposed method provides for the determination of the reversibility of the venous circulation south of the kidney, is not traumatic, does not complicate the examination, does not affect the condition of the patient, is simple in technical methods.  However, the proposed method is effective, gives more complete information than the known method helps. the choice of tactics for further treatment of the patient, especially.  / in intraoperative diagnosis, in determining indications for conservative therapy and judgment, on the prognosis of the disease

and to improve the results of adequately prescribed treatment of diseases associated with impaired renal hemodynamics.

Claims (1)

1. Freulich V.F., Neimark A.I. Rheography in clinical urology. Barnaul, pp.32-52, 1973.