UA20058U - Method for assessing structural and functional state of kidneys in patients with chronic pyelohephritis - Google Patents

Abstract

The method for assessing the structural and functional state of the kidneys in the patients with the chronic pyelohephritis comprises the estimation of the resistance indices for renal, segmental and interlobular arteries. In addition, the minute volume of the renal blood flow is measured and the patterns of the blood flow are analyzed in the mode of energetic Dopplerography. The normal pattern of the blood flow analyzed in the mode of energetic Dopplerography with the minute volume of the renal blood flow exceeding 340 mL/min are indicative of the preserved functions of the kidney examined. The presence of the depletion foci detected in the mode of energetic Dopplerography with the minute volume of the renal blood flow exceeding 340 mL/min is indicative of the focal nephrosclerosis. The diffuse depletion of the blood flow with the minute volume of the renal blood flow below 340 mL/min is indicative of the diffuse nephrosclerosis.

Description

Description of the invention

The proposed useful model refers to the field of medicine, namely urology and nephrology and can be used to determine the structural and functional state of kidneys in patients with chronic pyelonephritis.

Chronic pyelonephritis is an important medical, social and economic problem due to the high frequency of development of nephrosclerosis, nephrogenic arterial hypertension and chronic renal failure

IVivpor M., Alas! V., MUiidpeg MU. Ogipagu igasi iptesyope - vittagu oii aiadpoviis apa igeaytepi oriopve //

Epg. Ogoi. - 2001. - M. 39, Moi. - (Sctis. Ogoi. 2.6). - R.1-121). 70 In connection with this, the development and introduction into clinical practice of minimally invasive and highly informative methods of diagnosing nephrosclerosis and the functional state of kidneys in this category of patients become particularly relevant.

There is a well-known morphological method of diagnosing nephrosclerosis, which consists in histological examination of kidney tissue obtained by puncture biopsy. Tissue samples are fixed in a buffered formalin solution, followed by embedding in paraffin blocks, cutting and appropriate staining. The obtained preparations are examined microscopically, while nephrosclerosis is diagnosed in the presence of fibroplastic changes around and inside the kidney glomeruli, growth of connective tissue in the interstitium (Shulutko B.Y. Pathology of the kidneys:

Clinical and morphological research. - L: Medicine, 1983. - P.10-29). However, the extremely high invasiveness of the method, the need for hospitalization, anesthesia and antibacterial prophylaxis, the risk of intraoperative and postoperative complications sharply limit the use of this method in everyday practice.

There is a known method of diagnosing kidney shrinkage based on the assessment of the morphofunctional state of the renal parenchyma based on the results of excretory urography. Interpreting a series of urograms performed after the administration of an X-ray contrast agent, the degree of nephrosclerosis is assessed (ZteiPe .). Te ipigamepoiz igodgat ip (pe Deesiop ap emaichaiop oi hepai datade oPom/ipo hipagu (hasi ipbesiop. - Reaiiai. MerigoY. - 1995. - "kA

Mo1.9. - Mo2. - R. 213-2201.

Known methods of determining the functional state of the kidney parenchyma are based on the introduction of Ts"99-labeled drugs into the patient's body and kidney scintigraphy and radioisotope renography. After the administration of a radiopharmaceutical drug (most often Ts"799 - dimercaptosuccinic acid) with the help of a gamma camera, the accumulation is evaluated. distribution and elimination of the drug. Interpreting the obtained data, it is possible to determine the function of the kidney parenchyma and the degree of its shrinkage (Miap-Uom S., Zpap-Taig MU., Mipd-Ueg T. ei o a. Kepai! yiYabgovov: rgedisbyop iot asshe rueiIoperipgiiv Tosiz moYiShte teazigei ai 99ttTs aiitegsariovyssipis asii ZRESTI. - Kaidioiudu. - 2001. - Moi.221. - R.366-370; Kizpiop N., Mai M. Oitegsariosispsipis asii hepai (2 zsipidharpu yog (ybe emaishayop oi rueioperpgiiv apa vsatipd: a ogemiem oi ehregitepiai apa siipisa! University of Zitsayev, U.Ogoi, 1992, MoiI.148, R.1726-17321.

The disadvantages of the above X-ray and radiological methods of assessing the morpho-functional state of the kidney parenchyma are the high cost, the need to use X-ray contrast agents and radiopharmaceuticals, which is associated with a high risk of allergic reactions. The main drawback is the massive radiation load, which significantly limits the use of these methods in certain categories of examinees, in particular, pregnant women, children, people with hematological diseases, immunodeficiencies, victims of the accident at the Chernobyl nuclear power plant. c A well-known method of determining the functional state of the kidneys, based on the determination of the excretory function of the kidneys, 1» namely the clearance of certain substances |Shutov A.M. Evaluation of the detoxification function of the kidney based on the clearance of medium molecules. Clinical laboratory diagnostics. - 1996. - Mob. - P.28-30). The disadvantage of the method is low diagnostic sensitivity, besides, it does not provide separate information about the functional state of each kidney.

HF A well-known method of diagnosing nephrosclerosis, based on an ultrasound scan of the kidneys with determination of their size, volume, parenchyma thickness, and area of the renal sinus. The disadvantage of this method is the absence ("in") of information about the functional capacity of the kidney affected by the sclerotic process. o The method of determining the functional state of the kidneys with 5p Color Doppler mapping of the kidney with determination of the resistance index of the renal, segmental and o interlobular arteries of the kidney is the closest to the one proposed by us. The normal value of the resistance index is considered to be 0.7 -0.02. - Zresia. - ASO. Ragiv - 1980. -

R.125). The disadvantages of this method are that the study of the resistance index in the interlobular arteries does not fully reflect the state of blood circulation in the area between the medullary and cortical layers of the kidney; the study of blood flow parameters in patients who underwent kidney surgery can give false data about the severity of nephrosclerosis due to changes in the anatomical structure. c The useful model is based on the task of creating a method of determining the structural and functional state of the kidneys in patients with chronic pyelonephritis, which, according to the useful model, is distinguished by the fact that renal blood circulation is assessed by determining the minute volume of the kidney and studying the blood flow pattern in the mode of energy dopplerography, which gives information about slow blood flow in the cortical substance of the kidney. The task of this invention is to develop the least invasive and most informative method of diagnosing nephrosclerosis in patients with chronic pyelonephritis.

The method is carried out as follows. Kidney scan is performed from the side of the back and side wall of the abdomen. After obtaining a satisfactory picture of the kidney in the "gray scale" mode, the linear dimensions of the kidneys are estimated: b5 Length, longitudinal and anteroposterior dimensions. After assessing the linear dimensions of the kidneys, they move on to studying the blood circulation pattern in the energy dopplerography mode, which allows you to assess the total blood circulation and determine the areas of reduced blood flow that correspond to sclerotic foci. The next stage is the assessment of blood circulation parameters in the mode of color Doppler mapping. First, the image of the main vessels of the kidney is evaluated, then the quantitative parameters of the renal blood flow are studied, namely the resistance index of the renal, segmental and interlobular arteries, which is calculated according to the following formula:

IR-(Mre-Med)Mre; Where:

IR - resistance index;

Mr - peak systolic speed;

Mea - end diastolic velocity. 70 The minute volume of renal blood flow is calculated according to the following formula:

O-MuoihbO, where

MusZh THERE, where

Z-lO2/4, where:

O - minute volume of renal blood flow;

Muoi - volumetric (instantaneous) blood flow;

TAM - time-averaged mean blood flow velocity in the renal artery;

C - cross-sectional area of the renal artery; p is the diameter of the renal artery.

The interpretation of the obtained resistance indices was carried out according to the following criteria: the value of the resistance index on the renal artery above 0.70, on the segmental and interlobular arteries above 0.71 indicates the presence of sclerotic changes in the kidney parenchyma.

The limit value of the minute volume of renal blood flow should be considered to be 34 Oml/min. Focal nephrosclerosis is diagnosed in the presence of foci of blood flow impoverishment in the mode of energy dopplerography and the values of the minute volume of the renal RR of blood flow above 340 ml/min. Diffuse nephrosclerosis is diagnosed in the presence of diffuse impoverishment of blood flow in the mode of energy dopplerography and the value of the minute volume of renal blood flow below 34 Oml/min.

Example. Patient A, 58 years old, was examined in the urological department of the Poltava Regional Clinical Hospital from September 7, 2005. to 13.09.2005 In March 2004, he was treated in the urology department of the Poltava Regional Clinical Hospital with a diagnosis of urolithiasis. Stone of the left kidney.

Acute purulent pyelonephritis on the left (apostema nephritis). Systemic inflammatory response syndrome (septic-C2 shock). On March 12, 2004, nephrostomy with decapsulation of the left kidney, pyelolithotomy was performed. Upon admission, he complains of periodic aching pain in the lumbar region on the left, periodic headache, and an increase in blood pressure up to 165/90 mm Hg. An increase in blood pressure began to be noted 5 months after the surgical intervention. The results of the general analysis of urine: leukocytes 8-10 in the field of vision, erythrocytes 3-4 in the field of vision, oxalate salts. Rehberg's test (09.08.05) - glomerular filtration 77.2 ml/min, tubular reabsorption 9695. - Inspection and excretory urography (09.08.05) - the right kidney showed contrast for 7 minutes, the size, structure and position of the kidney are normal, urodynamics are not disturbed ; the left kidney secreted contrast for 17 minutes, the size of the kidney was reduced to 8.5x4.4 cm, the CMS was deformed, urodynamics were not disturbed. Ultrasound of the kidneys: right kidney with 11.0 x 4.1 x 3.2 cm, left kidney 8.b6 x 4.3 x 3.1 cm, CMS on the left is deformed, compacted. Doppler imaging of the kidneys

I" mode of energy dopplerography: the right kidney - without features, the left kidney - there is a diffuse impoverishment of the vascular pattern. The results of renal dopplerography in the mode of color doppler mapping are shown in the table: in the case of color doppler mapping of the kidneys of patient A., 58 years old. o 5 o so nderizistntest 000000000000055600 079 s Thus, this patient has a diffuse impoverishment of the vascular pattern in energy dopplerography, a significant increase in the resistance index, and a decrease in the minute volume of blood flow below 340 ml per min, which indicates the development of diffuse nephrosclerosis after purulent pyelonephritis . The obtained 60 data correlate with the results of excretory urography.

The proposed method of determining the structural and functional state of the kidneys is implemented in the urology department of the Poltava Regional Clinical Hospital. The specified method makes it possible to reliably estimate the minute perfusion of the kidney in a non-invasive way and allows dynamic monitoring of the structural and functional state of the kidneys with the aim of better medical examination of patients and determination of further treatment tactics.

Claims (1)

The formula of the invention is the method of determining the structural and functional state of the kidneys in patients with chronic pyelonephritis, which 2 includes the determination of resistance indices of the renal, segmental and interlobular arteries of the kidney, which is distinguished by the fact that renal blood circulation is additionally evaluated by determining the minute volume of the kidney and studying the blood flow pattern in the mode of energy dopplerography, while a normal pattern of blood flow according to the data of energy dopplerography and the value of the minute volume of renal blood flow above 340 ml/min indicate the preserved functional capacity of the kidney, in the presence of foci of impoverishment of blood flow in the mode of energy dopplerography and the value of the minute volume of renal blood flow blood flow above 340 ml/min is diagnosed with focal nephrosclerosis, in the presence of diffuse impoverishment of blood flow in the mode of energy dopplerography and the value of the minute volume of renal blood flow below 340 ml/min indicates diffuse nephrosclerosis. Official bulletin "Industrial Property". Book 1 "Inventions, useful models, topographies of integrated 19 microcircuits", 2007, M 1, 15.01.2007. State Department of Intellectual Property of the Ministry of Education and Science of Ukraine. what with (ee) Zo yu "c) "c) s - i" name) (in) (in) 1 IR e) 60 b5