| Primary hypertension(PH) is a clinical frequent disease and common disease. Renal is a common target organ of early damage in patients with essential hypertension. Early Renal structure and function in essential hypertension had no significant change. The PH Patients will finally develop into end-stage renal disease(ESRD) along with the course of the disease and age increasing. The change of renal structure and function caused by hypertension in clinic called Hypertensive Renal Damage. Our previous study suggested the change of artery hemodynamics in PH patients was earlier than that of urinary albumin excretion rate, blood urea nitrogen, serum creatinine and so on, especially the resistance index increase was the base of early impairment renal functions. So the detection of renal artery flow parameter by Color Doppler ultrasound provides an early method of detection of effect of renal caused by PH.Objective:To observe arteriorenal hemodynamics changes and explore the diagnostic value of early renal damage in PH patients by Color Doppler ultrasound.Methods:101 outpatients and inpatients whose primary diagnosis is PH, exclusion of acute or chronic renal parenchyma disease, aneurysm of renal artery-vein and other renal original diseases and urinary tract obstruction and 40 healthy adults were examined by PHILIPS IU22 ultrasonic device with transducer frequency 2-5MHz. Renal structure were observed, renal size, parenchyma thickness and sinus thickness were measured by gray scale ultrasound and parenchyma thickness/sinus thickness were calculated. The filling condition of blood signal of introrenal artery was observed and the display of main renal artery, segmental artery, interlobar artery, and arcuate arteries were recorded with color Doppler flow imaging(CDFI). Blood flow parameters of main renal artery of both kidneys and 1cm close to both kidneys, segmental artery of the intrarenal sinus, interlobar artery of vertebral body were measured with pulse Doppler. The angle(θ) between the sound beam and flow was smaller than 60 degrees. The sample volume size(1-3mm) was placed at arterial luminal center, one of three continuous same spectrums selected were measured and peak systolic velocity(PSV), end-diastolic velocity(EDV), resistance index(RI), and the width of blood flow were recorded. Blood flow was calculated. The blood pressure,β2- microglobin, serum creatinine, blood urea nitrogen, quantity of 24-hour urine protein were recorded. According to European Society of hypertension and European Society of Cardiology(ESH/ESC) guidelines for hypertension management 2007, patients with hypertension were divided into 1 grade group, 2 grade group, 3 grade group.Results:1 Renal image display of gray scale ultrasound there was no statistical significance between renal length-diameter, parenchyma thickness and parenchyma thickness/sinus thickness in 1 grade group and those in normal control group(P>0.05). there was no statistical significance between renal length-diameter in 2 grade group and those in normal control group(P>0.05). there was a remarkable difference between parenchyma thickness and parenchyma thickness/sinus thickness in 2 grade group and those in normal control group(P<0.05). Renal length-diameter, parenchyma thickness and parenchyma thickness/sinus thickness in 3 grade group were reduced obviously compared with that in normal control group, there was a remarkable difference(P<0.05).2 Renal blood flow image display of color Doppler2.1 Arcuate arteries blood flow image display of color Doppler40 case display in normal control group, display rate 100%; 32 case display in 1 great group, display rate 94.12%; 5 case display in 2 great group, display rate 15.63%; 0 case display in 3 great group, display rate 0. There was a remarkable difference and not cross-lineage phenomenon in display results of arcuate arteries of all grade groups(χ2=116.4, P<0.01).2.2 Interlobar arteries blood flow image display of color DopplerBlood flow display of four or more than four interlobar arteries in the same renal section. 40 case display in normal control group, display rate 100%; 32 case display in 1 great group, display rate 94.12%; 5 case display in 2 great group, display rate 15.63%; 0 case display in 3 great group, display rate 0. Blood flow display of three or less than three interlobar arteries in the same renal section. 0 case display in normal control group, display rate 0.2 case display in 1 great group, display rate 5.88%; 26 case display in 2 great group, display rate 81.25%; 12 case display in 3 great group, display rate 34.29%. Not display of blood flow of interlobar arteries. 0 case display in normal control group, display rate 0. 0 case display in 1 great group, display rate 0%; 1 case display in 2 great group, display rate 3.13%; 23 case display in 3 great group, display rate 65.71%. There was a remarkable difference and not cross-lineage phenomenon in display results of interlobar arteries of all grade groups(χ2=167.2, P<0.01).2.3 All display of segment arteries in all groups, display rate 100%2.4 All display of renal arteries in all groups, display rate 100%3 Blood parameter comparison of Renal Pulse Doppler Spectrum. There was no statistical significance between the flow spectrum parameters of main renal artery and segmental artery in 1 grade group and those in normal control group(P>0.05). RI of main renal artery and segmental artery in 2 grade group was significantly higher than those in control group. there was a remarkable difference(P<0.01). EDV in 2 grade group was reduced obviously compared with that in normal control group, there was a remarkable difference(P<0.05). There was no statistical significance between PSV in 2 grade group and that in normal control group(P>0.05). RI of main renal artery and segmental artery in 3 grade group was significantly higher than those in control group, there was a remarkable difference(P<0.01). PSV in 3 grade group was significantly lower than that in control group, there was a remarkable difference(P<0.01). EDV in 3 grade group was significantly lower than those in control group, there was a remarkable difference(P<0.01).4 Correlation Analysis between renal artery RI of PH patients and systolic pressure, diastolic blood pressure, pulse pressure and age RI of main renal artery, segmental artery and interlobar artery in PH patients showed a positive correlation with age. RI of main renal artery, segmental artery and interlobar artery in PH patients showed a positive correlation with PP and a negative correlation with DBP.5 Comparison of renal blood flow in groups Renal blood flow in 1 grade group was slightly higher than those in normal control group, but there was no statistical significance(P>0.05). Renal blood flow in 2 grade group was slightly Lower than those in normal control group, but there was no statistical significance(P>0.05). Renal blood flow in 3 grade group was significantly Lower than those in normal control group, and there was a remarkable difference(P<0.01).6 Laboratory results of PH patients Renal Function Comparing theβ2-microglobin of 1 grade group and 2 grade group with those of control group, there was a remarkable difference(P<0.05). Comparing blood urea nitrogen and serum creatinine of 1 grade group and 2 grade group with those of control group, there was no statistical significance(P>0.05). Comparing theβ2-microglobin, blood urea nitrogen and serum creatinine of 3 grade group with those of control group, there was a remarkable difference(P<0.05).7 Results of renal tissue pathological diagnosis of urenal arteriolar sclerosis in PH patients group Among 12 cases that pathological diagnosis of renal biopsy was renal damage cased by hypertension, the age was 59-74 years old (average 67.20 years old), the course of disease more than 10 year was 1, the course of disease from 5 years to 10 years was 3 cases, and the course of disease less than 5 years was 8 cases. Quantitative of ptoteinuria in 24 hour of 6 case was less than 2.0g/d, those of 6 case more than 2.0g/d and less than 3.5g/d, and no case was more than 3.5g/d.Conclusion:Renal size, parenchyma thickness, parenchyma thickness/ renal sinus thickness were measured and calculated and renal blood distribution, the display rate of renal vessel and the changing of hemodynamic parameters of renal artery flow were observed by Color Doppler Ultrasound in order to early detect renal damage and estimate damage degree refer to the result of laboratory examination, which provided favorable opportunity of reversing and recovering early damage of renal function. Also, for PH patients with proteinuria, whether the duration was long or short, the degree of renal damage was investigated by active pathologic biopsy of renal tissue and they were treated timely, which had important significance for delaying renal damage and improving prognosis.Compared with abdominal plain films, CT, MRI, renogram, and renal dynamic imaging, color Doppler ultrasonography of renal was convenient, low cost, safe, non-invasive, less restricted, and repealed detection, so it was used for mass screening.
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