| Objective: Approach the value of ultrasound evaluation for chronic renal insufficiency about clinical diagnosis . To assess the rate of perirenal hematoma after ultrasound-guided renal biopsy.Materials and Methods:1 Object:A group for comparison:40 age- and gender- matched normal volunteers(medical history, physical examination, chemical examination including routine urine, urine sediments and kidney functional check normalcy),male 20 and Female 20 cases with a mean age of 32.7±13.5 years.serum creatinine<138μmol/L. According to renal inadequacy, the patients of chronic glomerulonephritis are made to three groups。B group: 244 cases in compensation time,the serum creatinine<177μmol/L. B group was divided into two groups B1 and B2. 186 cases in group B1,the serum creatinine<138μmol/L, ages are from 18 to 65, including male 97 and female 89 cases with a mean age of 48.4±12.7 years. 58 cases in group B2, the serum creatinine between 138 and 177μmol/L, ages from 15 to 77, including male 26 and female 32 cases with a mean age of 44.7±17.2 years. C group: 56 cases in azotemia time, the serum creatinine between 178 and 445μmol/L, ages from 22 to 69, including male 31 and female 25 with a mean age of 49.2±11.8 years. D group: 49 cases in uremia time, the serum creatinine > 445, ages from 26 to 69, including male 27 and female 22 with a mean age of 48.8±10.9 years.2 Methods: The kidneys were examined with the Acuson Sequoia 512 and Philips iU22 US instruments with 2~5 MHz transducer. The biopsy device was Bard with 16G biopsy cut needle made in USA.The patients lying in the recumbent position was examed firstly by 2-D ultrasound. The echogenicities of the parenchyma and the renal structures were appeared. The length, width, and thickness and parenchyma thickness were measured. The renal blood flow was noted on CDFI. The resistance index(RI) of the main and segmental of renal artery(near the renal hilum 1 cm) were measured on PW.The puncturatic biopsy operation of kidney was made under the guidance of ultrasound. The samples was examed on light microscope.The patients had been examming on real time ultrasound when the biopsy procedure was done so as to confirm if the perirenal or sub perirenal hematoma were exist. The largest hematoma size was measured if the hematoma existed.3 Statistics: A least significant difference t-test was used to compare the length, width, thickness of kidney, parenchyma thickness and RI of the main and the segmental of renal artery among A, B2,C and D. The 2-D ultrasound grade and CDFI grade were compared with pathology respectively. The results were tested with Kruskal-Wallis test. The results of the rate of perirenal hematoma among group B2, C and D were tested with chi-square test respectively. P values < 0.05 were considered significant. The SPSS 13.0 was used to statistical computations.Results:1 The distribution of the pathological types of chronic renal insufficiency were (from high to low) IgA nephropathy, membranous nephropathy, focal segmental glomerular sclerosis, mesangial proliferative glomerulonephritis, minimal change glomerulonephritis, endocapillary proliferative glomerulonephritis, membranoproliferative glomerulonephritis, proliferative sclerosing glomerulonephritis and crescentic glomerulonephritis. The IgA nephropathy can be seen in various types of pathology.2 The secondary glomerular diseases were lupus nephritis (18 cases), purpura nephritis (16 cases), HBV-associated nephritis (7 cases) and hypertention nephritis (6 cases). The main pathological types of lupus nephritis was endocapillary proliferative glomerulonephritis, and part of them happened together with membranous nephropathy. The main pathological types of purpura nephritis were mesangial proliferative glomerulonephritis (7 cases) and focal segmental glomerular sclerosis(5 cases). The pathological type of HBV-associated nephritis was membranous nephropathy.3 Comparing about the length, width, thickness and renal parenchyma thickness of kidneys in each group, no difference was showed between B2 and A group(P>0.05) on statistics. Otherwise, the apparent difference was appeared between C and B2 group(P<0.05), the same result was noted between D and C group(P<0.05).4 The relationship between grading of chronic renal insufficiency on 2-D US and CDFI and clinical grading: The renal structure , echogenicity and renal flow were related with severity, and developing with the process. The echogenicity of renal parenchyma was devreased, the renal structure was chaotic. The signal of renal flow was decreased also. No difference was showed between B2 and A group(P>0.05) on statistics. Otherwise, the apparent difference was appeared among C, B2 and A group(P<0.05), the same result was noted among C and D and B group(P<0.05).5 The relationship between RI and clinical stage: No apparent difference of resistant index(RI) of the main and segmental of renal artery was demonstrated on statistics between A and B2 group(P>0.05). the apparent difference was appeared between C and B2 group(P<0.05), the same result was noted between D and C group(P<0.05). The flow spectrum of renal artery was increasing slowly in systole and decreasing slowly also in C and D group. The elasticity of blood vessel was decreased, and showed high RI. The spectrum appeared high resistance.6 The relationship between the grading of 2-D US, CDFI and pathology: No significance was noted on statistics(P>0.05).7 The relationship between the rate of perirenal hematoma and clinical stage: B2 group hematoma incidence was 6.90%, C group hematoma incidence 12.50%, D group hematoma incidence 16.33%. No statistical difference was demonstrated.Conclusion:1 The images of kidneys in azotemia time and uremia time were noted on real time 2-D ultrasound. The decreased length, width, thickness of kidney were appeared. The echogenicity of renal parenchyma was increased. The irregular renal structure was demonstrated. CDFI can detect blood flow perfusion of kidney and the changes of the renal hemodynamic. The injury of micro renal vessels could be demonstrated in early stage. 2-D ultrasound. And CDFI showed more significant in diagnosis and prognosis for CRI.2 No practical significance between grading on 2D-US, CDFI stage and pathological type was showed. To confirm pathology types is still dependent on ultrasound-guided needle aspiration.3 In the study, the rate of perirenal hematoma after ultrasound-guided needle aspiration was 9.46% and increased gradually with the extent of kidney damage mounting up. No significance was noted on statistics among the rate of hematoma. The Hematoma related biopsy and the relationship with the clinical stage should be studied in further.
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