Contrast-enhanced Ultrasound Assessment Of Changes Of Renal Microcirculation Before And After Treatment In Patients With Chronic Glomerulonephritis

Backgrounds and objectives：Chronic glomerulonephritis (Chronic Glomerulonephritis, CGN), referred to aschronic nephritis, can occur at any age with most in he green, middle-aged men. Nomally（generally） it happened insidiously and progressed slowly. It is caused by many reasonsand characterised by proteinuria, hematuria, edema, and hypertension, with many degreesof renal failure. After a period, many diseases will eventually develop into chronic renalfailure (chronic renal failure, CRF). The incidence of male patients was more than femalepatients. It is a common， frequently-occurring disease in our country, with the prevalencerate of about5%, which does great harm to people’s health. There is no specific treatmentfor chronic nephritis currently. The main purpose of treatment is to prevent or delay thedeterioration of renal function, improve or relieve clinical symptoms and severecomplications. Therefore, it is important to assess the efficacy and prognosis for chronicnephritis, which is the focus of current research. In our study, two-dimensional ultrasound,color Doppler (CDFI) and contrast-enhanced ultrasound （CEUS）quantitative evaluationwere performed to assess the efficiencet of drug therapy on chronic nephritis and provide areference for the clinical treatment.Objective：To evaluate the feasibility and clinical value of contrast-enhanced ultrasonography(CEUS) in quantitative analysis for the assessment of the renal microcirculation changesafter treatment in the patients with chronic renal failure. To evaluate whether or not thefollowing paraments, such as AUC、 PI、 TTP、 MTT， can assess precisely themicrocirculation improvement. Method：Twenty cases of clinical confirmed chronic glomerulonephritis (CGN) patients whoanticipated in the third phase clinical test of one medicine(the name of medicine is secrettemporally) in our urology department were included in our research from2011年10月-2013年2月.(Siemens S2000diagnostic ultrasound instrument was used to respectivelyassess the patients who were taken into clinical drug trials at the first day and three monthsafter relevant treatment. First of all, two-dimensional ultrasound was used to obverse thelength and thickness and renal cortex, medulla and renal sinus of right kidney. Then, theCDFI model and PW model of color Doppler ultrasonography technology was used to testthe maximal blood flow velocity and blood flow resistance index RI of right renal artery).After intravenous bolus injection of SonoVue, real time CEUS of renal cortex bloodperfusion were collected successively, and a time-intensity curve (TIC) were created withSiemens S2000system’ QLAB software. Changes of the area under curve (AUC), peakintensity (PI), time to peak (TTP) and mean transit time (MTT) were obtained. Urinaryprotein quantitative (NDBDL), urine protein count (PRO), serum creatinine (Scr) and bloodurea nitrogen (BUN) were collected at the same time. Their correlations with time-intensitycurve of each parameter value were analysed.Results：The kidneys of early renal glomerular nephritis patients were tested by thetwo-dimensional ultrasound and color doppler flow imaging(CDFI). The results showedthat there were no obvious difference of the size of kidney and the blood flow velocity andresistance index of segmental renal arteries before and three months after the treatmentswere taken. What is more, there were no statistical difference of the various parametersbefore and after the medicine experimentwere taken.The renal blood flow perfusion parameters, such as PI,TTP,AUC,MTT etc, have somereducing or increasing corresponding with urinary protein quantitative and urine proteincount in24hours. Especially the time-intensity curve quantitative parameter AUC wassignificantly correlated with urinary protein quantitativeanalysis with renal cortex bloodperfusion conditions..Conclusions：There are no obvious diagnostic significance to check kidney function in patientswith early chronic glomerular nephritis by the two-dimensional ultrasound and color doppler flow imaging(CDFI).Quantitative analysis of the CEUS can sensitively reflect the changes of renal corticalperfusion in chronic glomerulonephritis patients. It can be used as preferred technology forearly evaluation of the renal microcirculation changes in chronic nephritis patients.