The Diagnostic Value Of Renal Artery Hemodynamic Parameters In Benign Arteriolar Nephrosclerosis

Objective: To observe the changes of renal artery hemodynamic parameters in theprimary hypertension patients, to evaluate the diagnostic value of the renal arteryhemodynamic parameters in the benign arteriolar nephrosclerosis and to identify therisk factors affecting the renal artery hemodynamic parameters.Method: A total of90patients who were admitted in the Nephrology Department andCardiovascular Department in Dalian Medical University Second Affiliated Hospitalfrom2012January to2013March were enrolled. The control group included30normotensive patients. Sixty primary hypertension patients were divided into2groups:HTN group with30patients having isolated hypertension and BAN group with30patients clinically diagnosed as hypertensive benign arteriolar nephrosclerosis. Basicdemographic data, blood pressure and anthropometric measurements were recorded.Fasting blood samples were taken for biochemical analysis including total cholesterol,triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol,uric acid and creatinine. The fundoscopic examination was also done. The resistanceindex(RI) and acceleration time of both sides of segmental renal arteries and interlobarrenal arteries were measured by Color Doppler echocardiography. TheIndependent-Samples T-test was used for comparison between groups for continuousvariables and chi-square test was used for comparison between groups for categoricalvariables. Receiver operating characteristic curve (ROC) was used to evaluate thecutoff value of RI level of segmental renal arteries and interlobar renal arteries as adiagnostic indicator for the benign arteriolar nephrosclerosis. Further evaluation wasdone by using Pearson correlation coefficient and multiple logistic regression analysisto identify the risk factors of increase in RI level of interlobar renal arteries.Results:1. RI level of interlobar renal arteries in the BAN group（0.72±0.04）weresignificantly higher than the control group（0.59±0.04）and HTN group（0.60±0.07） (P＜0.001) and no significant difference was found between HTN group and controlgroup (P＞0.1); RI level of segmental renal arteries in the BAN group（0.69±0.10）were significantly higher than the control group（0.62±0.07）and HTN group（0.61±0.06）(P＜0.001) and no significant difference was found between HTN groupand control group (P＞0.1).2. The area under the ROC curve was0.919±0.037, Asymptotic95%Confidence Interval(95%CI) was0.847～0.991in the interlobar renal arteries RI levelas a diagnostic indicator for the benign arteriolar nephrosclerosis and the cutoff valuewas0.680. Their Sensitivity, Specificity, Positive predictive value, Negative predictivevalue and Youden value were83.3%,96.7%,96.2%,85.3%,1.8, respectively. The areaunder the ROC curve was0.852±0.051, Asymptotic95%Confidence Interval(95%CI)was0.753～0.952in the segmental renal arteries RI level as a diagnostic indicator forthe benign arteriolar nephrosclerosis and the cutoff value was0.655. Their Sensitivity,Specificity, Positive predictive value, Negative predictive value and Youden valuewere80.0%,80.0%,80.0%,80.0%,1.60, respectively.3. The RI level of interlobar renal arteries increase had significant correlationwith age, BMI, pulse pressure, hyperuricemia and gout(P＜0.05), and gender, courseof hypertension, coronary heart disease, hemoglobin, diabetic, serum uric acid, obesity,total cholesterol, triglyceride, low density lipoprotein were not related. Multiplelogistic regression analysis revealed that only age (OR:1.142, B:0.025, P＜0.05),pulse pressure (OR:1.011, B:0.011, P＜0.05) and gout (OR:13.085, B:2.572, P＜0.05) were independent risk factors for RI level increase of interlobar renal arteries.Conclusions: The resistance index level of interlobar renal arteries and segmentalrenal arteries in the hypertensive benign arteriolar nephrosclerosis patients aresignificantly higher than the isolated hypertension patient and normal popular andthere is no significant difference between isolated hypertension patient and normalpopular.The resistance index level of interlobar renal arteries and segmentalrenal arteries increase has a high diagnostic value to hypertensive benign arteriolarnephrosclerosis in hypertension patients and the value of the resistance index level ofinterlobar renal arteries is higher.Age, pulse pressure and gout are closely related the increase in resistance index level of interlobar renal arteries and segmental renal arteries andmay be the independent risk factors of the hypertensive benign arteriolarnephrosclerosis.