Study Of The Applied Value Of B-US, CDFI, CDE And SWEI In Chronic Kidney Diseases

Objective:To discuss the value of the B-mode ultrasound(B-US), color doppler flow imaging(CDFI), doppler energy(CDE) and shear wave elasticity imaging(SWEI) in chronic kidney diseases(CKD). Methods:1. 69 patients diagnosed with CKD as nephropathy group and 30 cases of healthy people as normal group were admitted in.2. We measured the length, width, thickness of renal parenchyma, boundary between cortex and medulla of kidney, and the echo of renal parenchyma by B-US. We also measured the peak systolic velocity(Vs) and resistance index(RI) of main renal arteries(MRA) and segmental renal arteries(SRA) by doppler ultrasound. We tested the central cortex of kidney by SWE when the experimental objects were in lateral position. All the numbers of nephropathy group would go through the ultrasound guided percutaneous renal biopsies biopsy. Observing renal tissue with light microscope and immunofluorescence.Results:1. According to the gray scale, the images of kidney in CKD were divided into five groups, there was a positive correlation between the gray scale and the clinical stage(r=0.621,P<0.001). The correlations of the young’s modulus value among the five groups were as following: there were significant differences between all five groups and the normal group(P<0.05), group ① and ③,group ② and ③, group ① and ④, group ② and ④, group ① and ⑤, group ② and ⑤(P<0.05). There were no significant differences between group ① and ②, group ③ and ④, group ④ and ⑤(P>0.05). The lengths of the kidney in different stages of CKD measured by B-US shortened while the clinical stage raising.2. Among the measurements of CDFI and PW, Vs of MRA and SRA slowed down, while RI increased when the CKD clinical stage raised.3. According to the condition of renal vessel filling, the CDE images of CKD were divided into four types: type ① was full-filled type, type ② was edge-defect type, type ③ was star-point type, type ④ was no-blood type. There was no significant differences between type ① and ②, there were significant differences between type ① and ③, type ② and ③. There wasn’t type ④ in this study.4. There was significant difference of young’s modulus value between different stages of CKD and normal group.5. There was a positive correlation between Lee’s stages of Ig A nephropathy and those young’s modulus values(r=0.599, P=0.025).6. The correlation between young’s modulus value and biochemical indicators in blood of each stage in CKD: There were positive correlations between young’s modulus value and BUN, Scr, Cys C level(r=0.556, 0.624, 0.695 respectively). In the stage one CKD patients, the levels of biochemical indicators were nomal while the young’s modulus values have already raised. In the stage two, the young’s modulus values also raised, while only the level of Cys C increased. In the stage three, all the biochemical indicators in blood increased, and the young’s modulus values raised obviously.7. In This study, the positive rate of B- US in CKD was 53.62%, that of CDFI was 52.17%, that of CDE was 37.68%, that of BUN level was 40.03%, that of Scr level positive rate was 57.97%, that of Cys C level was 59.42%, as well as that of SWEI was 66.67%. Conclusion:1. SWEI can provide diagnostic information when there’re no obvious abnormal changes in the B-US.2. SWEI technology can objectively measure the elastic modulus of renal cortex for patients diagnosed with CKD. Along with the progression of CKD, the tissue fibrosis and hardness of the renal raised, elasticity of renal parenchyma de-creased, young’s modulus value increased. We deduce that SWEI technology can provide more diagnostic information for the early diagnosis of CKD.3. There are positive correlations between the young’s modulus value and BUN, Scr, and Cys C in the CKD patients. Compared to the blood biochemical examination, the young’s modulus value can give an earlier hint to kidney damage.