The Clinical Study Of Early Renal Damage Diagnosis Of Nephritic Syndrome By CEUS

Objective:By comparatively analysis the difference of real-time ultrasound contrast quantitative analysis curve and perfusion parameters of healthy people and the patients with early renal damage of nephrotic syndrome to explore the clinic value of ultrasound contrast quantitative analysis techniques in the diagnosis of early renal dysfunction in the nephritic syndrome. Methods:The patients 30 in all with typical nephritic syndrome (NS) admitted to hospital were considered as the patient group. The serum creatinine and blood urea nitrogen of all members of the group were within normal range, and in line with the definition of stage 1- Normal renal function stage of The Chronic Kidney Disease by the America NKF-K/DOQI working group.10 healthy volunteers include as a control group. Whether serum creatinine (Scr) or blood urea nitrogen(BUN) levels were within the normal range in the two groups, and the blood and kidney tested in the day before the CEUS exam. Use PHILIPS iU 22 as the instrument of contrast ultrasound exam, subjects accept the two-dimensional, color Doppler (color Doppler flow imaging, CDFI) and contrast-enhanced ultrasound (CEUS) examination. Ultrasound contrast agent is SonoVue, dose of 1.0ml of each side of kidney. Observe the perfusion image of the renal cortex of subjects. The examiner uses the image analysis software-QLAB set the region of interest (ROI). All the subjects select the lower part of 1/3 cortical region of the right kidney as the region of interest. Monitoring the signal changes of contrast agent within the recording time, generate the time-intensity curve (TIC curve) correspondingly, and obtain the perfusion parameters, including the area under the curve (AUC), the slope of the curve raise branche (A), the time to peak (TTP), the peak intensity of peak(DPI). The case group members underwent percutaneous renal biopsy tissue and HE staining examination after the CEUS exam, and observe damage degree of the glomerular and renal interstitial results. Compare the perfusion parameters of the case group with the control group. All measurement data express as standard deviation(x±s). Comparison of parameters between the two groups using independent sample T-test. P<0.05 was considered statistically significant. Ultrasound contrast quantitative analysis of each index respectively, with 24-hours urine protein and β2-MG with the Spearman correlation coefficient to measure and test, P<0.05 was considered statistically significant. Results:1) Real-time CEUS technology can clearly show the whole process of contrast agent at the stage of cortical perfusion, medulla perfusion, and the resolution phase in the renal. Time- intensity curve can provide the quantitative parameters of renal perfusion. The area under the curve (AUC) of the left and the right kidney of the study group respectively were (1789.7±300.1) (1705.9±333.5) dB·s,were significantly higher than the control group (1453.7±527.3)、(1403.7±552.6) dB·s; The DPI of the left and the right kidney of the study group respectively were (16.9±2.2)、(16.6±2.1) dB, obviously lower than the control group (23.0±4.1), (22.6±4.3) dB (P值均 <0.01). The time to peak (TTP) of the left and the right kidney of the study group respectively were (35.2±3.6), (36.0±4.2)s, significantly longer than the control group (27.7±6.2), (28.1±7.0)s (P<0.01).The slope of the curve raise branche (A) of the left and the right kidney of the study group respectively were (0.8±0.2), (0.7±0.2)dB/s, obviously larger than the coutrol group (0.6±0.2),(0.5±0.2)dB/s(P<0.05).2) The analysis results of the correlation analysis of the contrast parameters of A, AUC, DPI, TTP respectively with show that:the correlation between Urinary Protein of 24h with AUC and DPI were statistically significant, the correlation coefficients (r=0.672,-0.645 respectively, P<0.01).3) The analysis between the contrast parameters A, AUC, DPI, TTP and serum 02-MG show that beta and TTP statistically significant, the correlation coefficient about -0.405. The correlation does not statistically significant with DPI, A. The renal biopsy results show that there were 14 cases of mesangial proliferative glomerulonephritis,5 cases of segmental glomerulosclerosis,6 cases of focal proliferative glomerulonephritis,5 cases of IgA nephropathy. The pathological results of all the cases were belong to early renal dysfunction stage. Conclusion:1) The ultrasound contrast quantitative analysis technology can evaluate the microcirculation or overall perfusion of left and right kidney separately.2) The series of indicators of ultrasound contrast quantitative analysis technology can quantitatively assess the renal interstitial damage. It was expected as a non-invasive detection means to observe the progress of the disease and estimate the prognosis.3) The CUES quantitative analysis technology can observe the state of renal perfusion, the functional status of the non-invasive reaction glomerular filtration membrane, prompted its abnormal state, not only that, you can also prompted renal interstitial injury to some extent, reflecting tubular filtration function.4) Compare to radionuclide renal dynamic imaging, quantitative analysis of contrast-enhanced ultrasound technology had the advantages of non-invasive, safe, time-saving, repetitive, and had board prospects in the renal microcirculation perfusion.