Research Of Contrast Enhanced Ultrasonography On Early Acute Kidney Injury Of Rabbits Caused By Cisplatin

Background: Acute kidney injury(AKI)is a kind of common critical disease in clinic.The morbidity of AKI raised gradually in recent years,and it increased the burden of social and household medicine.Oliguria and anuria are the major performances of AKI in clinic,the other performances include the accumulation of metabolic waste,such as urea nitrogen(BUN),serum creatinine(SCr),and the balance disorder of electrolyte and body fluid and so on.These performances would cause multisystem injury such as digestion,circulation,blood and so on,and it restricts the diagnosis and treatment of protopathy of the AKI.AKI has the characteristics of acute onset,and poor prognosis,and the course of the disease is emergent.Early detection and treatment of AKI is of great significance.As the leading diagnostic and staging indicator of AKI,SCr and urine volume were likely influenced by factors such as drugs,urinary obstruction and so forth,and it was difficult to reminder the onset of AKI timely,so they are not reliable.Although there are many kinds of new checking index emerging in clinic recently could remind the occurrence and development of AKI sensitively and early such as cystatin C(Cys C),kidney injury molecule 1(KIM-1),interleukin 18(IL-18),because of being susceptible to factors such as drug metabolism,age and body weight,the ability to diagnose the AKI of the new index needs further study to be confirmed.Studies have confirmed that the onset,development and prognosis of AKI were related to the change of the renal microcirculation to some extent.Contrast enhanced ultrasonography(CEUS)has gained rapid development in recent years,this kind of technology had the ability of capillaries angiography which could evaluate the degree of microcirculation,and it has many advantages such as dynamic display of the angiogram,low price and repeatability,and the contrast agent had no renal toxicity.According to a lack of fundamental research,applying the CEUS to explore the change rule of microcirculation of kidney with AKI may offer the new view of AKI early diagnosis and treatment,and it is the purpose of this study.Objective: Aimed to investigate the change of renal microcirculation of AKI led by cisplatin with CEUS,explore the relation of BUN,SCr and imaging parameters in different stages of AKI.in combination with the renal pathologic analysis to evaluate the clinical value of CEUS in early diagnosis and treatment of AKI.Methods: 40 male New Zealand rabbits were chosen randomly,cisplatin(5mg/kg)was injected through ear vein to make an AKI model.40 rabbits were divided into 5groups(T6,T12,T24,T36,T48)randomly according to the inspection time,each group contains 8 rabbits.CEUS was used to examine the kidneys and the venous blood of ear vein was extracted to check the BUN and SCr before and after the modeling.Using the Q-lab software,the imaging dynamic pictures were analyzed and imaging ration parameters such as RT,PI,WIS and AUC were gotten.SCr?1.5 times of cardinal number was considered as the diagnosis golden standard,and ROC curve analysis was conducted to each imaging parameters and to get the best cutoff value.Using SPSS22.0and Med Calc to analyze the data,P < 0.05 was as statistically significant.The renal tissue of rabbits were acquired after the experiment,paraffin-embedded specimens and hematoxylin-eosin staining,and the tissue was observed under light microscope.Results: BUN and SCr raised apparently after AKI modeling.The rabbits of T24,T36 and T48 groups got AKI.BUN,SCr and pathological observations reminded that the state of AKI showed progressive aggravation with the increasing of modeling time.The cortical RT of T12,T24,T36 and T48 groups,cortical PI of T24,T36 and T48 groups,cortical AUC and WIS of T36 and T48 groups were statistically significant than before modeling.The medullary imaging parameters showed no statistical significance than before modeling.CEUS could reflex the change of cortical microcirculation of kidneys with AKI led by cisplatin sensitively,RT changed early than BUN and SCr reached the standard of AKI.PI,WIS and AUC changed later.The analysis result of ROC curve showed that the diagnosis veracity of the cortical and medullary imaging parameters was better and general respectively,the inner comparison of the parameters of cortex and medulla showed insignificant difference.The diagnostic efficiency of cortical WIS was better than medullary WIS and RT,the diagnostic efficiency of cortical PI and AUC were better than medullary AUC.The diagnostic efficiency of cortical RT was better than SCr examination.Conclusion: AKI of rabbits caused by cisplatin showed progressive aggravation in 48 hours.CEUS could reflex the change of microcirculation of kidney,and cortical RT could remind the happen of AKI earlier than BUN and SCr,the cortical and medullary imaging parameters had a certain diagnostic efficiency in AKI diagnosis.The diagnostic efficiency of cortical RT was better than the rule SCr inspection.