Clinical Value Of Shear Wave Elastography In Different Pathological Types And Disease Activities Of Lupus Nephritis

Objective:Shear Wave Elastography(SWE)was used to evaluate the correlation between Young’s modulus value(YM)in renal cortex of patients with Lupus nephritis(LN)and its clinical and pathological changes,and to explore whether it can be used for dynamic monitoring of disease progression,prediction of prognosis and early diagnosis.Materials and methods:This study collected 103 patients with LN who underwent renal biopsy in the Department of Nephrology and Immunology of the First Affiliated Hospital of Nanchang University from September 2018 to October 2020,LN patients were classified according to the 2003 International Society of Nephrology/Renal Pathology Society(ISN/RPS)classification,including 10 cases of type I,32 cases of type II,22 cases of type III,25 cases of type IV,14 cases of type V,and 0 cases of type IV.A total of 40 healthy subjects from Physical Examination Center of the First Affiliated Hospital of Nanchang University were selected.All the subjects were female,ranging in age from 17 to 75 years.The basic data and clinical biochemical indexes of all selected candidates were recorded in detail.The AIXplorer SWE ultrasound diagnostic apparatus of Supersonic Image,a French company,was used to perform real-time shear-wave ultrasound elastography examination of the lower pole renal cortex of the right kidney in all the selected participants,and the YM value of the renal cortex was detected.Systemic lupus erythematosus disease activity scale(SLEDAL-2000 scale)was used to evaluate the disease activity index of all patients with LN,including 15 patients in the 0-4 group,37 patients in the 5-9 group,40 patients in the 10-14 group,and 11 patients in the 15 or above group.The Cockcroft-Gault formula was used to estimate Glomerular Filtration Rate(eGFR)of patients with LN.The correlation between YM of renal cortex and BMI of healthy control group was analyzed statistically.The difference of renal cortex YM value between LN patients and healthy control group was analyzed statistically.The correlation between the YM value of renal cortex and the activity index of clinical and biochemical indexes of blood and urine in patients with LN was statistically analyzed.The difference of renal cortex YM value in patients with different pathological types and different stages of LN was analyzed statistically.Results:1.The YM value of renal cortex in LN group was higher than that in healthy control group(P<0.05).With the aggravation of renal pathological types in patients with LN,the renal cortical YM value increased gradually,and the renal cortical YM value in patients with LN type III,IV,and V was higher than that in patients with LN type I and II(all P<0.05).There was no significant difference in renal cortex YM between LNI type and II type(P>0.05).2.In patients with LN,the YM value of renal cortex was correlated with serum creatinine,estimated glomerular filtration rate(EGFR),cystatin C,and serum uric acid(all P<0.05).3.In patients with type I and II LN,the YM value of renal cortex in serum complement C3 decreased group(LNC3+ group)was higher than that in serum complement C3 normal group(LNC3-group)(P<0.05).The YM value of renal cortex of LNC3+ group was higher than that of LNC3-group in type III,IV and V(P<0.01,P<0.05,P<0.05).4.With the increase of activity index,the renal cortex YM value of LN patients gradually increased,and the differences among all groups were statistically significant(all P<0.05).5.According to eGFR grouping,renal cortex YM values of LN G4 stage patients were higher than those of LN G1-3 stage patients(all P<0.05),there was no statistically significant difference in renal cortex YM value among G1,G2 and G3 LN patients(all P>0.05).6.There was no significant difference in renal cortex YM value among different age and body mass index in healthy control group(all p>0.05).Conclusion:1.The SWE technique can be used to measure the elasticity of renal cortex in real time and quantitatively,and can be used to distinguish the renal cortex of normal people and patients with LN.2.With the decrease of renal function,the value of YM in renal cortex increases.The application of SWE to measure the value of YM in renal cortex can provide some reference for the stage and pathological changes of LN,as well as the evaluation of disease activity and prognosis of patients with LN.3.SWE technique can provide a new non-invasive method for determining the degree of renal fibrosis and monitoring the progression of LN.