Clinical Value Of Shear Wave Elastography In Evaluating Primary Nephrotic Syndrome

Objective: This research through the real-time shear wave elastography(Shear wear elastography,SWE)technology,the detection of renal cortical elastic modulus value assessment of primary nephrotic syndrome(PNS)Primary Nephrotic syndrome,the difference between patients and healthy people,To analyze the clinical value of the correlation between the elastic modulus value and the degree of renal pathological fibrosis and the laboratory indicators of renal function,to explore the differences of the elastic modulus value of renal cortex in patients with different pathological types of PNS,and to evaluate whether SWE can provide certain clinical reference value in the early diagnosis of disease,dynamic detection of disease progression and prognosis of patients.Methods: A total of 70 patients with PNS who were admitted to the Department of Nephrology from July 2021 to November 2022 and confirmed by renal biopsy were selected as the case group,and 40 healthy people who underwent physical examination during the same period were selected as the control group,ranging in age from 18 to 68 years.The basic information and clinical biochemical indexes of all the candidates were recorded in detail.Use mindray Reason7 T color doppler ultrasonic diagnostic instrument(China),the application of acoustic touch organization quantitative technique(Sound Touch Quantification,STQ)to measure all the central object of left and right kidney essence of elastic modulus value,Combined with renal puncture pathology of PNS patients,renal artery Peaksystolicvelocity(PSV),renal artery Resistance Index(RI)and other routine ultrasound results,Serumcreatinine(SCr),albumin(ALbumin,propagated),urea nitrogen(Bloodureanitrogen,Bun),24 h urine protein quantitative(24-hoururinaryprotein,24 hupro),total Cholesterol(CHOL)Cholesterol,and glomerular filtration rate(estimated Gl Omerularfiltrationrate,e GFR),and other biochemical indicators,and according to the results of the renal biopsy in patients with renal pathology grading standards and e GRF numerical installment according to chronic kidney disease(Chronickidneydisease,CKD)group.The elastic modulus of renal parenchyma was compared between the case group and the control group,and the difference of the elastic modulus of renal parenchyma between different groups of the case group was compared,as well as the correlation of PNS with the results of general and laboratory tests.Results: The elastic modulus of renal cortex in PNS patients was significantly higher than that in healthy control group(P < 0.01).The elastic modulus of membranous nephropathy group was higher than that of microlesion group(P < 0.01).According to e GFR grading in PNS patients,the elastic modulus of renal cortex in patients with abnormal renal function was higher than that in patients with normal renal function(P <0.05).According to the degree of pathological fibrosis,the elastic modulus of renal cortex in the moderate fibrosis group was higher than that in the mild fibrosis group.In PNS patients,the elastic modulus of renal cortex was correlated with age,PSV,RI,SCr,BUN and e GFR(all P < 0.05),and the elastic modulus of renal cortex was negatively correlated with PSV and e GFR.ROC curve was established according to pathological results to evaluate the accuracy of SCr,BUN,UA and elastic modulus of right kidney in diagnosing PNS.SCr,BUN and UA were reliable for positive diagnosis,but there were different degrees of missed diagnosis.When the renal elastic modulus was evaluated,8.235 k Pa was used as the optimal diagnostic threshold to distinguish PNS patients from healthy individuals,the corresponding sensitivity was 80.0%,the specificity was 100%,the Yoden index was 0.80,and the area under the ROC curve was 0.883(95%CI:81.80%-94.70%).This means that the renal elastic modulus value has relatively high diagnostic value for PNS.Conclusion: Shear wave elastography can quantitatively detect the elastic modulus of renal cortex in real time,and can be used to evaluate the difference of renal cortex between PNS patients and normal people.With the decline of renal function,the elastic modulus of renal cortex increased.The application of SWE technology can provide a certain clinical reference for the analysis of patients’ pathological stages and the evaluation of disease prognosis.SWE technique provides a new non-invasive examination method for judging the degree of renal fibrosis in patients with PNS and evaluating the treatment effect and disease progression of patients with PNS.