Diagnostic Value Of Color Doppler Sonography From Region Of Interest In Renal Perfusion With Chronic Renal Disease

Objective:To explore the clinical value of perfusion measurement(VI,FI and VFI)measured by Qlab software based on color Doppler sonography from region of interest(ROI)in evaluating renal perfusion in patients with chronic kidney disease(CKD).Methods:We recruited 180 patients with CKD who were pathologically confirmed in our hospital and divided them into three groups according to the degree of chronic lesions:minimal chronic changes group,mild chronic changes group and moderate-severe chronic changes group.A total of 120 patients with sex and age matching in our hospital during the same period were selected as the control group.Baseline data such as age and comorbidities,as well as laboratory biochemical indicators such as blood creatinine(Scr)and 24 h uric protein(24h TP),were collected from the electronic records.Before percutaneous renal biopsy(PRB),routine ultrasound examination was performed on the ipsilateral kidney and parameters such as renal parenchyma thickness and interlobular artery resistance index(RI)were measured.Meanwhile,color blood flow dynamic images were collected and VI,FI and VFI were calculated automatically with Qlab software.The variables with statistical differences were analyzed and selected for multivariate Logistic regression analysis to predict the independent influencing factors of CKD.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic performance of ROI perfusion index.Bland-Altman analysis was used to further the consistency of perfusion measurement in ROI.Results:Primary glomerulonephritis(PGN)is the most common pathological type of renal biopsy in CKD patients.Membranous nephropathy(MN)was the main form in minimal chronic changes group and mild chronic changes group,and Ig A nephropathy(Ig AN)was the main form in moderate-severe chronic changes group.There were significant differences in combined risk diseases among the groups,Scr,albumin,urea nitrogen,uric acid,urinary red blood cell count(P < 0.01),while there were no statistically significant differences in baseline data such as sex,age,triglyceride,total cholesterol and conventional ultrasound indicators such as renal parenchyma thickness and RI between groups(P > 0.05).The renal blood bundles in CKD group were sparse and thin.VI,FI and VFI gradually decreased with the progression of chronic lesions,especially in moderate to severe chronic lesions group and VFI(P < 0.05).Logistic regression combined ROC curve showed that albumin(OR=0.747,95%CI 0.664-0.841),VFI(OR=0.342,95%CI 0.199-0.590)and urine red blood cell count(OR=1.641,95%CI1.304-2.064)were independent influencing factors of CKD(P < 0.01).In addition,VFI showed good sensitivity and specificity in predicting the progression of chronic CKD lesions.Bland-Altman result showed that the difference values of VI,FI and VFI among different observers and different positions were all less than 5.00% beyond the 95%consistency limit,indicating a good consistency(P < 0.05).Conclusion:Color Doppler sonography from ROI can reflect the changes of renal peripheral perfusion in patients with CKD in a non-invasive,convenient and early sensitive manner.VFI is a protective factor of CKD and has good sensitivity and specificity in predicting the progression of chronic lesions in CKD.Therefore,it has certain reference value for early screening and dynamic monitoring of chronic progression with CKD patients.