Lubas Arkadiusz, Kade Grzegorz, Ryczek Robert, Banasiak Piotr, Dyrla Przemysław, Szamotulska Katarzyna, Schneditz Daniel, Niemczyk Stanisław
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland.
Department of Cardiology, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland.
Int Urol Nephrol. 2017 Sep;49(9):1627-1635. doi: 10.1007/s11255-017-1634-7. Epub 2017 Jun 1.
Identifying the primary etiology of cardio-renal syndrome in a timely manner remains an ongoing challenge in nephrology. We hypothesized that hypertensive kidney damage can be distinguished from chronic glomerulonephritis at an early stage of chronic kidney disease (CKD) using ultrasound (US) Doppler sonography.
Fifty-six males (age 54 ± 15, BMI 28.3 ± 3.5 kg/m) with hypertension and stable CKD at stages 2-4 [38 with essential hypertension (HT-CKD); 18 with glomerulonephritis (GN-CKD)] were studied. Blood tests, UACR, echocardiography, ABPM, carotid IMT, and an ultrasound dynamic tissue perfusion measurement (DTPM) of the renal cortex were performed.
HT-CKD patients had reduced proximal renal cortex perfusion as well as reduced total and proximal renal cortex arterial area. Proximal renal cortex arterial area ≤0.149 cm identified hypertension-related CKD with a sensitivity of 71% and a specificity of 78% (AUC 0.753, p < 0.001).
Evidence of diminished arterial vascularity or perfusion of renal proximal cortex, both derived from US Doppler, could be helpful in differentiating hypertensive nephropathy from glomerulonephritis-related CKD.
及时确定心肾综合征的主要病因仍是肾脏病学中一项持续存在的挑战。我们假设，在慢性肾脏病（CKD）的早期阶段，使用超声（US）多普勒超声检查可以将高血压肾损害与慢性肾小球肾炎区分开来。
对56名患有高血压且处于2-4期稳定CKD的男性（年龄54±15岁，体重指数28.3±3.5kg/m）进行了研究[38名患有原发性高血压（HT-CKD）；18名患有肾小球肾炎（GN-CKD）]。进行了血液检查、尿白蛋白肌酐比值、超声心动图、动态血压监测、颈动脉内膜中层厚度测量以及肾皮质的超声动态组织灌注测量（DTPM）。
HT-CKD患者肾皮质近端灌注减少，肾皮质总动脉面积和近端动脉面积也减少。肾皮质近端动脉面积≤0.149cm可识别出高血压相关的CKD，敏感性为71%，特异性为78%（曲线下面积0.753，p<0.001）。
源自US多普勒的肾皮质近端动脉血管减少或灌注减少的证据，可能有助于区分高血压肾病与肾小球肾炎相关的CKD。
