Nephrology section, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
Pathology section, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
BMC Nephrol. 2020 Apr 6;21(1):123. doi: 10.1186/s12882-020-01789-7.
The renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes.
Kidney sonography and biopsy were performed in 112 patients. Histological changes were graded in 0, < 25%, ≥25%, ≤50 and > 50% of the sample. Cortical echogenicity was graded relative to liver or spleen parenchyma: less than, equal to and higher than the liver/spleen. Kidney length, the kidney length/body height ratio (KL/H) and cortical thickness were obtained. Each parameter was multiplied by a cortical echogenicity-weighting arbitrary factor: 1.17, 1 or 0.69 for cortex less than, equal to or higher than the liver, respectively. The GFR was estimated using the CKD-EPI formula. The accuracy of crude and composite parameters to identify patients with a high creatinine, a low GFR and histological changes were evaluated.
The discriminative power of kidney length and cortical thickness for renal dysfunction and histological changes was improved after weighting for cortical echogenicity. However, the best discriminative was the kidney length to height ratio weighted towards renal echogenicity (w-KL/H).
w-KL/H exceeded the other parameters as a marker of renal impairment and histological changes in CKD. Calculation of the w-KL/H index may be of help as a non-invasive tool to identify patients with significant renal disease and might be useful to guide therapeutic decisions.
肾长度和皮质回声强度与 CKD 患者的肾功能和组织学变化相关。本研究旨在评估基于肾脏测量和皮质回声强度的原始和综合超声参数在检测肾功能障碍和组织学变化方面的准确性。
对 112 例患者进行了肾脏超声和活检。组织学变化按 0、<25%、≥25%、≤50%和>50%的样本分级。皮质回声强度相对于肝或脾实质进行分级：低于、等于和高于肝/脾。获得肾脏长度、肾脏长度/身高比值（KL/H）和皮质厚度。每个参数都乘以皮质回声强度的任意加权因子：分别为 1.17、1 或 0.69，用于皮质回声低于、等于或高于肝的情况。使用 CKD-EPI 公式估计肾小球滤过率（GFR）。评估原始和综合参数识别高肌酐、低 GFR 和组织学变化患者的准确性。
对皮质回声进行加权后，肾脏长度和皮质厚度对肾功能障碍和组织学变化的区分能力得到提高。然而，对肾功能障碍和组织学变化具有最佳区分能力的是加权肾回声的肾脏长度与身高的比值（w-KL/H）。
w-KL/H 作为 CKD 中肾功能损害和组织学变化的标志物优于其他参数。计算 w-KL/H 指数可能有助于作为一种非侵入性工具来识别有显著肾脏疾病的患者，并可能有助于指导治疗决策。
