Application of Contrast-enhanced Ultrasound in Evaluation of Renal Function for Patients with Spinal Cord Injury Complicated with Hydronephrosis / 中国康复理论与实践

Objective:To apply contrast-enhanced ultrasound in renal function evaluation for patients with spinal cord injury complicated with hydronephrosis. Methods:From October, 2015 to November, 2018, 23 patients with spinal cord injury complicated with hydronephrosis and renal disfunction (spinal cord injury group) and 19 cases of normal kidneys (control group) accepted contrast-enhanced ultrasonography and the image was analyzed with software. The region of interest (ROI) in the renal cortex, and the time intensity curve was drawn. Logistic regression was performed with time to initial peak (TTP), peak intensity (DPI), slope of ascending time (A), area under the curve (AUC) as the independent variable and renography as the dependent variable. The data was analyzed with ROC. Results:There was no significant difference in serum creatinine and ureophil between two groups (P > 0.05). TTP was longer (t = 5.068, P < 0.001), and A and AUC were lower (t > 3.784, P < 0.01) in the spinal cord injury group than in the control group. AUC was the factor related to renography (P < 0.01). The smaller the AUC was, the greater the likelihood of kidney damage was. The sum of sensitivity and specificity was 1.759 and the corresponding AUC was 982.518 dBS. Conclusion:Contrast-enhanced ultrasound can evaluate renal function of patients with spinal cord injury complicated with hydronephrosis. The decrease in AUC of the time-intensity curve indicates that the renal function is impaired.

Variables hemodinámicas y desenlace de la función renal en pacientes de terapia intensiva / Haemodynamic variables and outcomes of renal function on intensive care patients / Variáveis hemodinâmicas e resultados da função renal em pacientes de terapia intensiva

Resumen: Introducción: Las variables hemodinámicas nos informan sobre la progresión de lesión renal aguda (AKI por sus siglas en inglés). Material y métodos: Estudio prospectivo, observacional, longitudinal, de pacientes ingresados a la Unidad de Terapia Intensiva del 2017 al 2018. Se incluyeron mayores de 18 años, con lesión renal aguda (AKI 1 o 2), monitoreo hemodinámico de tensión arterial media (TAM), tensión arterial diastólica (PAD), frecuencia cardiaca (FC) y de presión venosa central (PVC). Determinados desde las 24 horas del diagnóstico hasta el egreso. Resultados: Fueron 164 pacientes, 105 (64%) presentaron progresión de AKI cuando TAM < 75.98 mmHg. PAD < 61, PVC >8 cm H2O, FC > 90 x', TAM-PVC < 67.64 mmHg, PAD-PVC < 53.28 mmHg. Conclusiones: La TAM, PAD y la PVC tienen el mayor impacto en el riesgo de progresión de AKI cuando se calcula la presión de perfusión media con estas variables.

Abstract: Introduction: Haemodynamic variables inform us about the progression of acute kidney injury (AKI). Material and methods: Prospective, observational and longitudinal study of patients admitted to Intensive Care (ICU) from 2017-2018. patients over 18 years were included, with acute kidney injury (AKI 1, 2), and hemodynamic monitoring of mean arterial blood pressure (MAP), diastolic blood pressure (DBP), heart rate (HR) and central venous pressure (CVP). Determined from 24 hours after diagnosis and its evolution was recorded until discharge. Results: A total of 164 patients were included, progression of AKI presented when MAP < 75.98 mmHg, DBP < 61 mmHg, CVP < 8 cmH2O, FC 90 x', MAP-CVP 67.64 mmHg, DBP-CVP 53.28 mmHg, HR > 90 beats/minute. Conclusions: MAP, DBP and CVP have the greatest impact on the risk of AKI progression, especially when the mean perfusion pressure (PPM) is calculated with these two variables.

Resumo: Introdução: As variáveis hemodinâmicas informam sobre a progressão da lesão renal aguda (LRA). Materiais e métodos: Estudo prospectivo, observacional, longitudinal de pacientes admitidos em terapia intensiva (UTI) de 2017-2018. Foram incluídos pacientes maiores de 18 anos, com lesão renal aguda (LRA 1 ou 2), monitorização hemodinâmica da pressão arterial média (TAM), pressão arterial diastólica (PAD), freqüência cardíaca (FC) e pressão venosa central (PVC). Determinada a partir de 24 horas de diagnóstico até a alta. Resultados: 164 pacientes (p), 105 p (64%) apresentaram progressão da LRA quando TAM < 75.98 mmHg, PAD < 61 mmHg, PVC > 8 cmH2O, FC > 90 x´, TAM-PVC < 67.64 mmHg, PAD- PVC < 53.28 mmHg. Conclusões: TAM, PAD e PVC têm o maior impacto no risco de progressão da LRA quando a pressão média de perfusão (PMP) é calculada com essas variáveis.

Effects of Norepinephrine Combined with Dobutamine on Hemodynamics, Blood Lactic Acid, CCr, FEH2O and FENa of Patients with Septic Shock / 现代生物医学进展

Objective:To explore the effects of norepinephrine combined with dobutamine on the hemodynamics,blood lactic acid,creatinine clearance rate (CCr),fractional excretion ofH2O (FEH2O) and fractional excretion of sodium (FENa) of patients with septic shock.Methods:120 cases of patients with septic shock from January 2016 to December 2016 were selected as the research objectives and randomly divided into two groups with 60 cases in each group.Dobutamine was given to both groups,then norepinephrine was additionally given to the observation group,dopamine was additionally given to the control group.The clinical effect,changes of hemodynamics,blood lactic acid,CCr,FEH2O and FENa levels before and after treatment were compared between two groups.Results:The blood lactic acid and FENa levels of both groups were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those before treatment;the CCr and FEH2O levels were gradually increased and significantly higher than those before treatment (P＜0.01).The blood lactic acid and FENa levels were gradually decreased at 6,12,24 and 48 hours after treatment and were significantly lower than those of the control group at same time (P＜0.01),the FEH2O level was significantly higher than that of the control group at the same time (P＜0.01).The MAP,SVRI of both groups at 6,12,24 and 48 hours after treatment were significantly higher than those before treatment,but the CI at 24,48 hours after treatment were significantly higher than those before treatment (P＜0.01),the MAP of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those before treatment (P＜0.01),the MAP at 6,12 hours after treatment were significantly higher than those before treatment (P＜0.01),the HR of observation group at 6,12,24 and 48 hours after treatment were significantly lower than those of the control group,but SVRI was significantly higher than those of the control group (P＜0.01).The mortality of observation group was 18.33％ at 28th days after treatment,which was 35.00％ in the control group and significantly higher than that of the observation group (P＜0.05).Conclusion:Norepinephrine combined with dobutamine could improve the hemodynamics,reduce the blood lactate level,improve the renal perfusion and prognosis of patients with septic shock.

Quantitative analysis of renal injury using CEUS in hypertensive rabbits model induced by L-NAME / 天津医药

Objective To assess the value of contrast-enhanced ultrasound (CEUS) on quantitative analysis of re?nal cortex perfusion in hypertensive rabbits model. Methods Hypertensive rabbit modal (n=10) were established by inject?ing N-nitro-L-arginin methylester (L-NAME). CEUS and Cystatin C (CysC) serum level analysis were performed at differ?ent time points:before and the 2nd, 4th, 6th and 8th week after injecting L-NAME. Time-intensity curve and area under curve (AUC) were analyzed quantatively while correlation of AUC and CysC were also analyzed. Results Serum level of Cys C in?creased significantly at the 6th week after L-NAME administration which is earlier than the increase of serum levels of Scr and BUN. AUC decreased at first then increased after L-NAME administration. Upon addition of L-NAME, rise time (RT) and peak intensity (PI) decreased while mean transit time (MTT), time from peak to one half (HPT) and time to peak (TTP) in?creased. Our study confirmed a positive correlation between AUC and Cys C (r=0.950, P<0.001). Conclusion Setting up rabbits model by L-NAME is convenient and reproducible, which is an useful tool in experimental study of preclinical and clinical phase of hypertensive renal injury. CEUS combining with CysC serum level analysis is considered as an effective technology for evaluating renal function in hypertensive patients.

Validação conceitual e clínica do diagnóstico de enfermagem "risco de perfusão renal ineficaz" em transplantados de células tronco hematopoéticas / The nursing diagnosis of

O transplante de células tronco hematopoéticas é uma modalidade terapêutica para o tratamento de doenças oncológicas, hematológicas e congênitas. Este é complexo e pode implicar em complicações como a toxicidade renal. Para esses pacientes, o diagnóstico de enfermagem de risco de perfusão renal ineficaz é estabelecido, porém pouco estudado. Questiona-se se os fatores de risco relacionados na NANDA Internacional para o referido diagnóstico podem ser identificados e se são válidos para pacientes submetidos a este tipo de transplante. O presente estudo teve por objetivo geral validar o diagnóstico de enfermagem de “Risco de Perfusão Renal Ineficaz” em pacientes submetidos ao transplante de células tronco hematopoéticas. Como objetivos específicos foram estabelecidos: definir o conceito de perfusão renal ineficaz; buscar medidas padrão ouro na determinação de perfusão renal ineficaz; identificar fatores de risco para o desenvolvimento deste diagnóstico em pacientes submetidos ao transplante; propor modelo de predição de risco de desenvolvimento de perfusão renal ineficaz. O estudo foi conduzido em duas etapas metodológicas: revisão integrativa da literatura e validação clínica por meio de uma coorte histórica. Na revisão integrativa foram consultadas as bases de dados MEDLINE, LILACS, CINAHL e Biblioteca Cochrane. A amostra constitui-se de 30 estudos avaliados quanto ao tipo, local de publicação, língua utilizada e nível de evidência utilizando instrumento estruturado. A coorte histórica foi realizada em uma amostra de 216 prontuários de pacientes transplantados. Os dados foram submetidos à análise descritiva, univariada e multivariada. Na validação conceitual estabeleceu-se o conceito, identificação e fatores de risco de perfusão renal ineficaz a partir de publicações de nível de evidência grau III e VI. Para a validação clínica conduziu-se estudo nos prontuários de pacientes de modo a identificar os fatores de contribuintes para o risco de perfusão...

The hematopoietic stem cell transplantation is a therapeutic modality for the treatment of malignancies, and hematologic defects. It is full of complexity and may offer complications such as renal toxicity. For these patients, the nursing diagnosis of riskfor ineffective renal perfusion is established, but little studied specially related to risk factors listed in NANDA International and its identification and validity for patients undergoing to this type of transplantation. This study aimed to validated the nursing diagnosis of "Risk of Renal Perfusion Ineffective" with patients undergoing to hematopoietic stem cell transplantation. The specific goals established that define the concept of renal perfusion ineffective; for seek gold standard measures for determining ineffective renal perfusion; established to identify risk factors for the problem development in patients undergoing to transplantation and risk factors study and to propose a model for predicting the risk of ineffective renal perfusion. The study was conducted in two stages: an integrative literature review and clinical validation using a historical cohort. The databases MEDLINE, LILACS, CINAHL and the Cochrane Library were consulted for the integrative review. The sample consisted of 30 studies evaluated by the type, country, language and level of evidence using a structured instrument. A historical cohort study was conducted in 216transplant patients records. The data were submitted to descriptive, univariate and multivariate analysis. The concept of ineffective renal perfusion and the identification of the risk factors were established by the conceptual validation from publications level of evidence grade III and VI. Clinical validation was conducted in patient’s records in order to identify thefactors contributing to the risk of renal perfusion ineffective. The risk of ineffective renal perfusion was present in 54/216 patients (25%) and the normal renal function occurred...

Vascular homeostasis and disease progression in chronic kidney disease

Background: Vascular disease is unfortunately an asymptomatic process that is responsible for a variety of organ damages such as chronic kidney disease (CKD). Present therapeutic strategy in CKD which is usually initiated at the late stage of CKD fails to enhance renal perfusion or restore function.Objective: To summarize the mechanism of vascular homeostasis in different stages of CKD to explain the present therapeutic failure. Furthermore, the authors propose an innovative strategy to restore effectively renal perfusion and function in CKD.Results: Altered vascular homeostasis with impaired vascular repair is observed in late stage of CKD and would explain the present therapeutic failure. However, an adequate vascular repair is observed in early stage of CKD, which would provide an alternative innovative approach to restore renal function in this early stage under environment favorable for renal angiogenesis and regeneration.Conclusion: A restoration of renal perfusion and function can be accomplished in early stage of CKD with multidrug vasodilators.

Triplex Doppler da artéria renal e a relação entre a ecobiometria dos rins com distância atlanto-coccígea e altura em Canis familiaris / Renal artery Triplex Doppler and the relationship between kidney ecobiometry with atlanto-coccyges distance (ACD) and height (H) in Canis familiaris

O objetivo do trabalho foi estabelecer a relação entre a ecobiometria renal com medidas de conformação corporal como a distância atlanto-coccígea (DAC) e a altura (H) de cães adultos saudáveis, obtendo-se parâmetros de normalidade para avaliar o tamanho e volume renal, bem como estabelecer valores de referência para avaliar a perfusão sanguínea dos rins por meio do índice de resistividade (IR) e do índice de pulsatilidade (IP) do ramo principal da artéria renal. No estudo foram utilizados 22 cães adultos sem raça definida, sendo 11 machos e 11 fêmeas. Os animais foram previamente aferidos quanto a DAC e a H. Os exames ultra-sonográficos foram realizados com um aparelho HDI 4000 PHILIPS munido de um transdutor microconvexo multifreqüêncial (5-8 MHz), dispositivos Doppler Colorido e Doppler de Fluxo. Os animais foram posicionados em decúbito lateral direito ou esquerdo, de acordo com o rim a ser avaliado. Os diâmetros longitudinal (DL) e dorsoventral (DDV) dos rins foram mensurados na secção longitudinal e, o diâmetro transversal (DT) foi aferido no plano transversal. O volume (V) foi calculado automaticamente pelo software do ultra-som. Com o uso do Triplex Doppler, o IR e o IP das artérias renais direita e esquerda foram obtidos. Todos os dados foram apresentados em média ± EPM. Análises de regressão linear foram realizadas tendo o DL, DDV, DT e V como variáveis dependentes e a DAC e H como variáveis independentes. Os IR e IP dos rins direito e esquerdo foram comparados pelo teste t de Student. A DAC variou de 54-78cm para machos e 37-71cm para fêmeas e a altura variou entre 34-64 cm para os machos e 24-57cm para as fêmeas. As médias obtidas para DL, DDV, DT e V dos rins esquerdo e direito foram: 5,24±0,27cm, 3,07±0,15cm, 3,07±0,9cm, 28,01±3,4mL e 4,50±0,19cm, 2,88±0,14cm, 2,71±0,15cm, 21,27±2,6mL, respectivamente. As análises de regressão linear entre as medidas lineares e volume renal com a DAC e a H foram significativas para os interceptos ...

The aim of this paper was to establish the relation between the kidney ecobiometry with atlanto-coccyges distance (ACD) and height (H) in adult healthy dogs, to obtain normality parameters for assessment of renal size and volume, as well as establish reference values to evaluate kidney blood perfusion by the resistivity index (RI) and pulsatility index (PI) of main renal artery. The study was applied at 22 adult dogs, 11 males and 11 females. Previously, the DAC and H of all animals were measured. For ultrasonographic examination, the ultra-sound system HDI 4000 PHILIPS equipped with a multi-frequency microconvex transducer, Color Doppler and Spectral Doppler devices was used. The animals were placed into right or left lateral decubitus position, in agreement with the kidney to be assessed. The longitudinal (LD) and dorsoventral diameters (DVD) of kidney were measured in longitudinal plane, and the transverse diameter (TD) was determined in transversal section. The renal volume (V) was automatically calculated by the ultrasound software. With Triplex Doppler, the RI and PI of right and left main renal arteries were obtained. All data were represented in mean ± SEM. Linear regression analyses were performed with renal LD, DVD, TD and V as dependent variable, and ACD and H as independent variable. RI and PI were compared between right and left renal arteries with Student's t-test. The LD, DVD, TD (cm) and V (ml) mean measurements for the left and right kidneys were: 5.24±0.27, 3.07±0.15, 3.07±0.9, 28.01±3.4 and 4.50±0.19, 2.88±0.14, 2.71±0.15, 21.27±2.6. All regression analyses were significant for the intercept and regression coefficient (P<0.01). There were statistical differences on RI and PI means between right and left renal arteries (P=0.001). The RI and PI means of left and right renal artery obtained were: 0.62±0.08 and 1.34±0.18; 0.70±0.06 and 1.62±0.13. The data obtained in the present paper can be used as parameters for evaluation ...

The Systemic Hemodynamic and Renal Effects of Nicardipine Administration Followed by Supraceliac Aortic Cross Clamping and Unclamping in Experimental Dogs / 대한마취과학회지

BACKGROUND: The incidence of renal insufficiency is reported about 18-27% during the thoracoabdominal aneurysm surgery. The possible mechanisms are reduction and maldistribution of renal blood flow, activation of renin angiotensin system, release of various mediators. In this study, we observed the effect of nicardipine, one of the calcium channel blockers that commonly used, on the systemic hemodynamics and the renal fuctions. METHODS: A total of 13 mongrel dogs were divided into two groups: control group (C, n = 7), nicardipine administration group (N, n = 6). After brachial arterial and Swan-Ganz catheterization, midline abdominal incision was made. For the aortic cross clamping the supraceilac aorta was exposed and the doppler flowmeter probe was placed on the left renal artery. The thermal diffusion microprobe was inserted in the renal parenchyme to measure local renal perfusion. At sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow and local renal perfusion were measured and at 1, 2, 3, 4, 5 and 6 hours after unclamping the same parameters were measured. RESULTS: There were no differences on renal blood flow, renal perfusion and oxygen extraction ratio between two groups. The renal blood flow and renal perfusion did not recover to the baseline level after unclamping in both groups. The plasma renin activity, serum creatinine concentration and cystatin-c did not show any difference between groups respectively. CONCLUSIONS: We concluded that the administration of nicardipine after supraceliac aortic unclamping to improve the renal function was not effective in experimental dogs.

Studies on the Change in Renal Functions after an Occlusion of Blood Supply and Perfusion of the Kidney in Dog / 대한비뇨기과학회지

It is generally known that the renal function is significantly decreased immediately after renal transplantation. However, there is no literature concerning the influence of vascular factor such as thrombus formation and narrowing of the vascular lumen due to its anastomosis on the renal functions following kidney transplantation. As an attempt to dissociate the effect of vascular factors from the immediate functional capacity after transplantation. the author studied the various renal function after clamping the renal artery and perfusing the kidney for 45 minutes while avoiding injury to the renal pedicle as much as possible. Then the recovery pattern of renal function was observed for 2 weeks. In every phase of the experiment (immediately, 1,3,7, and 14 days after the clamping and perfusion) various renal functions of the experimental kidney (left kidney) were compared with that of the normal kidney (right kidney). The results are summarized briefly as follows: 1. Hemodynamic changes such as glomerular filtration rate and renal plasma flow were decreased to approximately 65~75% of the control kidney by 7 days after the experiment and then recovered to the values of the normal kidney. 2. Tubular reabsorption of water and electrolytes were reduced in the experimental kidney until the 7th day after the procedures, but these decreases were improved to nearly normal 2 weeks after the renal artery clamping and perfusion. This reduction of tubular reabsorption capacity is considered to be brought by ischemia-induced tubular damage 3. The extraction ratio of PAH was significantly dropped to about 50% of the normal at 3 days after the experiment, then it recovered almost to normal at 14 days after the procedures. In addition total renal plasma flow calculated from C(pah)/E(pah) was almost identical in both kidneys except in the 3 days group which showed a significant increase in the experimental kidney. This finding suggested that postocclusive reactive hyperemia developed. 4. The above mentioned results showed that renal functions after renal artery clamping and perfusion of the kidney with cold (4 degrees C) solution were decreased significantly by the 7th followed with almost normal recovery 2 weeks after the experiment. It was suggested that the period of recovery of renal function was shortened by cold perfusion of the kidney, and day and vascular factors did not influence significantly on the decrease in renal functions after renal transplantation.