TIPSS术后肾脏血流动力学改变的超声评价

目的　探讨经颈静脉肝内门 -体静脉分流术 (TIPSS)术后肾脏血流动力学改变及超声评价的价值。方法　应用超声技术检测并分别比较肝硬化腹水患者 (含肝肾综合征 )和肝硬化无腹水患者 TIPSS术前及术后 1周的肾脏血流动力学改变 ,同时测定并分别比较两组患者相应时相点肾功能情况。结果　肝硬化腹水患者术后 1周肾脏多普勒能量图显示较术前各级动脉血流信号明显增多 ,部分患者皮质血流得以显示 ,肾血流量 (V)较术前明显增加 (P<0 .0 1) ,肾血流阻力指数 (RI)较术前明显减小 (P<0 .0 1) ,血清肌酐 (Cr)、血清尿素氮(BUN)也较术前减少 (P<0 .0 1)。而肝硬化无腹水患者肾脏血流动力学以及肾功能各项指标手术前后无明显改变。结论　 TIPSS手术可明显改善肝硬化腹水患者肾血流灌注和肾功能 ,并可成为治疗肝肾综合征 (HRS)的有效手段 ,而对于肝硬化无腹水患者的肾血流动力学及肾功能则无明显影响。超声检测可客观地评价这些变化     

彩色多普勒超声检测糖尿病肾病早期肾脏改变的临床价值

目的探讨彩色多普勒超声检测糖尿病肾病(DN)早期肾脏声像改变的临床价值。方法收集该院2016年1月至2017年9月收治的早期糖尿病患者80例作为观察组,同时80例健康体检者作为对照组。采用彩色多普勒超声检测各组研究对象肾脏二维及肾实质叶间动脉血流参数,记录肾脏长径、肾实质厚度、肾窦厚度,并计算肾实质厚度/肾窦厚度比值、肾实质叶间动脉血流阻力指数(RI),并对各组各项参数进行比较。结果观察组患者肾脏长径、实质厚度、肾窦厚度、实质厚度/肾窦厚度比值均高于对照组,差异有统计学意义(P0.05);观察组患者肾实质叶间动脉舒张期最低血流速度(Vmin)明显低于对照组,而RI高于对照组,差异有统计学意义(P0.05),2组肾脏肾实质叶间动脉收缩期最大血流速度(Vmax)比较,差异无统计学意义(P0.05)。结论彩色多普勒超声可以检测DN早期肾脏二维结构及肾实质叶间动脉血流动力学参数,可反映肾脏结构及肾实质叶间动脉血流灌注的改变,为临床治疗早期肾功能损伤提供重要诊断价值。     

肾综合征出血热的肾脏CT、超声改变及临床意义

目的:提高对肾综合征出血热所致肾脏损害的CT、超声影像诊断水平,分析二者图像的影像特点,提出CT在诊断肾破裂出血的影像特异性,使临床医生能主动掌握病情。方法:63例临床确诊病例进行了肾脏CT、超声观察,总结出肾脏改变的5点影像征象,从不同年龄组进行统计分析。结果:肾脏改变影像特征:①双肾脏呈球形对称性增大。②肾小盏聚集,肾盂腔缩小。③肾实质密度不均匀,肾皮质呈低密度,肾髓质呈稍高密度。④肾破裂出血表现为肾实质、肾周间隙及肾包膜下的血肿,血肿形态早期呈团状及不均匀性高密度影像,以后逐渐密度下降,超声呈混合密度影像。⑤CT增强扫描肾髓质密度增高,肾小盏界限模糊。本文分析了肾脏影像改变与出血热患者在发热期、休克期、少尿期、多尿期中肾脏改变和病情的关系。结论:肾综合征出血热起病急,以发热、出血及肾脏损害为主要征象,肾脏行影像学检查尤其是疑有肾破裂出血做CT扫描,具有特异性诊断。     

肾综合征出血热发热期与恢复期肾脏超声改变观察

目的观察肾综合征出血热患者发热期、恢复期肾脏结构及血流动力学变化。方法经血清学证实的肾综合征出血热(HFRS)患者292例,采用彩色多普勒超声诊断仪检测HFRS患者发热期、恢复期肾脏结构、血流动力学,并与104例正常人对照。结果 147例HFRS发热期患者双肾肿大、肾脏结构改变与正常对照组有显著差异,肾动脉血流最大峰值流速(Vaxm)和阻力指数(RI)值与正常对照组无显著差异;145例恢复期肾脏结构、血流动力学与正常对照组无显著差异。结论 HFRS发热期可出现肾脏超声异常,对早期诊断具有重要意义;恢复期后肾脏结构恢复正常,肾脏结构的改变为可逆性,符合HFRS临床变化特点。     

B超在肾综合征出血热诊疗中的价值（69例临床研究）

目的：观察肾脏等胸腹腔脏器,旨在探索B超在肾综合征出血热诊疗中的价值。方法：常规B超检查肾脏,观察双肾大小、轮廓形态、包囊边界、内部结构及周围情况,并测量、记录。进一步全面检查腹盆腔,观察肝睥大小、胆囊情况、有无腹腔积液等。结果：肾综合征出血热肾脏水肿肿大,肾周少量炎性渗出,可继发包膜下血肿。出现少量胸腹水。胆囊炎性改变。肝脾轻度肿大。结论：根据肾脏等声像图特点,结合临床表现、血尿变化可提高早期诊断率,尤其对包膜下血肿等意外变化的发现有肯定价值。B超监测病情变化,对临床治疗方案的调整有一定帮助。     

原发性高血压的肾脏超声改变及临床意义

报告３６０例原发性高血压的肾脏超声观察结果，并以８０例正常人进行对照，提出并讨论了肾脏改变的声像图分型，诊断方法及应用价值．发现其主要超声改变为肾切面面积减小，皮质变薄，肾窦面积与肾面积比率增加，肾皮质回声增强，皮髓质分界模糊。认为肾萎缩和肾皮质增强是提示肾脏受损的主要标志．它对估计肾脏有无受损及受损程度，指导治疗和判断预后有重要参考价值。     

小儿肾小管性酸中毒的超声表现分析

目的增加对此病的认知度，提高此病的检测率，延长患儿生命。方法采用仪器为Diasonic Gatway和Sequoia 512型彩色多普勒超声诊断仪，探头频率3．5～6MHz。对32例患此病患儿肾脏的大小、形态、结构、病灶的分布、回声以及血供情况进行检测。结果病变均为双侧，患肾有正常的肾轮廓，肾包膜完整。Ⅰ型患儿的肾髓质回声显著增高，高回声的锥体围绕肾窦呈放射状排例，内部为光亮的细点状回声，后方淡声影或无声影。早期肾血供无明显改变，晚期段动脉、叶间动脉可受压变细，弓形动脉以下血供减少。Ⅱ型患儿几乎无肾钙沉着。结论超声对Ⅰ型肾小管性酸中毒有很高的诊断价值，对临床确诊的病例，超声可作为鉴别Ⅰ型或Ⅱ型病变的重要手段之一。     

腹膜透析治疗肝肾综合征大量腹水并发重度脐疝1例

肝肾综合征是肝硬化发生严重或大量腹水症状后，大量体液潴留于腹腔或其他组织细胞间隙，导致有效循环血量减少。肾血流量减少，肾脏严重缺血、缺氧，肾小球滤过率下降，发生肾前性氮质血症或肾实质损害的综合征。临床上肝硬化合并肾衰竭腹水的病例并不少见。2004年我科收治1例肝肾综合征大量腹水并发重度脐疝的病人，运用腹膜透析技术，成功地清除了严重腹水并使脐疝回纳，效果满意。现将护理体会报告如下。     

超声技术在诊断慢性肾功能不全中的价值

目的探讨超声技术在诊断慢性肾功能不全中的价值。方法应用二维超声图像、彩色多普勒及频谱多普勒技术对68例慢性肾功能不全患者进行肾脏形态及血流的观察，对肾内各级动脉进行血流动力学分析，并与30例健康人进行对照。结果慢性肾功能不全患者较健康对照组肾脏体积缩小、皮质变薄、实质回声增强，肾血流明显减少，速度减低，阻力指数及搏动指数增高。结论超声技术能直观地显示慢性肾功能不全患者肾脏形态的改变，能早期反映肾脏血流灌注情况，对临床诊断、治疗及预后评估有重大意义。     

具有肾脏意义的单克隆免疫球蛋白病的发病机制研究

具有肾脏意义的单克隆免疫球蛋白病（monoclonal gammopathy of renal significance,MGRS）表现为不同肾脏损害的一组疾病，是一种新的肾病类型，且病种多种多样，疾病机制复杂。当MGRS时，由于B淋巴或浆细胞克隆性增殖，出现大量单克隆免疫球蛋白（monoclonal immunoglobulin,MIg）和/或大量的游离轻链（free light chain,FLC）。完整的MIg可与肾小球的固有细胞相互作用改变以改变其生物学并促进肾脏疾病发展，但单克隆FLC可潜在地改变整个肾单位中各种细胞的功能。鉴于MIg和单克隆FLC与MGRS的关系，抑制MIg和单克隆FLC将是一种有前景的治疗MGRS的方法。该文主要从肾脏受累部位即肾小球、肾小管-间质、肾血管对MGRS的发病机制作一综述。     

Ascites as a cause of hyperechogenic kidneys

In 40 patients with ascites, hyperechogenicity of the kidneys was directly proportional to the amount of fluid interposed between the clinically normal kidney and the transducer. The beam-enhancing phenomenon of ascites on renal parenchymal echogenicity should be distinguished from renal disease causing the increase in parenchymal echoes.     

Renal haemodynamics in patients with liver cirrhosis assessed by colour ultrasonography

Colour Doppler flow imaging was used in this prospective, cross-sectional study to analyse renal haemodynamics in 50 cirrhotic patients and 15 healthy controls. Mean renal arterial resistive index (RI) was higher in cirrhotic patients than in healthy controls. Mean RI was also higher in cirrhotic patients with non-refractory ascites than in those without ascites, suggesting that the degree of renal vasoconstriction varies with the severity of ascites. A gradient of RI values across the main renal artery, interlobar artery and interlobular renal artery was retained in cirrhotic patients even in the decompensatory stage with non-refractory ascites but was not present in the decompensatory stage with refractory ascites. The disappearance of this gradient may be an important prognostic factor in the development of hepatorenal syndrome (HRS). An inverse correlation between creatinine clearance and interlobular arterial RI was shown for all cirrhotic patients suggesting that even patients with refractory ascites are in a prophase of HRS.     

不同诊断类型血吸虫病患者血清肾功能检测及其临床意义

目的 探讨不同诊断类型血吸虫病患者尿素氮(Urea)、肌酐、尿酸、胱抑素C(CysC)和β2微球蛋白(β2MG)的血清水平变化及各项检测指标的临床意义.方法 对80例慢性血吸虫病患者、72例巨脾型晚期血吸虫病患者、76例腹水型晚期血吸虫病患者和40例健康体检者进行肾功能检测和分析.结果 健康对照组、慢性血吸虫病组、晚期巨脾型血吸虫病组和晚期腹水型血吸虫病组患者血清β2MG、CysC、Urea水平呈逐渐升高趋势.血吸虫病各组血清β2MG水平与健康对照组之间差异均有统计学意义(P＜0.01).晚期腹水型血吸虫病组血清CysC水平与其余各组之间差异有统计学意义(P＜0.01).结论 血吸虫病患者随着病情的加重,CysC和β2MG水平会升高,加强对血吸虫病患者血清中CysC和β2MG的监测,有助于早期发现功能性肾衰竭,这对于该病的治疗具有一定参考价值.     

彩色多普勒超声对肝硬化的肾血流动力学改变的研究

目的 评价彩色多普勒超声对肝硬化的肾血流动力学变化的研究价值.方法 应用彩色多普勒技术检测13例肝硬化腹水组、13例肝硬化无腹水组和24例正常对照组的肾血流动力学,并互相进行对照.结果 肝硬化腹水组的阻力指数（RI）、肾血流量（Q）与肝硬化无腹水组、正常对照组比较,具有显著性的差异（P＜0.01）;肝硬化无腹水组的阻力指数、肾血流量与正常组比较,无显著性差异（P＞0.05）.结论 彩色多普勒超声能无创的监测肝硬化对肾血流的影响,对病情的监测、HRS的预测提供重要的价值.     

Observation on intrarenal and intraperitoneal pressures in patients with tense ascites: Feasibility of unassisted ascites drainage into the urinary system

Summary

Feasibility of unassisted drainage of tense ascites into the urinary system was studied by measuring pressures in the peritoneal cavity and renal pelvis. It was done in patients with refractory debilitating non-loculated ascites due to either cirrhotic portal hypertension (n=1) or intraperitoneal spread of colon carcinoma (n= 1). The pressures were measured before, during and after ascites decompression. It was found that intrarenal pressure (a) approximated intraperitoneal, (b) changed as a function of intraperitoneal, and (c) was always between 3 and 7cm H₂O higher than intraperitoneal. Therefore, unassisted drainage of the ascitic fluid into the renal pelvis could not be achieved. Nevertheless, the obtained data may be of value for better understanding of renal physiology in tense ascites.     

实时剪切波弹性成像评价慢性肾脏病早期肾脏损害的价值

目的 探讨实时剪切波弹性成像（RT-SWE）技术在慢性肾脏疾病早期肾损害中的潜在应用价值。 方法 应用RT-SWE技术检测早期慢性肾病1~3期患者肾脏皮质杨氏模量均值（E_mean）,与患者24 h尿蛋白定量、血肌酐值及肾穿刺活检病理间质纤维化程度作对比;引入年龄因素校正E_mean值（pyE_mean）,比较早期慢性肾病各期患者pyE_mean值的差异。 结果 E_mean值在慢性肾病1~3期患者不同组的差异无统计学意义（P > 0.05）;根据患者年龄校正得出的pyE_mean值在慢性肾病1期与2期患者之间差异无统计学意义（P > 0.05）,但1、2期与3期的差异有统计学意义（P < 0.05）。 结论 pyE_mean值排除了年龄对肾脏硬度值的影响,对评估早期慢性肾病患者肾脏纤维化程度可能具有重要的潜在应用价值,RT-SWE技术可以应用于慢性肾病早期肾损害评估。      

超声在经皮肾穿刺取石术治疗上尿路结石中的临床应用

目的 探讨超声在经皮肾穿刺取石术(PCNL)治疗上尿路结石中的应用价值.方法 对116例上尿路结石患者应用超声引导经皮肾穿刺并建立人工取石通道,其中肾结石95例,输尿管上段结石21例;肾结石伴肾积水27例,输尿管上段结石伴肾积水21例,无肾积水68例;肾功能正常105例,伴有不同程度肾功能受损11例.术毕对肾及腹腔行超声扫查,了解是否存在残余肾结石及肾周、腹腔积液.结果 116例上尿路结石患者在超声引导下均一次穿刺成功,顺利建立良好的人工取石通道,其中单通道107例,双通道9例;Ⅰ期取石109例,Ⅱ期取石7例,结石清除率92.7%;3例腹腔积液患者在超声引导下穿刺引流后及时得到缓解,无一例出现严重并发症.结论 对上尿路结石患者在超声引导下行PCNL,不但提高了定位穿刺的准确性及科学性,且无辐射,值得在基层医院推广.     

Surgical considerations of the renal fascia and the retroperitoneal space around the kidney

Surgical anatomy around the kidney remains controversial. We therefore examined the constitutions of renal fascia and retroperitoneal space around the kidney through the close observations of intraoperative views. The surface of the removed kidney was covered with a smooth membrane, which is the so-called renal fascia. However, such a smooth membrane could not be observed at the dissection site around the kidney during surgery. Only an intricate connective tissue could be observed. On the other hand, using an operative procedure such as dissection or pulling tissue in some direction, an intricate connective tissue changed to a membranous structure. These results suggest that the retroperitoneal area around the kidney would be filled with connective tissue including some fat, which is arranged in a chaotic manner without any specific alignment tridimentionally. As a result of operative procedures, such connective tissue would be grouped, which would be recognized as renal fascia.     

Prenatal diagnosis of persistent cloaca associated with VATER (vertebral defects, anal atresia, tracheo-esophageal fistula, and renal dysplasia)

The cloaca is a single canal from which the urinary, genital, and intestinal tracts arise around gestational weeks 5-6. Persistent cloaca can result from cystic mass formation within the pelvis, which is commonly association with multiple developmental defects. VATER association, which is a spectrum of anomalies, manifested by vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, and renal dysplasia, arises from abnormalities in mesodermal differentiation. Recently, both conditions have been proposed to represent a continuous spectrum of anomalies, but the pathophysiology concerning the continuity of the development and the clinical condition are still unclear. Since renal failure becomes a serious problem after birth, timely infant delivery is essential to avoid loss of renal function. We report a patient, in whom the overlap between these two conditions was identified, and renal function was lost from one kidney. A polycystic mass was found in the fetal abdomen at 26 weeks of gestation. By ultrasonography, we detected a polycystic left kidney, a single umbilical artery, a ventricular septal defect, an esophageal atresia, ascites, an anal atresia, and a cystic mass with debris behind the bladder. The left kidney was non-functioning and the right kidney showed signs of hydronephrosis at 30 weeks of gestation. We measured the size and the blood flow of renal artery sequentially, and could deliver the fetus before the function was lost from the right kidney. Our observations will help inform future patients where prompt intervention can help improve renal function and infant health.     

Effective plasma volume in cirrhosis with ascites. Evidence that a decreased value does not account for renal sodium retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR during drug-induced diuresis

A reduction in effective (nonportal) plasma volume is considered the basis for renal sodium retention, a spontaneous reduction in glomerular filtration rate (GFR), and a fall in GFR occurring during drug-induced diuresis in patients with cirrhosis and ascites. In the present study the concept of a reduced effective plasma volume in cirrhosis is challenged by two lines of evidence, even though effective plasma volume itself could not be measured. (a) Total plasma volume failed to rise in 10 patients with the spontaneous loss of ascites, the appearance of sodium in the urine, and a rise in GFR. Portal pressure remained constant in these patients as ascites left, suggesting that effective plasma volume had not increased while portal plasma volume decreased. (b) Reduction of GFR could not be prevented in five patients with cirrhosis and ascites while total plasma volume was prevented from falling with albumin infusions during drug-induced diuresis. Reduction of GFR during drug-induced diuresis in 15 patients with cirrhosis and ascites was completely reversed with saline infusion despite continued diuresis with the identical drugs, excluding drug nephrotoxicity as the cause for the reduced GFR.The ascites of cirrhosis might no longer be regarded as a cause of effective plasma volume contraction, stimulating renal sodium retention and a reduction in GFR. More likely, this form of ascites is a result of plasma volume expansion and sodium retention. The causes for renal sodium retention and a spontaneous reduction in GFR remain unknown. The cause for a fall in GFR during drug-induced diuresis also remains unknown, but effective plasma volume contraction and drug nephrotoxicity seem excluded.