hrvatski

Procjena renalne hemodinamike opstrukcijske i neopstrukcijske pijelokaliektazije duplex color Doppler sonografijom.

Between November 1993 and June 1995 renal ultrasound examinations and intrarenal arterial Doppler studies were performed on 55 volunteers without renal impairment, 54 patients with unilateral urinary tract obstruction and 17 patients with nonobstructive pyelocaliectasis. The mean renal resistive index in patients without renal impairment was 0.643 ± 0.044 (± 1 standard deviation). The mean RI was not significantly different between left and right kidney, as well as between men (33) and women (22) in the control group. Positive correlation between the mean RI and age (Pearson's coefficient r=0.85) was statistically significant (p<0.01). After 50 years the mean RI increased and rapid increase was detected after 60 years. The mean RI in the obstructed kidney was elevated (0, 719 ± 0.040) and was higher than the mean RI in the contralateral kidney, as well as the mean RI in the control group (p<0.01). The mean difference between the RIs (ΔRI) of the obstructed kidney and their contralateral nonobstructed pairs (0.089 ± 0.035) was also significantly higher (p<0.01) then the differences between pairs of normal kidneys (0.020 ± 0.013). We have detected a rapid return to normal renal vascular impedance and the fall of RIs occurred after relief from obstruction in 15 patients. In this group the mean RI in the obstructed kidney was 0.715 ± 0.041 before and 0.650 ± 0.025 after relief from obstruction, which meant return to the normal values. ΔRI returned from 0.093 ± 0.044 to 0.019 ± 0.028. The degree of pyelocaliectasis did not statistically significant correlate with RIs and ΔRIs in the obstructive uropathy group. In the hydronephrotic kidney without obstruction (nonobstructive uropathy group) RI was 0.644 ± 0.033 and ΔRI 0.004 ± 0.025. Both parameters ranged within normal values of the control group (p>0.05), but were significantly lower compared with obstructive uropathy group (p<0.01). Use of a discriminatory RI value of 0.70 defined to differentiate obstructive from nonobstructive pyelocaliectasis or normal kidney resulted in a sensitivity of 80%, specificity 89% and accuracy of 84%. If a discriminatory ΔRI value was 0.07, sensitivity was 86%, specificity 100%, and accuracy 94%. If the criterion of the renal obstruction was satisfying only one of the two mentioned parameters (RI ≥ 0.70 or ΔRI ≥ 0.07) applied to the same examinee, we can improve sensitivity and accuracy (91 and 94%, respectively) without impairment of specificity (100%). The mean pulsatility index (PI) in patients without renal impairment was 1.139 ± 0.141. In the obstructed kidneys we have detected a significant elevation (p<0.01) of the mean PI (1.149 ± 0.167). There was no significant difference of the mean PI between left and right kidney, as well as between men and women (p>0.05). Correlation between the mean PI and age were significant (p<0.01) with Pearson coefficient r=0.82. The ΔPI changed adequately to the ΔRI values. A degree of pyelocaliectasis did not significantly influence on the mean PI of the obstructed kidneys. Nonobstructive hydronephrosis did not elevate the mean PI. In the examinees without renal impairment right kidney was 110 ± 8 mm, and left kidney 112 ± 9 mm long. There was a significant difference between left and right kidney length (p<0.01). The kidney length significantly (p<0.01) corresponds with the body height. Therefore we have calculated a relative kidney length expressed with the KBR (kidney/body ratio). There was a negative correlation between the KBR and age (right r=-0.49, left r=-0.45). A significant decrease of the KBR in the sixth decade has been detected. Obstructive uropathy has increased kidney length (116 ± 10 mm), which was statistically significant (p<0.01), while nonobstructive pyelocaliectasis did not influence on the kidney length (p<0.05). Obstructed right kidney was 114 ± 5 mm long, while obstructed kidney achieved 118 ± 4 mm in longitudinal diameter.

renalna hemodinamika; pijelokaliektazija; Doppler

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