Андрология и генитальная хирургия. 2021; 22: 36-44
Математический постпроцессинговый анализ данных компьютерной томографии почек с контрастированием в оценке раздельной ренальной функции у пациентов с мочекаменной болезнью
https://doi.org/10.17650/1726-9784-2021-22-4-36-44Аннотация
Введение. Нами проведено собственное исследование с использованием математического анализа данных компьютерной томографии (КТ) почек c контрастированием при мочекаменной болезни (МКБ), которое позволило оценить некоторые внутрипочечные процессы, в частности скорость клубочковой фильтрации (СКФ), раздельно для каждой почки.
Цель исследования - оценить СКФ и структуру паренхимы почек при МКБ и определить возможные закономерности внутрипочечного транспорта контрастного вещества (КВ) у этих пациентов с помощью математического анализа данных КТ.
Материалы и методы. В исследовании ретроспективно проанализированы данные 27 пациентов обоего пола с диагнозом МКБ. Для оценки СКФ раздельно для каждой из почек выполнялся численный анализ данных КТ с контрастированием (референсные значения СКФ: 0,55 % КВ в секунду). Критериями включения в исследование были: 1) впервые выявленная МКБ; 2) камни размером не более 1,5-2,0 см, не нарушающие отток мочи; 3) отсутствие в анамнезе операций на почках и верхних мочевых путях; 4) возраст пациентов - до 45 лет; 5) отсутствие отягощенного интеркуррентного фона. Критерии включения позволили нивелировать влияние вторичных факторов на процессы интраренального транспорта КВ и провести исследование per se.
Результаты. Математический анализ результатов КТ почек с контрастированием позволил выявить изменения СКФ у 26 (96,3 %) пациентов. Гиперфильтрация выявлена у 12 (44,4 %) пациентов (правая почка: СКФ - 0,6-0,77 %, среднее значение - 0,65 %; левая почка: СКФ -0,59-0,79 %, среднее значение - 0,67 %). Гипофильтрация выявлена у 13 (48,1 %) пациентов (правая почка: СКФ - 0,2-0,54 %, среднее значение - 0,37 %; левая почка: СКФ - 0,2-0,53 %, среднее значение - 0,4 %). Показатели СКФ значимо различались в группах как справа (p = 0,000014), так и слева (p = 0,000045). В группах не выявлено значимых различий по возрасту (p = 0,895). Показатели индекса резистентности в магистральных и сегментарных артериях при допплерографии почек в обеих группах были в норме и значимо не различались (магистральная артерия справа: p = 0,221; слева: p = 0,850; сегментарная артерия справа: p = 0,306, слева: p = 0,957). У 1 пациента с камнями почек не выявлены изменения СКФ. Еще у 1 пациента с одной стороны выявлена гиперфильтрация (0,62 %), с другой - гипофильтрация (0,48 %).
Выводы. Изменения со стороны СКФ у большего количества пациентов (92,6 %) с МКБ как в сторону гипофильтрации, так и в сторону гиперфильтрации могут свидетельствовать об измененном интраренальном кровотоке и транспорте мочи у этой группы пациентов.
Список литературы
1. Carr R.J. A new theory on the formation of renal calculi. Br J Urol 1954;26(2):105—17. DOI: 10.1111/j.1464-410x.1954.tb06073.x.
2. Stoller M.L., Meng M.V, Abrahams H.M., Kane J.P. The primary stone event: a new hypothesis involving a vascular etiology. J Urol 2004;171(5):1920-4. DOI: 10.1097/01.ju.0000120291.90839.49.
3. Kramer G., Klingler H.C., Steiner G.E. Role of bacteria in the development of kidney stones. Curr Opin Urol 2000;10(1):35-8. DOI: 10.1097/00042307-200001000-00009.
4. Martel J., Wu C.-Y., Young J.D. Translocation of mineralo-organic nanoparticles from blood to urine: a new mechanism for the formation of kidney stones? Nanomedicine (Lond). 2016;11(18):2399-404. DOI: 10.2217/nnm-2016-0246.
5. Brown C.M., Ackermann D.K., Purich D.L. EQUIL 93: a tool for experimental and clinical urolithiasis. Urol Res 1994;22(2):119-26. DOI: 10.1007/BF00311003.
6. Bagga H.S., Chi T., Miller J., Stoller M.L. New Insights Into the Pathogenesis of Renal Calculi. Urol Clin North Am 2013;40(1):1-12. DOI: 10.1016/j.ucl.2012.09.006.
7. Robertson W.G. Potential role of fluctuations in the composition of renal tubular fluid through the nephron in the initiation of Randall's plugs and calcium oxalate crystalluria in a computer model of renal function. Urolithiasis 2015;43(Suppl 1):93-107. DOI: 10.1007/s00240-014-0737-1.
8. Asplin J.R., Mandel N.S., Coe F.L. Evidence for calcium phosphate supersaturation in the loop of Henle. Am J Physiol 1996;270(4 Pt 2):F604-13. DOI: 10.1152/ajprenal.1996.270.4.F604.
9. Finlayson B., Reid F. The expectation of free and fixed particles in urinary stone disease. Invest Urol 1978;15(6):442-8.
10. Helck A., Schonermarck U., Habicht A. et al. Determination of split renal function using dynamic CT-angiography: preliminary results. PLoS One 2014;9(3):e91774. DOI: 10.1371/journal.pone.0091774.
11. Patankar K., Low R.S.-T., Blakeway D., Ferrari P. Comparison of computer tomographic volumetry versus nuclear split renal function to determine residual renal function after living kidney donation. Acta radiol 2014;55:753-60.
12. Barbas A.S., Li Y., Zair M. et al. CT volumetry is superior to nuclear renography for prediction of residual kidney function in living donors. Clin Transplant 2016;30(9):1028-35. DOI: 10.1111/ctr.12784.
13. Mitsui Y., Sadahira T., Araki M. et al. The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy. Clin Exp Nephrol 2018;22(2):453-8. DOI: 10.1007/s10157-017-1454-1.
14. Houbois C., Haneder S., Merkt M. et al. Can computed tomography volumetry of the renal cortex replace MAG3-scintigraphy in all patients for determining split renal function? Eur J Radiol 2018;103:105-11. DOI: 10.1016/j.ejrad.2018.04.016.
15. You S., Ma X., Zhang C. et al. Determination of single-kidney glomerular filtration rate (GFR) with CT urography versus renal dynamic imaging Gates method. Eur Radiol 2018;28(3): 1077-84. DOI: 10.1007/s00330-017-5061-z.
16. Rohrschneider W.K., Hoffend J., Becker K. et al. Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. I. Evaluation of the normal status in an animal model. Pediatr Radiol 2000;30(8):511-22. DOI: 10.1007/s002470000270.
17. Pedersen M., Shi Y., Anderson P. et al. Quantitation of differential renal blood flow and renal function using dynamic contrast-enhanced MRI in rats. Magn Reson Med 2004;51(3):510-7. DOI: 10.1002/mrm.10711.
18. Rohrschneider W.K., Haufe S., Wiesel M. et al. Functional and morphologic evaluation of congenital urinary tract dilatation by using combined staticdynamic MR urography: findings in kidneys with a single collecting system. Radiology 2002;224(3):683-94. DOI: 10.1148/radiol.2243011207.
19. Fiev D., Proskura A., Khokhlachev S. et al. A prospective study of novel mathematical analysis of the contrast-enhanced computed tomography vs renal scintigraphy in renal function evaluation. Eur J Radiol 2020;130:109169. DOI: 10.1016/j.ejrad.2020.109169.
20. Himmelfarb J., Ikizler T.A. Chronic kidney disease, dialysis, and transplantation: companion to Brenner and Rector's the kidney. Elsevier, 2018.
21. Moeller T.B., Reif E. Normal Findings in CT and MRI. Shtuttgart, New York: Thieme, 2000.
22. Mudraia I.S., Kirpatovskii V.I. [The functional assessment of the upper urinary tract by the methods of 2-frequency impedance measurement and multichannel impedance ureterography (In Russ.)]. Urol Nefrol (Mosk) 1993;5:4-9.
23. Wen J.G., Frokiffir J., J0rgensen T.M., Djurhuus J.C. Obstructive nephropathy: An update of the experimental research. Urol Res 1999;27(1):29-39. DOI: 10.1007/s002400050086.
24. Docherty N.G., O'Sullivan O.E., Healy D.A. et al. Evidence that inhibition of tubular cell apoptosis protects against renal damage and development of fibrosis following ureteric obstruction. Am J Physiol Renal Physiol 2006;290(1):F4-13.
Andrology and Genital Surgery. 2021; 22: 36-44
Mathematical postprocessing analysis of contrast-enhanced computed tomography data of the kidneys in evaluation of split renal function in patients with kidney stone disease
https://doi.org/10.17650/1726-9784-2021-22-4-36-44Abstract
Introduction. An original research work was performed to assess split kidney function by glomerular filtration rate (GFR) with mathematical analysis of the kidneys computed tomography (CT) data in patients with kidney stone disease (KSD). Objective was to evaluate the GFR and the parenchyma structure of each kidney and identify the possible patterns of contrast medium intrarenal transport with mathematical analysis of the kidneys CT data in patients with KSD.
Materials and methods. Data of 27 patients of both genders with KSD were retrospectively analyzed. To evaluate GFR separately for each kidney we analyzed the data of contrast-enhanced CT (GFR reference values are 0.55 % of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size ≤1,5-2,0 cm, no obstruction of the urine flow registered; 3) no kidney or upper urinary tract surgical history; 4) age - ≤45 years; 5) no severe chronic diseases. All of these allowed to minimize influence of any other disorders on split renal function except for SKD and conduct per se research.
Results. The mathematic analysis of the contrast-enhanced CT data revealed GFR changes in 26 (96.3 %) out of 27 patients. Hyperfiltration was found in 12 (44.4 %) patients: right kidney GFR - 0.6-0.77 %, mean value - 0.65 %; left kidney GFR - 0.59-0.79 %, mean value - 0.67 %. Hypofiltration was found in 13 (48.1 %) patients: right kidney GFR - 0.2-0.54 %, mean value - 0.37 %; left kidney GFR - 0.2-0.53 %, mean value - 0.4 %. The GFR values significantly differed between the groups both for the right (p = 0.000014) and left (p = 0.000045) kidneys. We found no significant age-related difference between the groups (p = 0.895). As well as that no significant differences in Resistance Index both in magistral (right kidney: p = 0.221; left kidney: p = 0.850) and segmental (right kidney: p = 0.306; left kidney: p = 0.957) arteries between the groups with hyperfiltration and hypofiltration were observed. One patient demonstrated no changes in GFR, and the other one had hyperfiltration (0,62 %) in one kidney and hypofiltration (0,48 %) in another.
Conclusion. Most of the patients (92.6 %) with SKD demonstrate GFR changes (either hyperfiltration or hypofiltration) that may indicate the disturbed intrarenal blood and urine flow through the kidney.
References
1. Carr R.J. A new theory on the formation of renal calculi. Br J Urol 1954;26(2):105—17. DOI: 10.1111/j.1464-410x.1954.tb06073.x.
2. Stoller M.L., Meng M.V, Abrahams H.M., Kane J.P. The primary stone event: a new hypothesis involving a vascular etiology. J Urol 2004;171(5):1920-4. DOI: 10.1097/01.ju.0000120291.90839.49.
3. Kramer G., Klingler H.C., Steiner G.E. Role of bacteria in the development of kidney stones. Curr Opin Urol 2000;10(1):35-8. DOI: 10.1097/00042307-200001000-00009.
4. Martel J., Wu C.-Y., Young J.D. Translocation of mineralo-organic nanoparticles from blood to urine: a new mechanism for the formation of kidney stones? Nanomedicine (Lond). 2016;11(18):2399-404. DOI: 10.2217/nnm-2016-0246.
5. Brown C.M., Ackermann D.K., Purich D.L. EQUIL 93: a tool for experimental and clinical urolithiasis. Urol Res 1994;22(2):119-26. DOI: 10.1007/BF00311003.
6. Bagga H.S., Chi T., Miller J., Stoller M.L. New Insights Into the Pathogenesis of Renal Calculi. Urol Clin North Am 2013;40(1):1-12. DOI: 10.1016/j.ucl.2012.09.006.
7. Robertson W.G. Potential role of fluctuations in the composition of renal tubular fluid through the nephron in the initiation of Randall's plugs and calcium oxalate crystalluria in a computer model of renal function. Urolithiasis 2015;43(Suppl 1):93-107. DOI: 10.1007/s00240-014-0737-1.
8. Asplin J.R., Mandel N.S., Coe F.L. Evidence for calcium phosphate supersaturation in the loop of Henle. Am J Physiol 1996;270(4 Pt 2):F604-13. DOI: 10.1152/ajprenal.1996.270.4.F604.
9. Finlayson B., Reid F. The expectation of free and fixed particles in urinary stone disease. Invest Urol 1978;15(6):442-8.
10. Helck A., Schonermarck U., Habicht A. et al. Determination of split renal function using dynamic CT-angiography: preliminary results. PLoS One 2014;9(3):e91774. DOI: 10.1371/journal.pone.0091774.
11. Patankar K., Low R.S.-T., Blakeway D., Ferrari P. Comparison of computer tomographic volumetry versus nuclear split renal function to determine residual renal function after living kidney donation. Acta radiol 2014;55:753-60.
12. Barbas A.S., Li Y., Zair M. et al. CT volumetry is superior to nuclear renography for prediction of residual kidney function in living donors. Clin Transplant 2016;30(9):1028-35. DOI: 10.1111/ctr.12784.
13. Mitsui Y., Sadahira T., Araki M. et al. The assessment of renal cortex and parenchymal volume using automated CT volumetry for predicting renal function after donor nephrectomy. Clin Exp Nephrol 2018;22(2):453-8. DOI: 10.1007/s10157-017-1454-1.
14. Houbois C., Haneder S., Merkt M. et al. Can computed tomography volumetry of the renal cortex replace MAG3-scintigraphy in all patients for determining split renal function? Eur J Radiol 2018;103:105-11. DOI: 10.1016/j.ejrad.2018.04.016.
15. You S., Ma X., Zhang C. et al. Determination of single-kidney glomerular filtration rate (GFR) with CT urography versus renal dynamic imaging Gates method. Eur Radiol 2018;28(3): 1077-84. DOI: 10.1007/s00330-017-5061-z.
16. Rohrschneider W.K., Hoffend J., Becker K. et al. Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. I. Evaluation of the normal status in an animal model. Pediatr Radiol 2000;30(8):511-22. DOI: 10.1007/s002470000270.
17. Pedersen M., Shi Y., Anderson P. et al. Quantitation of differential renal blood flow and renal function using dynamic contrast-enhanced MRI in rats. Magn Reson Med 2004;51(3):510-7. DOI: 10.1002/mrm.10711.
18. Rohrschneider W.K., Haufe S., Wiesel M. et al. Functional and morphologic evaluation of congenital urinary tract dilatation by using combined staticdynamic MR urography: findings in kidneys with a single collecting system. Radiology 2002;224(3):683-94. DOI: 10.1148/radiol.2243011207.
19. Fiev D., Proskura A., Khokhlachev S. et al. A prospective study of novel mathematical analysis of the contrast-enhanced computed tomography vs renal scintigraphy in renal function evaluation. Eur J Radiol 2020;130:109169. DOI: 10.1016/j.ejrad.2020.109169.
20. Himmelfarb J., Ikizler T.A. Chronic kidney disease, dialysis, and transplantation: companion to Brenner and Rector's the kidney. Elsevier, 2018.
21. Moeller T.B., Reif E. Normal Findings in CT and MRI. Shtuttgart, New York: Thieme, 2000.
22. Mudraia I.S., Kirpatovskii V.I. [The functional assessment of the upper urinary tract by the methods of 2-frequency impedance measurement and multichannel impedance ureterography (In Russ.)]. Urol Nefrol (Mosk) 1993;5:4-9.
23. Wen J.G., Frokiffir J., J0rgensen T.M., Djurhuus J.C. Obstructive nephropathy: An update of the experimental research. Urol Res 1999;27(1):29-39. DOI: 10.1007/s002400050086.
24. Docherty N.G., O'Sullivan O.E., Healy D.A. et al. Evidence that inhibition of tubular cell apoptosis protects against renal damage and development of fibrosis following ureteric obstruction. Am J Physiol Renal Physiol 2006;290(1):F4-13.
