Method for the treatment of patients with renal microangiopathy

 

(57) Abstract:

The invention relates to medicine, Nephrology. Carried ultrasound of the kidneys. Assess vascular blood flow in the capillaries at the level of the glomeruli by indices of vascular resistance in the arc artery. When the value of these indicators are below the norm judge defeat of capillary blood flow in the kidney glomeruli and diagnose the circulation. The effectiveness of drug therapy assess the value of these indicators, continuing the treatment until their normalization. The method allows to obtain a more pronounced and persistent therapeutic effect, reduce the treatment time. Rapid and objective assessment of the effectiveness of the treatment allows adequate correction of therapy tailored to the individual characteristics of each patient.

The invention relates to medicine, namely Nephrology.

There is a method of treatment of patients with renal microangiopathy, including the administration of drugs having vasodilator and antispasmodic action. (Pediatric Nephrology. A guide for physicians/M. S. Ignatov, Y. E. Ultidev. - L.: - Medicine, 1989, S. 235, 338).

Also known is a method of treatment of patients with renal microangiopathy (pediatric radiology//S. P. Mironov, Y. N. Kasatkin): - RMAPO, - 1993, S. 107-130), namely, that previously conducted radioisotope study, in which establish the existence of a violation of microcirculation in the renal parenchyma. After appropriate therapy, including the introduction of a vasodilator and antispasmodic drugs, a refresher study. When you re-scan register changes of microcirculation in terms of the accumulation of pharmaceuticals in all departments of the parenchyma of the kidney with the same intensity. However, the known method has some disadvantages: the irradiation of patients, the complexity of the sanitary-hygienic requirements, the need for complex equipment, the duration of the preparatory and diagnostic procedures, the need for large numbers of trained personnel.

As the prototype accepted method for the treatment of patients with renal microangiopathy (x-ray Diagnostics in Pediatrics. Guide to the doctor who conduct the assessment of renal tissue and collective complex visual interpretation, roentgenometry, rentgenpelviometrii and quantitative determination of parameters of the filtration-concentration of kidney function. By the last parameter in the main provide an opinion about the state of the glomerular apparatus of the kidneys. In the event of a defeat and, with the appropriate clinical signs of child conduct adequate therapy vasodilator and antispasmodic drugs. As monitoring the effectiveness of treatment are repeated excretory urography.

However, the known method has the disadvantages associated with the introduction of the contrast agent, which is a toxic substance, exposure of the body, the legislative limitations of the research, the complexity of the method of processing x-ray image and the low accuracy of the conclusion. In this regard, the treatment is not effective enough, because there is no possibility of frequent monitoring, which in turn leads to an increase in treatment time

The objective of the invention is to provide a method of treatment of patients with microangiopathy kidney to prevent side effects, get more persistent and pronounced clinical effect and reduce the time of treatment.

The use of the invention allows to obtain the following technical result.

The method allows to obtain a more pronounced and persistent therapeutic effect and reduce the time of treatment.

Almost daily monitoring of ongoing therapy allows you to quickly and objectively assess the effectiveness of drugs and to make them adequate replacement for more is aparatow.

The method of control by ultrasound is completely safe for the patient.

Ease of obtaining diagnostic information, no need special training to study its efficiency, the absence of contraindications in contrast to radiological and radiological methods to diagnose lesions at an early stage and to heal him until recovery, and in severe forms to use more than adequate, sustainable and targeted therapy.

A typical result is achieved due to the fact that the authors found that patients with microangiopathy of the kidneys is impaired circulation at the level of the glomeruli of the cortical substance of the kidney, as well as through monitoring of treatment and timely correction on objective indicators of vascular resistance at the level of the arc of the arteries of the renal parenchyma.

The method is performed in the following way. Patient pre-carried ultrasound of the kidneys by well-known methods. For this purpose, devices equipped with sensors to 3.5-5-7.5 MHz mode color Doppler mapping or energy which makes sure triplex (at least duplex) scanning for example Aloka-1700, 2000, or Akuson XP 128. On the screen receive ultrasound image of the kidney in longitudinal and transverse planes, while appreciate the anatomical preservation of renal tissue location, dimensions, size, differentiation, and echogenicity of the parenchyma, the collective state of the complex, the mobility of the kidney in a vertical position and when the breath, followed by a qualitative assessment of perfusion of renal tissue color Doppler mapping at low speeds (to identify the most small vessels of the kidney) or using power Doppler. Then using a pulsed abnormal Doppler waveforms study the blood flow parameters (resistance) at all levels of renal arterial vessels (in the trunk of the renal artery in the transverse scan at the level of the gate kidney, segmental, muzdalifah, arc and midorikawa branches in the longitudinal scan). At this calculate IL (the resistance index is the ratio of the difference between systolic and diastolic velocity to systolic velocity), PI (pulse index - the ratio of the difference between systolic and diastolic velocity to average velocity), DM (systolicdiastolic ratio). For children over 3 years of R & d in the norm extending t the renal artery with a uniform reduction in systolic and diastolic velocities (absolute values) are stored on one level values of peripheral resistance (relative performance). In the event of a loss of capillaries at the level of the glomeruli in the arc artery occurs a sharp drop in peripheral resistance (IR becomes less than 0,6, reaching values of 0.4 - 0.5, PI is less than 1.0) due to the connection of the shunt Trueta" or juxtamedullary apparatus by which arterial blood, bypassing the main path, is discharged into the venous system, thereby exacerbating the primary pathological process in the glomeruli. When conducting adequate therapy aimed at reducing inflammation, and improve blood flow in small vessels of the kidney, you can control the action of drugs on the change (increase to normal) peripheral resistance at the level of arc artery. When stable normal change (reduce) the dose of the medication or supportive therapy. The lack of vascular response indicates improper treatment or irreversible pathological process. In cases of severe damage of the renal parenchyma, when affected glomeruli both cortical and juxtamedullary zone vascular resistance at all levels of arterial blood flow increased (blood nowhere to be discharged). The purpose of antispasmodics and with the udah then, when the positive effect of the peripheral resistance will fall and strive to normal. If a similar effect from the use of drugs not see, then talk about the irreversibility of the pathological process.

Clinical trials conducted at the Russian medical Academy of postgraduate education (Department of radiology, children's age) on the basis of Nephrology and endocrine Department Tushinskaya children's hospital, Moscow. Surveyed more than 10 children at the age from 3 to 15 years with a diagnosis of glomerulonephritis, purpura nervosa, diabetes mellitus (insulin-dependent form), obstructive nephropathy. The control group consisted of 50 children of the same age. Sexual differences in the characteristics of renal blood flow has not been found.

Example. Patient K., aged 6, arrived again in the unit in a serious condition with edema, high blood pressure, protein and hematuria. During previous hospitalizations was diagnosed with interstitial glomerulonephritis, confirmed by biopsy. For a long time was on hormonal therapy, received cytostatics. Concomitant disease is atopic dermatitis, food Allergy, NEPA traslacoon study the location of the kidney normal, mobility not changed, contours equal, precise. The size of the symmetric and age-appropriate. Parenchyma increased echogenicity, differentiation significantly reduced. Collective complexes is not extended. When color Doppler mapping at a speed of 5 cm/sec, and power Doppler study of blood flow in podkapsulnaya zone parenchyma is almost not observed. During the spectral analysis of the Doppler signal from all branches of the renal artery on both sides there is a significant difference between the numbers of vascular resistance, a significant drop compared to the norm of these indicators at the level of arc arteries (IL OR = 0.51, P = 1,1, SD = 1,8). After a single intramuscular injection shpy in a single age dosage after 30 minutes it was noted improving blood flow to the peripheral parts of the parenchyma of the kidney, increased peripheral resistance in the arc artery. These data testified to the relative safety of the circulation in the small vessels of the kidney. The child was assigned the chimes together with the basic therapy. When the control ultrasonic studies of renal blood flow was restored after 10 days. Such terapias and after discontinuation of drug therapy remained on normal numbers.

Method for the treatment of patients with renal microangiopathy, including a preliminary study of the kidneys and subsequent drug therapy with drugs antispasmodic and vasodilatory action, characterized in that is carried ultrasound of the kidneys, which provide a qualitative assessment of blood supply to the renal parenchyma, as well as quantitative assessment of capillary blood flow in the kidney, which determine the indices of vascular resistance in the spectrogram of blood flow at all levels of renal arterial vessels, and when the value of these indicators at the level of arc artery below the norm judge the violation of capillary blood flow in the glomeruli of renal parenchyma and diagnose the disorder of microcirculation, while drug therapy are under the control of these parameters to their normalization and stabilization, spend, if necessary, timely correction.

 

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