A method for diagnosing renal dysfunction

 

(57) Abstract:

The invention relates to medicine, namely to surgery and is intended for the diagnosis of acute pancreatitis. Patients take 2 ml of the morning portion of urine. Determine the maximum electrical conductivity in the frequency range from 1,000 to 120,000 Hz AC. When its value is less than 238 S/m diagnosed with renal dysfunction. The method allows to simplify and improve the accuracy of diagnosis.

The invention relates to medicine, namely to laboratory methods, and can be used for the diagnosis of renal dysfunction in patients with acute pancreatitis.

To diagnose renal failure/dysfunction determine the concentration of creatinine plasma kinetic method and glomerular filtration by the formula F=CcrV, where Ccr- concentration index creatinine (ratio of the concentration of creatinine in the urine to that in the blood); V - min diuresis [Simanco I. I., Musselius S., Acute renal and hepatic failure. - M.: Medicine, 1993, 288 S.]. The increase in creatinine concentration of 200 µmol/l and decreased glomerular filtration rate of 50 ml/min was regarded as a sign of latent period po-38].

The disadvantages of the prototype should include the need for specially trained personnel and equipment, the complexity and duration of the study, the complexity of monitoring control and lack of information content in the initial stage of renal dysfunction.

The invention is directed to solution of the task: improve accuracy and simplify the method.

This is accomplished by examining the maximum specific electrical conductivity (SEC) urine volume of 2 ml in the frequency range from 1000 to 1200000 Hz alternating electric current, and determine the maximum value SEC. The conductivity of this volume is the biophysical characteristics of the urine sample. When the value of the electric conductivity of the urine below 238 S/m (Siemens/meter) diagnosed with renal dysfunction. Urine for the study take the day of surgery or admission and the subsequent 4 days.

The method is as follows

The examined patient on the day of receipt or transaction and the subsequent 4 days of observation take 2 ml portion of morning urine. Urine poured into a test tube and with the help of the device Qualy Tester determines the maximum electrical conductivity in the frequency range per dysfunction.

In healthy persons (control group) and patients with calculous cholecystitis without concomitant renal dysfunction SEC urine during the first 4 days of observation exceeds 238 S/m. In acute pancreatitis the conductivity is below the specified value. The study was conducted with the help of the device Qualy Tester, OJSC Morion, Russia, Perm, RT 940.008 THAT.

Examples of specific performance:

Example 1. Patient, 27 years, case history No. 1115. Diagnosis: Severe acute pancreatitis. Mixed pancreonecrosis. Acute post-traumatic pancreatic pseudocyst of the pancreas. Acute renal failure, oligoanalgesia period.

Received in the emergency Department surgery Bureau 28.08.2000 with complaints of acute girdle pain pain in the upper floor of the abdomen, bloating, weakness, fever up to 37.5 With chills. When applying the General state of moderate severity. Complete blood count: erythrocytes - 3,81012/l, leucocytes - 4,1109l (eosinophils - 5, band - 2, segmented neutrophils - 42, lymphocytes 44, monocytes - 7), platelet - 290109/l, erythrocyte sedimentation rate of 30 mm per hour, the clotting time is 15 minutes urinalysis: specific gravity 1020, color yellow, muddy, neutral reaction, protein - neg., the leukocyte - 3-5, an epithelium flat - entirely, oxalates - creatinine - 0,17 mmol/l, total bilirubin of 12 µmol/l, ALAT - 14 ME, alkaline phosphatase - 130 U/l, amylase - 370 mg/ml, including ultrasound and x-ray computed tomography detected an increase in the echogenicity of the parenchyma of the pancreas, in the projection Trofimovna tail rounded anechoic mass with education 1009083 ml volume of 420 ml isoechogenic suspension in the bottom. The kidneys unchanged.

13.09.2000 operated. In the abdominal cavity 200 ml of hemorrhagic effusion and plaque stefanakos on the greater omentum and the gastrocolic ligament. In the left hypochondrium large size of the cyst solid elastic consistence, with its opening received 800 ml content with amylase activity 19000 mg/ml PM Deleted curtailment of the pancreas. Performed external drainage of the cyst.

In the postoperative period conducted comprehensive treatment. Infusion volume of 2400 ml, daily diuresis in the first 3 days 500-600 ml. Value SEC urine, taken on the day of surgery, amounted to 205 S/m, in the next 4 days its value does not exceed 210 S/m, which was confirmed by renal dysfunction. On day 7 after surgery diuresis in the amount of 1200-1500 ml per day. The magnitude of the electrical conductivity of the urine amounted to 270 S/m, indicating that the normalization of kidney function. General and biochemical and what about the epithelial cells.

Example 2. Patient S., 41,, case history No. 1218. Diagnosis: Acute pancreatitis. Chronic acalculous cholecystitis. The initial period of acute renal failure.

Received in the emergency Department surgery Bureau 11.10.1999, with complaints of severe cutting pain in the upper floor of the abdomen with irradiation to the left departments of the torso, nausea, vomiting, bringing relief, bloating, weakness. The General state of moderate severity. Complete blood count: erythrocytes - 6,110l2/l, leucocytes - 9,6109/l (eosinophils - 1, band - 6, segmented neutrophils - 65, lymphocytes - 20, monocytes - 8), ESR - 6 mm per hour. Urinalysis: specific gravity 1020, color yellow, muddy, neutral reaction, protein - neg., the leukocyte - 1-2, an epithelium flat single - field-of-view, phosphates +++. Biochemical blood test: whole protein - 76 g/l, glucose - 4.5 mmol/l, creatinine - 0,122 mmol/l, total bilirubin - 21 µmol/l (associated with 5 µmol/l), ALT - 33 ME, alkaline phosphatase - 116 U/l, amylase - 15 mg/ml including ultrasound signs of chronic cholecystitis. The pancreas is not increased, contours fuzzy, heterogeneous parenchyma, ahogany density is reduced. The kidneys unchanged.

Conducted complex the AI, 173 S/m, in the next 4 days its value did not exceed 170 S/m, indicating that the presence of renal dysfunction. Before discharge from the hospital daily diuresis in the volume of 2000 ml, the value of the electrical conductivity of the urine amounted to 255 S/m, reflecting the normalization of kidney function. General and biochemical blood analysis - without a pathology, remained neutral reaction of the urine.

Example 3. Patient Z., 47 years old, medical history No. 1355. Diagnosis: cholelithiasis. Chronic calculous cholecystitis, senior aggravation.

Hospitalized in the Department of emergency surgery 18.10.2001, with the attack of biliary colic. The General condition is satisfactory. Complete blood count: erythrocytes - 4,83109/l, leucocytes - 4,5109/l (stab - 4, segmented neutrophils - 44, lymphocytes - 48, monocytes - 4), ESR - 23 mm per hour. Urinalysis: specific gravity - 1030, color yellow, laborota, the reaction of the acidic, protein - neg., the leukocyte - 8-10, an epithelium flat - 3-5 in the field of view, oxalates ++. Biochemical analysis of a blood in norm. Ultrasound signs of lipodystrophy liver, gall bladder 5819 mm, thickened wall, the lumen is determined by many concretions. Common bile duct - 9 mm in diameter. Pancreas Iberoamericana cholangiography. Signs of disturbance of outflow of bile is not detected. Pancreas visually and by palpation is not changed. The magnitude of the electrical conductivity of the urine, taken on the day of surgery, amounted to 255 S/m, in the next 4 days its value ranged 283-295 S/m, indicating the absence of renal dysfunction. Laboratory tests before discharge without deviation from the norm.

Example 4. Patient, 27 years old, healthy.

Complete blood count: erythrocytes - 5,51012/l, leucocytes - 6,2109/l (eosinophils - 2, band - 2, segmented neutrophils - 52, lymphocytes - 33, monocytes - 11), ESR - 5 mm per hour. Urinalysis: specific gravity - 1013, color yellow, transparent, the reaction of the acidic, protein - neg., the leukocyte - 0-1, epithelium flat - 0-3 in the field of view. Biochemical analysis of blood without pathology. On the first day of observation, the magnitude of the electrical conductivity of the urine amounted to 280 S/m, in the next 4 days its value ranged 270-293 S/m, indicating the absence of renal dysfunction.

The advantage of the proposed method are the increased sensitivity of early and latent stages of renal failure/dysfunction, convenience and high performance, non-invasive collection of material simplification issledovanij equipment.

A method for the diagnosis of renal dysfunction in patients with acute pancreatitis by examination of the urine, characterized in that it determines the maximum electrical conductivity in the frequency range 1000 - 120000 Hz alternating current and its magnitude below 238 S/m, diagnose renal dysfunction.

 

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