SIW Theme : “Visual diagnostics of glomerulonephritis”

DRMG
Conclusion
References

of glomerulonephritis is established on the basis of clinical and

laboratory data. Distinguish between acute and chronic glomerulonephritis.
Acute glomerulonephritis is characterized by proteinuria, edema, hematuria, renal insufficiency and hypertension.
Chronic is a slowly progressive disease that leads to irreversible renal failure and can be primary and secondary (due to systemic diseases).

radiographic (in the presence of concomitant diseases).
Ultrasound in the

case of glomerulonephritis reveals
an increase or decrease in the size of the kidneys
a diffuse increase in the echogenicity of the parenchyma
a violation of the boundary between the cortical and medullary layer
the protruding hypoechoic pyramids of the medulla.
These signs are not pathognomonic for glomerulonephritis are found against the background of other kidney diseases.

is used to assess the function of the kidneys and

the extent to which it is disturbed. The most informative methods are the IRPH (indirect radionuclide radiography is a technique for assessing the temporal and quantitative parameters of renal hemodynamics using radiopharmaceuticals.) And DRМG (dynamic reno-scintigraphy is a technique for visualizing the kidneys and urinary tracts with a scintigraphy method and a gamma camera to determine the parameters of accumulation and secretion Nephrotropic radiopharmaceuticals of tubular and glomerular elimination mechanisms) with ⁹⁹ᵐTc-DTPO (technetium complex with precipitate).

a slowing of the arterial and venous phases of the

blood flow (Ta. Tv), an increase in the time of aortic transit (Tar).
DRМG with ⁹⁹ᵐТс-DTPО allows to define symmetric retardations of filtration-excretory processes in kidneys - renograms of the parenchymal type. In the case of glomerulonephritis, the kidneys are clearly visualized on scintiphotos. Changes in renal circulation and functional state of the organ are more significant in the presence of clinically unfavorable variants of the disease (nephrotic syndrome with hematuria, elevated blood pressure, disturbance of the renal nitrogen function).

before the beginning of the program therapy of glomerulonephritis, it

is possible to predict the course of the disease.
In case of chronicization of the pathological process in the kidneys or its further progression with the development of CRF
by slowing down of Ta and Tar, glomerular filtration rate, Tmax (the time of maximum accumulation of RFP in the kidneys)
an increase in the percentage of excretion of RFP is possible in comparison with the control group (intact kidneys)
the elongation of Ta is possible in the absence of the effect of treatment (progression) in comparison with the results characteristic of patients with complete clinical and laboratory remission.
Slowing Ta> 8 is a sign of significant changes in renal circulation and an unfavorable prognosis of the disease. On the background of treatment and after its completion, the majority of patients notice improvement in the parameters of NRH and DRSG, but in the history of renal dysfunction and slowing of renal hemodynamics remain in almost a quarter of patients with remission, which indicates the incompleteness of the pathological process in the kidneys and the need for a constant clinical and laboratory And radionuclide monitoring.

kidneys - dopplerography of renal vessels.

patient's position with his back to the gamma detector or

lying on his back. The middle of the detector is set at the level of the XII rib from behind.
RFPs are administered bolus (0.3-0.5 ml) under a tourniquet, fast, with an activity of at least 3 MBq / kg.
After the injection, the tourniquet is removed and several movements are made by the patient's hand up and down for quick passage of the "bolus". Further, the program for recording information on a computer in the event that a heart image appears on the monitor for collecting information.
Angiographic examination is carried out with exposure 1 frame per 1s. The recommended time of the procedure is 30 s (for children) and 45 s (for adults).
After the study, several angiogram points are marked to determine the parameters of the NNRG. Such points are the beginning of the RFP entering the kidneys, the time of the maximum passage of the "bolus" and the time to reach a balanced concentration. Based on this, the time of the arterial phase (Ta) of renal blood flow (c), the time of the venous phase (Tv) of renal blood flow (c) and the time of arterial transit (Tar) (c) are calculated.

includes:
* Normal physiological regimen (light breakfast) and 100-200 ml of

tea or mineral water 30 min before the study;
Empty bladder;
* Immobility of the patient during the study.
The study is conducted in the patient's position while sitting with his back to the gamma detector or lying on his back. The middle of the detector is set at the level of the XII rib from behind. RFP is administered in an amount of 0.3-0.5 ml, rapidly. After the introduction of the RFP, the computer program is launched and the information begins to be collected with the exposure of 1 frame per minute. The duration of the study is 20 min (children) and 30 min (adults).

during the study gives primary information about the degree of

visualization of the kidneys at each minute, the presence of ureter imaging and the time of the appearance of the image of the bladder.
2. Single-frame viewing of the kidney scintigraphy image gives preliminary information about the function of the parenchyma and the state of urodynamic.
3. Analysis of the "zone of interest".
4. Segment analysis.
5. Analysis of secretory-excretory and filtration-excretory functions of each kidney is carried out by calculating the basic parameters of its functional capacity.

a combination of the definition of symptoms of the clinical

picture, the conduct of various types of laboratory diagnosis and various instrumental methods. For correct differential diagnosis, a combination of all available methods is necessary.

The preliminary diagnosis is made on the basis of clinical manifestations of the disease, complaints and anamnesis, identification of diagnostic criteria during examination and physical examination.

Further the doctor appoints additional researches for specification of the form of disease and its etiology. To determine the primary or secondary form of glomerulonephritis, the connection with the transmitted infectious diseases, for example, with streptococcal infections, is taken into account.