nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2012-16-1-45-51nefr-563Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSДОППЛЕРОГРАФИЧЕСКАЯ ОЦЕНКА АРТЕРИАЛЬНОГО КРОВОТОКА И ИЗМЕНЕНИЯ ФУНКЦИИ ПОЧЕК У БОЛЬНЫХ С АТЕРОСКЛЕРОЗОМ ПОЧЕЧНЫХ АРТЕРИЙ ПОСЛЕ РЕВАСКУЛЯРИЗАЦИИDOPPLER EVALUATION OF RENAL BLOOD FLOW AND CHANGES OF KIDNEY FUNCTION IN PATIENTS WITH ATHEROSCLEROTIC RENAL ARTERY DISEASE AFTER REVASCULARIZATIONСеменовД. В.SemionovD. V.

Кафедра госпитальной хирургии №1  

СмирновА. В.SmirnovA. V.

Кафедра пропедевтики внутренних болезней

КирилловаЕ. В.KirillovaE. V.

Кафедра госпитальной хирургии №1  

ДерябинаО. А.DeryabinaO. A.

Кафедра госпитальной хирургии №1  

РябиковМ. А.RyabikovM. A.

Кафедра госпитальной хирургии №1  

ДобронравовВ. А.DobronravovV. A.

Кафедра пропедевтики внутренних болезней

197022, Санкт-Петербург, ул. Л. Толстого, д. 17, корп. 54. Тел.: (812)-2346656

dobronravov@nephrolog.ruСанкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation2012100120121614551Copyright © Семенов Д.В., Смирнов А.В., Кириллова Е.В., Дерябина О.А., Рябиков М.А., Добронравов В.А., 20122012Семенов Д.В., Смирнов А.В., Кириллова Е.В., Дерябина О.А., Рябиков М.А., Добронравов В.А.Semionov D.V., Smirnov A.V., Kirillova E.V., Deryabina O.A., Ryabikov M.A., Dobronravov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/563

ЦЕЛЬ ИССЛЕДОВАНИЯ. Изучение связи между исходными показателями допплерографического исследования артериального кровотока в ишемизированных почках и функциональным состоянием органа после их реваскуляризации у больных с атеросклеротическими окклюзионными поражениями почечных артерий (АОППА). ПАЦИЕНТЫ И МЕТОДЫ. У 64 больных с гемодинамически значимыми АОППА (40 мужчин и 24 женщины в возрасте от 47 до 78 лет, в среднем – 60 ± 8 лет) проведен анализ пиковой систолической скорости кровотока, конечно диастолической скорости кровотока (КДСК), пульсационного (ПИ), резистивного (РИ) индексов и времени ускорения кровотока (ВУК), определенных в в почечной артерии (ПА) и внутрипаренхиматозных артериях в 85 ишемизированных почках в зависимости от состояния почечной функции (ПФ) после реваскуляризации почек (РП). Также выполнен морфометрический анализ мелких артерий. РЕЗУЛЬТАТЫ. У больных с отдаленным улучшением ПФ после их реваскуляризации были достоверно ниже РИ и ПИ в дистальной трети ПА, сегментарных и междолевых артериях. Отдаленная динамика скорости клубочковой фильтрации (СКФ) прямо ассоциировала с КДСК и обратно – с ПИ и РИ на всех уровнях артериального русла почек. В ишемизированных почках пациентов с отдаленным снижением СКФ после РП были достоверно выше СИ, толщина медии и меньше внутренний просвет артерий с наружным диаметром > 100 мкм. Последний был прямо связан с КДСК и обратно – с РИ в сегментарных артериях. ЗАКЛЮЧЕНИЕ. Ренопротективный эффект РП, определяемый по относительной динамике СКФ в до и послеоперационном периодах, в значительной степени, независим от снижения АД и определяется состоянием внутрипочечного артериального русла. Повышения СКФ после восстановления кровотока в ишемизированных почках можно ожидать при сниженном внутрипочечном периферическом сопротивлении сосудов, проявляющимся сохранным КДСК, а также низкими показателями ПИ и РИ при допплерографии.

THE AIM. To study the relationship between baseline Doppler parameters of arterial blood flow in the ischemic kidney and the functional state of organs after revascularization in patients with atherosclerotic renal artery disease (ARAD). PATIENTS AND METHODS. In 64 patients with haemodinamically significant ARAD (40 men and 24 women at the age of 47-78 years, average age 60±8 years) were analyzed the following parameters: blood flow peak systolic velocity, end-diastolic blood velocity (EDBV), pulse index (PI), resistive index (RI) and blood flow acceleration time (BAT) defined in renal artery (RA) and intraparenchymal arteries in 85 ischemic kidneys depending on renal function (RF) status after kidneys revascularization (KR). Also morphometric analysis of arterioles was performed. RESULTS. At patients with distant RF mend after its revascularization RI and PI were significantly lower in distal third of RA, segmental and interlobar arteries. The thickness of media and vascular index were significantly higher in ischemic kidneys of patients with distant GFR decline after KR. On the contrary, inner lumen of the arteries with external diameter>100 μm was less. The latter was directly related to the EDBV and back - with the RI in segmental arteries. CONCLUSION. Renoprotective effect of KR is detected by relative dynamics of GFR in pre- and postoperative periods, irrespective of blood pressure decreasing and is determined by intrarenal arterial bed status. After blood flow recovery in ischemic kidneys GFR can be increased at decreased intrarenal peripheral resistance which appears by saved EDBV and also low values of PI and RI at Doppler examination.

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The authors declare that there are no conflicts of interest present.