Tip 2 Diabetes Mellituslu Hastalarda Böbreklerin Renal Doppler Ultrasonografi ve Ultrason Elastografi ile Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı diyabetik nefropatiyi ultrason elastografi ile erken teşhis etmektir. Bu çalışma renal biyopsiye gerek kalmadan diyabetik nefropati gelişme olasılığını tahmin etmektir. Materyal ve metod: Bu çalışmaya 100 hasta ve 100 sağlıklı gönüllü dahil edildi. Renal parankimden shear wave elastografi incelemesi ve renal arter Resistive Index değerleri alındı. Bulgular: Hasta grubunda elastografi değerleri sağ böbrek parankiminde 7,02±2,15 kPa, solda 6,90±2,09 kPa olarak ölçüldü. Kontrol grubunda elastisite değerleri sağ böbrek parankiminde 4,14±0,98 kPa, solda 4,11±0,85 kPa olarak ölçüldü. RI ortalama değerleri hasta grubunda sağ böbrekte 0,59±0,05 ve sol böbrekte 0,59±0,04, kontrol grubunda sağ böbrekte 0,52±0,05 ve sol böbrekte 0,52±0,05 olarak ölçüldü. Sonuç: Tip 2 DM'li hastalarda elastografi değerleri ve RI değerleri kontrol grubuna göre anlamlı olarak yüksekti. Böylece non-invazif SWE ve renkli Doppler US yöntemleri ile biyopsiye gerek kalmadan böbrek fibrozisini belirlemenin ve diyabetik nefropati gelişme olasılığını tahmin etmenin mümkün olduğu söylenebilir.

Anahtar Kelimeler

• shear wave elastografi
• böbrek
• doppler

Evaluation of Kidneys with Renal Doppler Ultrasonography and Ultrasound Elastography in Patients with Type 2 Diabetes Mellitus

Öz

Introduction: The aim of this study early recognize diabetic nephropathy by ultrasound elastography.This study was to predict the possibility of developing diabetic nephropathy without the need for renal biopsy. Methods:This study included 100 patients and 100 healthy volunteers. Shear wave elastography examination were taken of the renal parenchyma and the Resistive Index values were taken renal artery. Results:.In the patient group, the elastography values were measured as 7.02±2.15 kPa in the right kidney parenchyma and 6.90±2.09 kPa in the left. In the control group, the elasticity values were measured as 4.14±0.98 kPa in the right kidney parenchyma and 4.11±0.85 kPa in the left. The RI mean values were determined as 0.59±0.05 in the right kidney and 0.59±0.04 in the left kidney in the patient group and 0.52±0.05 in the right kidney and 0.52±0.05 in the left kidney in the control group. Conclusion: The elastography values and the RI values were significantly higher in the patients with Type 2 DM than in the control group. Thus, it can be concluded that it is possible to determine renal fibrosis and predict the possibility of diabetic nephropathy development with the non-invasive methods of SWE and colour Doppler US, without the need for biopsy.

Anahtar Kelimeler

• shear wave elastography
• kidney
• doppler
• type 2 diabetes mellitus

Kaynakça

1. 1. Satman I, Yilmaz T, Sengul A, et al.Population-based study of diabetes and risc characteristics in Turkey: results of the Tur-kish diabetes epidemiology study (TUR-DEP).Diabetes Care 2002;25:1551-1556.
2. 2. Satman I, Tutuncu Y, Gedik S, et al. The TURDEP-II Study Group, Diabetes epidemic in Turkey: Results of the second population based survey of diabetes and risk characteristics in Turkey (TURDEP-II). Poster: A-11-2498. 47th EASD Annual Meeting, 12-16 Sept 2011, Lisbon, Portugal. Diabetologia 2011; 2498-2499.
3. 3. El Nahas AM. Growth factors and glomerular sclerosis. Kidney Int Suppl 1992;36: 15-20.
4. 4. Balleyguier C, Ciolovan L, Ammari S, et al. Breast elastography: The technical process and its applications. Diagn Interv Ima-ging 2013; 94: 503–513.
5. 5. Tublin ME, Bude RO, Platt JF. The resistive index in renal Doppler sonography: Where do we stand? Am J Roentgenol 2003;180:885–892.
6. 6. Taş S, Onur MR, Yılmaz S, et al. Shear Wave Elastography Is a Reliableand Repeatable Methodfor Measuring the Elastic Modulus of theRectus Femoris Muscleand Patellar Tendon. J UltrasoundMed 2017;36: 565-570.
7. 7. Rübenthaler J, Müller-Peltzer K, Reiser M, et al. [Sonoelastog-raphy in dailyclinicalroutine] Radiologe 2017; 17: 17-224.
8. 8. Dr. A.Yiğit Göktay, Dr. Adnan Kabaalioğlu, Dr. Cem Yücel DDA. Renal Renkli Doppler Ultrasonografi İncelemesi Uygulama Kı-lavuzu. Tıbbi Ultrason Derneği. 2006.

9. 9. Mogensen CE, Christensen CK, Vittinghus E. The stages in diabetic renal disease. With emphasis on the stage of incipi- ent diabetic nephropathy. Diabetes 1983;32: 64-78.
10. 10. Kahn CR, Weir GC, King GL, et al. Joslin's Diabetes Mellitus Yumuk M (çev.ed) İstanbul Medikal Yayıncılık, 2008; 331-339.
11. 11. Klein R, Klein B. Epidemiology of proliferative diabetic retino-pathy. Diabetes Care 1992; 15: 1875–1891.
12. 12. Akahashi T, Wang F, Quarles CC, et al. Current MRI Techniques for the Assessment of Renal Disease. Curr Opin Nephrol He-pertens 2016;24: 217–223.
13. 13. Sar MA. Elastography Usage in Renal Patients Turkish Nephrol Dial Transplant J 2017; 26: 18–20.
14. 14. Galesić K, Sabljar-Matovinović M, Tomić M BB. Renal Vascular Resistance in Glomerular Diseases – Correlation of Resistance Index with Biopsy Findings. Coll Antropol 2004;28: 667– 674.
15. 15. Koc, AS & Sumbul, HE J Ultrason 2018; 21: 279-80.
16. 16. Hassan K, Loberant N, Abbas N, et al. Shear wave elastog-raphy imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease. Ther Clin Risk Manag 2016;12: 1615–1622.
17. 17. Samir AE, Allegretti AS, Zhu Q, et al. Shear wave elastography in chronic kidney disease: A pilot experience in native kidneys. BMC Nephrol 2015;16: 119-120.
18. 18. Grass, L., Szekely, N., Alrajab, A, et al. Pointshear wave elas-tography (pSWE) using Acoustic Radiation Force Impulse (AR-FI) imaging: a feasibility study and norm values for renal pa-renchymal stiffness in healthy children and adolescentsMedi-cal Ultrasonography 2017;19: 366-373.
19. 19. Fiorini F, Barozzi L. The role of ultrasonography in the study of medical nephropathy. J Ultrasound 2007;10:161–167.
20. 20. Tatsuo Kawai, Kei Kamide, Miyuki Onishi, et al. Usefulness of the resistive index in renal Doppler ultrasonography as an in-dicator of vascular damage in patients with risks of atheroscle-rosis, Nephrology Dialysis Transplantation 2011;26:3256–3262
21. 21. Toledo C, Thomas G, Schold JD, et al. Renal Resistive Index and Mortality in Chronic Kidney Disease. Hypertension 2015.
22. 22. Ohta Y, Fujii K, Arima H, et al. Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Dopp-ler sonography. J Hypertens 2015;23: 1905–1911.