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The absence of anisotropic effect on the renal cortical echogenicity in feline chronic kidney disease
chronic kidney disease
renal cortical echogenicity
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|摘要:||貓之慢性腎病被定義為腎臟功能不可逆的喪失，通常為一種長期且慢性的病程。然而，即使符合慢性腎病的標準，未必所有的病患都會在臨床初期就表現出現氮血症的症狀。(Jepson, 2016)因此在懷疑患有慢性腎病的動物，常會建議進行腹腔超音波檢查以獲取更多臨床資訊。在正常犬貓的腎臟中可見的各向異性，是一種和角度相關的局部腎臟皮質回音性上升的現象(約位於腎臟皮質三點鐘與九點鐘位置)，應當留意不要與真正的高回音性病變混淆。(Ruth et al., 2013)由於腎臟疾病最常見的特徵之一就是腎臟皮質回音性的上升，因此我們假設由各向異性所導致的局部皮質高回音性，將會因此被腎病引起的整體回音性上升所掩蓋掉。本研究期望評估腎臟皮質回音各向異性於貓慢性腎病消失所代表之臨床意義。回溯2012年一月至2017年十二月之間國立中興大學獸醫教學醫院的病歷資料，選入35個病情穩定的貓慢性腎病病例，並且招募18隻臨床上健康的貓。費雪精確檢定和趨勢檢定分別顯示出腎臟皮質回音各向異性的消失和貓隻慢性腎病之間具有顯著相關(p<0.001)，以及在慢性腎病各分級之間有顯著趨勢關係(p<0.0001)。多重邏輯式回歸分析中，腎臟皮質回音各向異性的消失表示出和年齡的顯著正相關(p=0.0172, odds ratio=1.427)以及體重之間顯著的負相關(p=0.0173, odds ratio=0.231)。在本研究以此方式去診斷貓之慢性腎病，能夠表現出82.9%的敏感度和83.3%的特異度。此外，無論是在單一觀測者內，或是有經驗的影像科醫師和初學的影像科研究生的觀測者間都保有良好的一致性，表示出主觀評估的穩定性以及這是一個簡易可行，而且比較不受經驗不足影響的影像診斷方法。總結來說，腎臟皮質回音各向異性消失的比例會隨著貓之慢性腎病的嚴重程度在統計上有依次增加的相關，我們認為這將有助於診斷貓之慢性腎病。|
Chronic kidney disease (CKD) in cats is a prolonged process marked by irreversible loss of kidney function, but not all of the conditions fulfilling the criteria of CKD will result in azotemia initially. (Jepson, 2016) Abdominal ultrasound is therefore suggested in animals with suspected renal diseases. In normal canine and feline kidneys, anisotropic effect, focal angle-dependent regions of increased renal cortical echogenicity (at about 3 o' clock and 9 o' clock positions), could be detected and should not be mistaken for true hyperechoic lesion. (Ruth et al., 2013) Because one of the most common signs of kidney disease is increased cortical echogenicity, we hypothesized that the focal regions of hyperechogenicity caused by anisotropic effect in the renal cortex would be accordingly disguised. The purpose of this study is to evaluate the absence of anisotropic effect on renal cortical echogenicity in cats with CKD. A retrospective research from January 2012 to December 2017 was performed in the veterinary medical teaching hospital of National Chung Hsing University to enroll 35 cats with stable progress of CKD, and to recruit 18 clinically health cats. Significant association between the absence of anisotropic effect on the renal cortical echogenicity and CKD stages was revealed using the Fisher exact test (p<0.001), and the Cochran-Armitage trend test also showed the significant ordering of CKD stages (p<0.0001). According to the multiple logistic regression, the model showed significantly positive correlation in age (p=0.0172, odds ratio=1.427) and negative correlation in body weight (p=0.0173, odds ratio=0.231). The diagnostic method demonstrate 82.9% sensitivity and 83.3% specificity to differentiate the cats with CKD from the population of our study. Both intra-observer and inter-observer agreement between an experienced radiologist and a graduate student demonstrated substantial agreement, indicating consistency of the subjective evaluation and an easy and feasible method less likely influenced due to the insufficiency in experience. In conclusion, the absence of anisotropic effect on renal cortical echogenicity was statistically associated with the CKD progress and considered helpful to evaluate feline CKD.
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