Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/13633
標題: 應用彩色都卜勒超音波評估犬腎臟疾病治療之研究
Roles of Doppler Intrarenal Indices in Evaluation of Canine Renal Diseases
作者: 郭立傑
Guo, Lee-Jae
關鍵字: canine;犬;renal disease;ultrasound;doppler;腎臟;超音波;都卜勒
出版社: 獸醫學系暨研究所
引用: 參考文獻 Books: 沈永绍。附錄II 正常值。獸醫實驗診斷學提要。華香園,台北,483-490,2004。 詹益萍。應用彩色都卜勒超音波評估犬腎臟疾病之研究。國立中興大學獸醫學研究所 碩士論文,2003。 Dibartola SP. Renal disease: clinical approach and Laboratory evaluation. In: Ettinger SJ, Feldman EC, ed. Textbook of veterinary internal medicine. 6th ed. Saunders, Philadelphia, 1716-1730, 2004. Kealy JK, McAllister H. The kidneys. In: Diagnostic radiology and ultrasonography of the dog and cat. 4th ed. Elsevier, St. Louis, USA, 108-111, 2005. Mathews KA. Monitoring fluid therapy and complications of fluid therapy. In: Dibartola SP et al, ed. Fluid, electrolyte, and acid-base disorders in small animal practice. 3rd ed. Saunders, St. Louis, 377-391, 2006. McCurnin DM, Poffenbarger EM. Cardiovascular system. In: Small animal physical diagnosis and clinical procedures. Saunders, Philadelphia, 53-63, 1991. Nyland TG, Matton JS, Herrgesell ER, Wisner ER. Physical principles, instrumentation, and safety of diagnostic ultrasound. In: Small animal diagnostic ultrasound 2nd. WB Saunders CO, Philadelphia, 1-18, 2002. Penninck D, d’Anjou Marc-André. Kidneys and ureters. In: Atlas of small animal ultrasonography. 1st ed. Blackwell, USA, 339-364, 2008. Verlander JW. Glomerular filtration. In: Cunningham JG et al, ed. Textbook of veterinary physiology. 2nd ed. WB Saunders CO, Philadelphia, 511-521, 1997. Papers: Akçar N, Ozkan IR, Adapinar B, Kaya T. Doppler sonography in the diagnosis of urinary tract obstruction by stone. J Clin Ultrasound 32: 286-293, 2004. Ardalan MR, Tarzamani MK, Shoja MM. A correlation between direct and indirect Doppler ultrasonographic measures in transplant renal artery stenosis. Transplant Proc 39: 1436-1438, 2007. Bude RO, DiPietro MA, Platt JF, Rubin JM, Miesowicz S, Lundquist C. Age dependency of the renal resistive index in healthy children. Radiology 184: 469-473, 1992. Buturović-Ponikvar J, Visnar-Perovic A. Ultrasonography in chronic renal failure. Eur J Radiol 46: 115-122, 2003. Cupples WA, Braam B. Assessment of renal autoregulation. Am J Physiol Renal Physiol 292: F1105-F1123, 2007. Deeg KH, Wörle K, Wolf A. Doppler sonographic estimation of normal values for flow velocity and resistance indices in renal arteries of healthy infants. Ultraschall Med 24: 312-322, 2003. Diez-Prieto I, García-Rodríguez MB, Ríos-Granja MA, Cano-Rábano MJ, Gonzalo-Orden JM, Pérez-García CC. Diagnosis of renal agenesis in a beagle. J Small Anim Pract 42: 599-602, 2001. Dodd GD, Kaufman PN, Bracken RB. Duplex Doppler evaluation of urinary obstruction in dogs. J Urol 145: 644-646, 1991. Dubbins PA. Doppler ultrasound in renal disease. Current Imaging 1: 32-38, 1989. Espada Y, Novellas R, Ruiz de Gopegui R. Renal ultrasound in dogs and cats. Vet Res Commun 30: 133-137, 2006. Fitzgerald GA, Murray R, Price P, Catella F. The molecular, biochemical and human pharmacology of thromboxane A2 in renal disease. Adv Exp Med Biol 259: 325-360, 1989. Galesic K, Brkljacic B, Sabljar-Matovinovic M, Morovic-Vergles J, Cvitkovic-Kuzmic A, Bozikov V. Renal vascular resistance in essential hypertension: duplex-doppler ultrasonographic evaluation. Angiology 51: 667-675, 2000. Goel MC, LaPerna L, Whitelaw S, Modlin CS, Flechner SM, Goldfarb DA. Current management of transplant renal artery stenosis: clinical utility of duplex Doppler ultrasonography. Urology 66: 59-64, 2005. Gosling RG, King DH. Arterial assessment by doppler-shift ultrasound. Proc Roy Soc Med 67: 447-449, 1974. Halling KB, Graham JP, Newell SP, Ellison GW, Detrisac CJ, Martin FG, VanGilder JM, Grossman D. Sonographic and scintigraphic evaluation of acute renal allograft rejection in cats. Vet Radiol Ultrasound 44: 707-713, 2003. Ikee R, Kobayashi S, Hemmi N, Imakiire T, Kikuchi Y, Moriya H, Suzuki S, Miura S. Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis 46: 603-609, 2005. Koma LM, Kirberger RM, Scholtz L. Doppler ultrasonographic changes in the canine kidney during normovolaemic anaemia. Res Vet Sci 80: 96-102, 2006. Knapp R, Plotzeneder A, Frauscher F, Helweg G, Judmaier W, zur Nedden D, Recheis W, Bartsch G. Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation. J Ultrasound Med 14: 427-429, 1995. Keller MS. Renal Doppler sonography in infants and children. Radiology 172: 603-604, 1989. Łebkowska U, Malyszko J, Łebkowski W, Brzósko S, Kowalewski R, Łebkowski T, Janica J, Michalak P, Gacko M, Myśliwiec M, Walecki J. The predictive value of arterial renal blood flow parameters in renal graft survival. Transplant Proc 39: 2727-2729, 2007. Mareschal A, d''Anjou MA, Moreau M, Alexander K, Beauregard G. Ultrasonographic measurement of kidney-to-aorta ratio as a method of estimating renal size in dogs. Vet Radiol Ultrasound 48: 434-438, 2007. Mitchell SK, Toal RL, Daniel GB, Rohrbach BW. Evaluation of renal hemodynamics in awake and isoflurane-anesthetized cats with pulsed-wave Doppler and quantitative renal scintigraphy. Vet Radiol Ultrasound 39: 451-458, 1998. Morrow KL, Salman MD, Lappin MR, Wrigley R. Comparison of the resistive index to clinical parameters in dogs with renal disease. Vet Radiol Ultrasound 37: 193-199, 1996. Mostbeck GH, Gössinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D. Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology 175: 511-513, 1990. Mostbeck GH, Kain R, Mallek R, Derfler K, Walter R, Havelec L, Tscholakoff D. Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation. J Ultrasound Med 10: 189-194, 1991. Murat A, Akarsu S, Ozdemir H, Yildirim H, Kalender O. Renal resistive index in healthy children. Eur J Radiol 53: 67-71, 2005. Nelson TR, Pretorius DH. The Doppler signal: where does it come from and what does it mean? AJR Am J Roentgenol 151: 439-447, 1988. Nezami N, Tarzamni MK, Argani H, Nourifar M. Doppler ultrasonographic indices after renal transplantation as renal function predictors. Transplant Proc 40: 94-99, 2008. Nimura Y, Matsuo H, Hayashi T, Kitabatake A, Mochizuki S. Studies on arterial flow patterns-instantaneous velocity spectrums and their phasic changes-with directional ultrasonic Doppler technique. Br Heart J 36: 899-907, 1974. Novellas R, Espada Y, Ruiz de Gopegui R. Doppler ultrasonographic estimation of renal and ocular resistive and pulsatility indices in normal dogs and cats. Vet Radiol Ultrasound 48: 69-73, 2007. Novellas R, Ruiz de Gopegui R, Espada Y. Effects of sedation with midazolam and butorphanol on resistive and pulsatility indices in healthy dogs. Vet Radiol Ultrasound 48: 276-280, 2007. Onur MR, Cubuk M, Andic C, Kartal M, Arslan G. Role of resistive index in renal colic. Urol Res 35: 307-312, 2007. Platt JF. Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol 158: 1035-1042, 1992. Platt JF, Ellis JH, Rubin JM, DiPietro MA, Sedman AB. Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy finding. AJR Am J Roentgenol 154: 1223-1227, 1990. Platt JF, Rubin JM, Ellis JH. Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. AJR 153: 997-1000, 1989. Platt JF, Rubin JM, Ellis JH, DiPietro MA. Duplex Doppler ultrasound of the kidney: differentiation of obstructive from non-obstructive dilatation. Radiology 171: 515-517, 1989. Pozniak MA, Kelcz F, Stratta RJ, Oberley TD. Extraneous factors affecting resistive index. Invest Radiol 23: 899-904, 1988. Radermacher J. Resistive index: an ideal test for renovascular disease or ischemic nephropathy? Nat Clin Pract Nephrol 2: 232-233, 2006. Rieser TM. Urinary tract emergencies. Vet Clin North Am Small Anim Pract 35: 359-373, 2005. Rivers BJ, Walter PA, Letourneau JG, Finlay DE, Ritenour ER, King VL, O''Brien TD, Polzin DJ. Estimation of arcuate artery resistive index as a diagnostic tool for aminoglycoside-induced acute renal failure in dogs. Am J Vet Res 57: 1536-1544, 1996. Rivers BJ, Walter PA, Polzin DJ, King VL. Duplex doppler estimation of intrarenal pourcelot resistive index in dogs and cats with renal disease. J Vet Intern Med 11: 250-260, 1997. Robertson R, Murphy A, Dubbins PA. Renal artery stenosis: the use of duplex ultrasound as a screening technique. Br J Radiol 61: 196-201, 1988. Satomura S. Study of flow patterns in peripheral arteries by ultrasonics. J Acoust Soc Jpn 15: 151-158, 1959. Sigirci A, Hallaç T, Akyncy A, Temel I, Gülcan H, Aslan M, Koçer M, Kahraman B, Alkan A, Kutlu R. Renal interlobar artery parameters with duplex Doppler sonography and correlations with age, plasma renin, and aldosterone levels in healthy children. AJR Am J Roentgenol 186: 828-832, 2006. Taylor KJW, Marks W, Vasseur B, Ramos I, Feyock A. A procine model to investigate causes for increase in renal vascular impedance. J Ultrasound Med 7: S63, 1988. Terry JD, Rysavy JA, Frick MP. Intrarenal Doppler: characteristics of aging kidneys. J Ultrasound Med 11: 647-651, 1992. Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 180: 885-892, 2003. Vade A, Subbaiah P, Kalbhen CL, Ryva JC. Renal resistive indices in children. J Ultrasound Med 12: 655-658, 1993. Webb JA. Ultrasonography and Doppler studies in the diagnosis of renal obstruction. BJU Int 86: 25-32, 2000. Yamazoe K, Ohashi F, Kadosawa T, Nishimura R, Sasaki N, Takeuchi A. Computed tomography on renal masses in dogs and cats. J Vet Med Sci 56: 813-816, 1994. Zubarev AV. Ultrasound of renal vessels. Eur Radiol 11: 1902-1915, 2001.
摘要: 
摘要

小動物臨床醫學上,利用超音波來協助診斷腎臟疾病早已行之有年。隨著都卜勒超音波的問世,藉由都卜勒來評估腎臟的血液灌流,便成為另一種可行的評估方法。其中,阻抗指數(RI)、脈動指數(PI)及收縮-舒張比(S/D)是最常被測量的都卜勒係數,其代表了腎臟血管內的阻力大小,故常被用以推估腎血流。至今尚無有關都卜勒係數應用於治療方面之研究,因此本實驗之目的在於觀察腎臟病患犬於輸液治療期間的都卜勒係數變化。壹拾柒隻臨床診斷有腎臟功能異常的犬隻(BUN>28 mg/dL, Creatinine>1.5 mg/dL),經紀錄基本資料與基礎生理值後,分別於輸液治療前(Time 1)、脫水補足後(Time 2)、其後24(Time 3)、48(Time 4)、72(Time 5)小時之不同時間點進行都卜勒超音波的檢測。對於脫水的患犬,會於12-48小時內將脫水補足,並於實驗中維持輸液速率60-120 mL/kg/day進行治療。結果經統計分析後可得,都卜勒係數受到年齡、每分鐘心跳數、收縮壓、舒張壓所影響。寡尿患犬其治療前的都卜勒係數有顯著較高的情形(P<0.05);而治療前的都卜勒係數則可被視為預後評估的指標。輸液治療方面,脫水的患犬於補足脫水後(Time 2),其都卜勒係數有顯著下降的情形(P<0.05),但在脫水補足48小時後(Time 4),卻有不明原因的顯著上升(P<0.05)。無脫水的患犬,其都卜勒係數雖呈現下降的趨勢,但未達顯著差異。此外,輸液速率的快慢與都卜勒係數的變化量之間並未呈現相關性,且患犬的腎臟功能也與都卜勒係數變化不太一致。總結,脫水患犬經輸液補足脫水後,其腎臟血液灌流的改善,可藉由都卜勒係數的下降所偵測出來。但應用都卜勒超音波來評估腎臟病患犬於輸液治療期間的腎血流變化,進而監測腎臟功能,仍不是一個理想的方法。

Abstract

Duplex Doppler ultrasonography is a valuable diagnostic tool in clinical medicine. Resistive index (RI), pulsatility index (PI), and systolic-to-diastolic flow velocities ratio (S/D ratio) are indirect measurements of blood flow resistance that have been used to evaluate vascular changes in renal diseases. Up to the present, only few reports have been published regarding the use of Doppler ultrasonography to measure intrarenal Doppler indices in canine renal diseases. The aim of this study was to examine the variance of Doppler indices for dogs with renal diseases during fluid therapy. Seventeen dogs (BUN>28 mg/dL, Creatinine>1.5 mg/dL) were included and examined for RI, PI, and S/D measurements. The scheduled times of Doppler were set respectively on pre-treatment (Time 1), rehydration (Time 2), and subsequent 24 (Time 3), 48 (Time 4), and 72 hours (Time 5) later. The dogs with dehydration were restored in 12-48 hours, and then fluid rate was maintained in 60-120 mL/kg/day. Doppler indices were found to be associated with age, heart rate, systolic, and diastolic blood pressure. The resistive indices were significantly increased in oligouric dogs (P<0.05). Before fluid administration, the Doppler indices could assist to evaluate the prognosis of patients. After rehydration, the mean RI, PI, and S/D were significantly decreased at Time 2 (P<0.05). However, an unexpected increase of indices was noted in dehydrated dogs at Time 4. The variance of the indices was not correlated with fluid rate. All indices shared common trend at all occasions. The interpretation of Doppler indices didn't support the renal functional evaluation. These results indicate that the improvement of renal perfusion in rehydrated dogs may be detected by signs of decreasing intrarenal RI, PI, and S/D. It is concluded that Doppler indices may not represent a reliable method to evaluate the improvement of renal function in non-differentiated canine renal diseases.
URI: http://hdl.handle.net/11455/13633
其他識別: U0005-2307200811062800
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