Kidney Cortex

肾皮质
  • 文章类型: Journal Article
    心房利钠肽(ANP)在血压调节中起重要作用。低水平的ANP与盐敏感性高血压(SS-HTN)的发展有关。我们先前的研究表明,ANP缺乏会加剧SS-HTN的肾功能下降。在心脏和脂肪组织中,据报道,ANP会影响脂质过氧化和线粒体生物能学,但尚未研究ANP对肾脏线粒体功能的影响。我们假设SS-HTN中的ANP缺乏会导致肾脏生物能量转移,导致线粒体网络破坏和氧化应激。为了解决这个假设,我们将DahlSS野生型(SSWT)和ANP敲除(SSNPPA-/-)大鼠置于4%NaCl高盐(HS)饮食中,以诱导HTN或将其维持在0.4%NaCl常盐(NS)饮食中,并使用荧光光谱法评估线粒体生物能学和动力学,海马试验,电子顺磁共振(EPR)光谱,西方印迹,电子显微镜,PCR和细胞因子测定。我们报告说,在高盐条件下,与高血压和肾损害有关,与SSWT相比,SSNPPA-/-大鼠表现出线粒体膜电位降低和线粒体ROS水平升高。通过SSNPPA-/-菌株中更明显的髓质脂质过氧化的存在,氧化还原的变化也很明显。我们还揭示了支离破碎,SSNPPA-/-大鼠线粒体受损更多,伴随着营业额和生物发生的增加。总的来说,我们的数据表明,ANP缺乏会导致线粒体生物能学和动力学的破坏,这可能导致DahlSS大鼠肾脏损害和高血压的加重;主要病理效应在盐和ANP缺乏联合诱导的线粒体应激组明显.
    Atrial Natriuretic Peptide (ANP) plays an important role in blood pressure regulation. Low levels of ANP correlate with the development of salt-sensitive hypertension (SS-HTN). Our previous studies indicated that ANP deficiency exacerbated renal function decline in SS-HTN. In the heart and fat tissue, ANP was reported to affect lipid peroxidation and mitochondrial bioenergetics but the effects of ANP on mitochondrial function in the kidney are unexplored. We hypothesized that ANP deficiency in SS-HTN causes renal bioenergetic shift, leading to disruption of mitochondrial network and oxidative stress. To address the hypothesis, we placed Dahl SS wild-type (SSWT) and ANP knockout (SSNPPA-/-) rats on 4% NaCl high salt (HS) diet to induce HTN or maintained them on 0.4% NaCl normal salt (NS) diet and assessed mitochondrial bioenergetics and dynamics using spectrofluorimetry, Seahorse assay, electron paramagnetic resonance (EPR) spectroscopy, Western blotting, electron microscopy, PCR and cytokine assays. We report that under high salt conditions, associated with hypertension and renal damage, the SSNPPA-/- rats exhibit a decrease in mitochondrial membrane potential and elevation in mitochondrial ROS levels compared to SSWT. The redox shift is also evident by the presence of more pronounced medullar lipid peroxidation in the SSNPPA-/- strain. We also revealed fragmented, more damaged mitochondria in the SSNPPA-/- rats, accompanied by increased turnover and biogenesis. Overall, our data indicate that ANP deficiency causes disruptions in mitochondrial bioenergetics and dynamics which likely contributes to aggravation of the renal damage and hypertension in the Dahl SS rat; the major pathological effects are evident in the groups subjected to a combined salt and ANP deficiency-induced mitochondrial stress.
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  • 文章类型: Journal Article
    肾肾单位中的ATP6AP2敲除会损害受体介导的内吞作用,增加尿白蛋白和葡萄糖排泄并损害体重增加。尿液中的非酯化脂肪酸(NEFA)与白蛋白结合,并通过megalin-cubilin复合物通过受体介导的内吞作用在近端小管中重新吸收。我们假设ATP6AP2敲除通过减少megalin增加尿NEFA排泄。对具有肾单位特异性诱导型ATP6AP2敲除和非诱导对照的10周龄雄性C57BL/6小鼠饲喂正常饮食(ND12%脂肪)或高脂肪饮食(HFD45%脂肪)6个月。ATP6AP2敲除显著增加ND和HFD饲喂小鼠的尿白蛋白:肌酸酐比率,而与各自的对照相比,ND和HFD敲除小鼠的归一化尿NEFA浓度增加489%和259%。敲除使ND和HFD的肾皮质megalinmRNA降低了47%,而megalin蛋白表达分别降低了36%和44%。同时,mTOR活性标志物增加,自噬受损.我们的结果表明,在受体介导的内吞作用受损的情况下,肾单位特异性ATP6AP2敲除会增加尿NEFA的排泄。进一步的研究应确定ATP6AP2是否有助于近端小管中肥胖相关的异位脂质沉积。
    ATP6AP2 knockout in the renal nephron impairs receptor-mediated endocytosis, increasing urinary albumin and glucose excretion and impairing weight gain. Nonesterified fatty acids (NEFA) in urine are bound to albumin and reabsorbed in the proximal tubule through receptor-mediated endocytosis by the megalin-cubilin complex. We hypothesized that ATP6AP2 knockout increases urinary NEFA excretion through a reduction in megalin. Ten-week-old male C57BL/6 mice with nephron specific inducible ATP6AP2 knockout and noninduced controls were fed either normal diet (ND 12% fat) or high fat diet (HFD 45% fat) for 6 months. ATP6AP2 knockout significantly increased urine albumin:creatinine ratio in both ND and HFD fed mice while normalized urine NEFA concentration increased 489% and 259% in ND and HFD knockout mice compared to respective controls. Knockout decreased renal cortical megalin mRNA by 47% on ND and 49% on HFD while megalin protein expression decreased by 36% and 44% respectively. At the same time, markers of mTOR activity were increased while autophagy was impaired. Our results indicate that nephron specific ATP6AP2 knockout increases urinary NEFA excretion in the setting of impaired receptor-mediated endocytosis. Further investigation should determine whether ATP6AP2 contributes to obesity related ectopic lipid deposition in the proximal tubule.
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  • 文章类型: Journal Article
    使用超声检查的猫氮质血症的临床结果信息有限。本研究旨在了解住院后猫氮质血症的皮质各向异性后向散射伪影(CABA)与血清肌酐(sCr)变化之间的相关性,并探讨CABA是否有助于预测猫氮质血症的临床结局。65只患有氮质血症的住院猫,包括49只中度或重度氮质血症猫(重度组)和16只轻度氮质血症猫(轻度组)。这项回顾性研究使用2016年至2021年间患有氮质血症的猫的超声图像回顾了CABA。CABA与患有氮质血症的猫的临床结果之间的相关性使用卡方或Fisher精确检验进行研究。使用McNemar和Cohenkappa检验评估CABA中的观察者内部和观察者之间的协议。CABA的存在与仅在严重组中患有氮质血症的猫的临床结果显着正相关(p=0.0034,比值比=8.57)。CABA与轻度氮质血症猫的临床结果之间没有关联(p=0.75)。CABA可用于中度和重度猫氮质血症的临床结果预测,敏感性为80.8%,特异性为73.9%。此外,在超声图像审查过程中,CABA的检测显示了令人满意的观察者内部和观察者之间的一致性.我们的研究表明,在超声检查中观察到的中度和重度氮质血症与CABA的猫可能具有更好的临床结果。这些发现为猫氮质血症的预后和治疗提供了更多信息。
    Information on the clinical outcomes of feline azotemia using ultrasound examinations is limited. This study aimed to understand the correlation between cortical anisotropy backscattering artifact (CABA) and serum creatinine (sCr) changes in feline azotemia after hospitalization and to investigate whether CABA is useful for predicting the clinical outcome of feline azotemia. Sixty-five hospitalized cats with azotemia, including 49 cats with moderate or severe azotemia (severe group) and 16 cats with mild azotemia (mild group). This retrospective study reviewed the CABA using ultrasound images of cats hospitalized with azotemia between 2016 and 2021. The correlation between CABA and the clinical outcomes of cats with azotemia was investigated using the chi-squared or Fisher\'s exact test, and the intra- and inter-observer agreements in CABA were assessed using McNemar\'s and Cohen\'s kappa tests. The presence of CABA was significantly positively correlated with the clinical outcomes of cats with azotemia only in the severe group (p = 0.0034, odds ratio = 8.57). There was no association between CABA and clinical outcomes in cats with mild azotemia (p = 0.75). CABA can be used for clinical outcome prediction in moderate and severe feline azotemia, with a sensitivity of 80.8% and a specificity of 73.9%. Also, satisfactory intra- and inter-observer agreements were revealed in the detection of CABA during ultrasound image review. Our study demonstrated that cats with moderate and severe azotemia with CABA observed during ultrasonography might have better clinical outcomes. These findings provide additional information on the prognosis and treatment of feline azotemia.
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  • 文章类型: Journal Article
    详细了解肾单位成分的脂质组成对于理解生理过程和肾脏疾病的发展至关重要。然而,肾小管段的脂质组成未知.我们手动分离了近曲小管(PCT),来自五只瘦肥胖小鼠的Henle'sloop(cTAL)和皮质收集管(CCD)的皮质厚上升肢体,并通过高分辨率质谱采集对样品进行shot弹枪脂质组学分析。在所有样品中,超过五百种脂质被鉴定出来,量化和比较。我们观察到三个管状段之间的显着组成差异,作为真正的签名。这些固有的脂质组学特征与调节高度特异性生理功能的独特蛋白质组学程序相关。三个部分中每一个的独特脂质组学特征主要基于中性脂质的相对组成,长链多不饱和脂肪酸,鞘脂,和醚磷脂。这些特征支持指定给特定管状节段的脂型假说。肥胖深刻影响近端曲小管的脂型。总之,我们对小鼠肾小管的三个皮质段进行了全面的脂质组学分析。这一宝贵的资源提供了无与伦比的细节,增强了我们对管状生理学和病理状况潜在影响的理解。
    A detailed knowledge of the lipid composition of components of nephrons is crucial for understanding physiological processes and the development of kidney diseases. However, the lipidomic composition of kidney tubular segments is unknown. We manually isolated the proximal convoluted tubule (PCT), the cortical thick ascending limb of Henle\'s loop, and the cortical collecting duct from 5 lean and obese mice and subjected the samples to shotgun lipidomics analysis by high-resolution mass spectrometry acquisition. Across all samples, more than 500 lipid species were identified, quantified, and compared. We observed significant compositional differences among the 3 tubular segments, which serve as true signatures. These intrinsic lipidomic features are associated with a distinct proteomic program that regulates highly specific physiological functions. The distinctive lipidomic features of each of the 3 segments are mostly based on the relative composition of neutral lipids, long-chain polyunsaturated fatty acids, sphingolipids, and ether phospholipids. These features support the hypothesis of a lipotype assigned to specific tubular segments. Obesity profoundly impacts the lipotype of PCT. In conclusion, we present a comprehensive lipidomic analysis of 3 cortical segments of mouse kidney tubules. This valuable resource provides unparalleled detail that enhances our understanding of tubular physiology and the potential impact of pathological conditions.
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  • 文章类型: Journal Article
    背景:目前尚缺乏探测肾脏肿块侵袭性的临床成像工具,而T2加权成像作为磁共振成像协议的组成部分仅提供定性信息。我们基于回波合并并使用k-t欠采样和减小的翻转角(TEMPURA)开发了高分辨率和加速的T2映射方法,并测试了其量化肾脏肿瘤亚型和等级之间差异的潜力。
    方法:对24例初治肾肿瘤患者进行成像:7例肾嗜酸细胞瘤(RO);1例嗜酸性/嗜酸性肾细胞癌;2例发色细胞RCC(chRCC);3例乳头状RCC(pRCC);12例透明细胞RCC(ccRCC)。median,峰度,在肿瘤和正常-邻近肾皮质中量化T2的偏度,并在肾脏肿瘤亚型和ccRCC等级之间进行比较。
    结果:与常规T2加权成像相比,高分辨率TEMPURA以提高的分辨率描绘了肿瘤结构。pRCC中存在最低的T2中值(高分辨率,51ms;加速,45ms),显著低于RO(高分辨率;加速,p=0.012)和ccRCC(高分辨率,p=0.019;加速,p=0.008)。RO显示出最低的峰度(高分辨率,3.4;加速,4.0),提示肿瘤内异质性低。与较低等级的ccRCC相比,在较高的地方观察到较低的T2值(高分辨率的等级2、3和4,209毫秒,151ms,和106毫秒;在加速时,172ms,160ms,和102毫秒,分别),与加速TEMPURA相比显示统计学意义(p=0.037)。
    结论:高分辨率TEMPURA和加速TEMPURA都显示出明显的潜力,可以量化肾脏肿瘤亚型之间和ccRCC等级之间的差异。
    背景:ClinicalTrials.gov,NCT03741426。2018年11月13日注册。
    结论:新开发的T2作图方法提高了分辨率,更短的采集时间,和有希望的可量化读数来表征偶然的肾脏肿块。
    BACKGROUND: Clinical imaging tools to probe aggressiveness of renal masses are lacking, and T2-weighted imaging as an integral part of magnetic resonance imaging protocol only provides qualitative information. We developed high-resolution and accelerated T2 mapping methods based on echo merging and using k-t undersampling and reduced flip angles (TEMPURA) and tested their potential to quantify differences between renal tumour subtypes and grades.
    METHODS: Twenty-four patients with treatment-naïve renal tumours were imaged: seven renal oncocytomas (RO); one eosinophilic/oncocytic renal cell carcinoma; two chromophobe RCCs (chRCC); three papillary RCCs (pRCC); and twelve clear cell RCCs (ccRCC). Median, kurtosis, and skewness of T2 were quantified in tumours and in the normal-adjacent kidney cortex and were compared across renal tumour subtypes and between ccRCC grades.
    RESULTS: High-resolution TEMPURA depicted the tumour structure at improved resolution compared to conventional T2-weighted imaging. The lowest median T2 values were present in pRCC (high-resolution, 51 ms; accelerated, 45 ms), which was significantly lower than RO (high-resolution; accelerated, p = 0.012) and ccRCC (high-resolution, p = 0.019; accelerated, p = 0.008). ROs showed the lowest kurtosis (high-resolution, 3.4; accelerated, 4.0), suggestive of low intratumoural heterogeneity. Lower T2 values were observed in higher compared to lower grade ccRCCs (grades 2, 3 and 4 on high-resolution, 209 ms, 151 ms, and 106 ms; on accelerated, 172 ms, 160 ms, and 102 ms, respectively), with accelerated TEMPURA showing statistical significance in comparison (p = 0.037).
    CONCLUSIONS: Both high-resolution and accelerated TEMPURA showed marked potential to quantify differences across renal tumour subtypes and between ccRCC grades.
    BACKGROUND: ClinicalTrials.gov, NCT03741426 . Registered on 13 November 2018.
    CONCLUSIONS: The newly developed T2 mapping methods have improved resolution, shorter acquisition times, and promising quantifiable readouts to characterise incidental renal masses.
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  • 文章类型: Journal Article
    OBJECTIVE: Obesity related glomerulopathy (ORG) is induced by obesity, but the pathogenesis remains unclear. This study aims to investigate the expression of early growth response protein 3 (EGR3) in the renal cortex tissues of ORG patients and high-fat diet-induced obese mice, and to further explore the molecular mechanism of EGR3 in inhibiting palmitic acid (PA) induced human podocyte inflammatory damage.
    METHODS: Renal cortex tissues were collected from ORG patients (n=6) who have been excluded from kidney damage caused by other diseases and confirmed by histopathology, and from obese mice induced by high-fat diet (n=10). Human and mouse podocytes were intervened with 150 μmol/L PA for 48 hours. EGR3 was overexpressed or silenced in human podocytes. Enzyme linked immunosorbent assay (ELISA) was used to detcet the levels of interleukin-6 (IL-6) and interleukin-1β (IL-1β). Real-time RT-PCR was used to detect the mRNA expressions of EGR3, podocytes molecular markers nephrosis 1 (NPHS1), nephrosis 2 (NPHS2), podocalyxin (PODXL), and podoplanin (PDPN). RNA-seq was performed to detect differentially expressed genes (DEGs) after human podocytes overexpressing EGR3 and treated with 150 μmol/L PA compared with the control group. Co-immunoprecipitation (Co-IP) combined with liquid chromatography tandem mass spectrometry (LC-MS) was used to detect potential interacting proteins of EGR3 and the intersected with the RNA-seq results. Co-IP confirmed the interaction between EGR3 and protein arginine methyltransferases 1 (PRMT1), after silencing EGR3 and PRMT1 inhibitor intervention, the secretion of IL-6 and IL-1β in PA-induced podocytes was detected. Western blotting was used to detect the expression of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) after overexpression or silencing of EGR3.
    RESULTS: EGR3 was significantly upregulated in renal cortex tissues of ORG patients and high-fat diet-induced obese mice (both P<0.01). In addition, after treating with 150 μmol/L PA for 48 hours, the expression of EGR3 in human and mouse podocytes was significantly upregulated (both P<0.05). Overexpression or silencing of EGR3 in human podocytes inhibited or promoted the secretion of IL-6 and IL-1β in the cell culture supernatant after PA intervention, respectively, and upregulated or downregulated the expression of NPHS1, PODXL, NPHS2,and PDPN (all P<0.05). RNA-seq showed a total of 988 DEGs, and Co-IP+LC-MS identified a total of 238 proteins that may interact with EGR3. Co-IP confirmed that PRMT1 was an interacting protein with EGR3. Furthermore, PRMT1 inhibitors could partially reduce PA-induced IL-6 and IL-1β secretion after EGR3 silencing in human podocytes (both P<0.05). Overexpression or silencing of EGR3 negatively regulated the expression of PRMT1 and p-STAT3.
    CONCLUSIONS: EGR3 may reduce ORG podocyte inflammatory damage by inhibiting the PRMT1/p-STAT3 pathway.
    目的: 肥胖会导致肥胖相关性肾病(obesity related glomerulopathy,ORG),但其发病机制并不明确。本研究拟检测早期生长反应蛋白3(early growth response protein 3,EGR3)在ORG患者和高脂饮食诱导的肥胖小鼠肾皮质组织中的表达,并探讨EGR3抑制棕榈酸(palmitic acid,PA)诱导的人足细胞炎症损伤的分子机制。方法: 收集排除其他疾病导致的肾损害并经组织病理学证实的ORG患者(n=6)和高脂饮食诱导的肥胖小鼠的肾皮质组织(n=10)。使用150 μmol/L PA干预人和小鼠足细胞48 h;人足细胞中分别过表达或沉默EGR3。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测白细胞介素(interleukin,IL)-6和IL-1β的含量;real-time RT-PCR检测EGR3、足细胞分子标志NPHS1(nephrosis 1)、NPHS2(nephrosis 2)、足糖萼蛋白(podocalyxin,PODXL)、平足蛋白(podoplanin,PDPN)mRNA的表达;RNA-seq检测人足细胞过表达EGR3并150 μmol/L PA干预后与对照组的差异表达基因(differentially expressed genes,DEGs);免疫共沉淀(co-immunoprecipitation,Co-IP)+液相色谱串联质谱(liquid chromatography tandem mass spectrometry,LC-MS)检测EGR3可能的相互作用蛋白质,并与RNA-seq的结果取交集;Co-IP验证EGR3与蛋白精氨酸甲基转移酶1(protein arginine methyltransferases 1,PRMT1)的相互作用;沉默EGR3和PRMT1抑制剂干预后检测PA诱导的足细胞培养液中IL-6和IL-1β的含量;蛋白质印迹法检测分别过表达或沉默EGR3后磷酸化信号转导及转录激活蛋白3(phosphorylated signal transducer and activator of transcription 3,p-STAT3)的蛋白质表达。结果: EGR3在ORG患者和高脂饮食诱导的肥胖小鼠肾皮质组织中的表达均显著上调(均P<0.01),150 μmol/L PA干预人和小鼠足细胞48 h后显著上调2种细胞EGR3的表达(均P<0.05)。人足细胞过表达或沉默EGR3分别抑制或促进PA干预后细胞培养液中IL-6和IL-1β的分泌,并分别上调或下调NPHS1、PODXL、NPHS2及PDPN的表达(均P<0.05)。RNA-seq结果显示共有988个DEGs,Co-IP+LC-MS共发现238个可能与EGR3相互作用的蛋白质,且Co-IP证实PRMT1为EGR3的相互作用蛋白质。PRMT1抑制剂能部分减少人足细胞沉默EGR3后PA诱导的IL-6及IL-1β的分泌(均P<0.05);此外,过表达或沉默EGR3负调控PRMT1及p-STAT3的表达。结论: EGR3可能通过抑制PRMT1/p-STAT3通路减轻ORG足细胞炎症损伤。.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    大多数功能磁共振研究主要检查了受影响的肾脏的改变,经常忽略对侧肾脏。我们的研究旨在探讨成像参数是否准确地描绘了单侧输尿管梗阻大鼠模型中肾皮质和髓质的变化。从而展示了体素内不相干运动(IVIM)在评估对侧肾脏变化中的实用性。
    六只大鼠进行MR扫描,随后处死用于基线组织学检查。在诱导左输尿管梗阻后,扫描48只大鼠,在第3、7、10、14、21、28、35和42天进行组织病理学检查。表观扩散系数(ADC),纯分子扩散(D),伪扩散(D*),和灌注分数(f)值使用IVIM测量。
    在阻塞的第10天,UUO10组与假手术组的皮质和髓质ADC值均有显著差异(p<0.01)。在其他时间点,UUO3组与假手术组之间的皮质D值显示出统计学上的显着差异(p<0.01),而在UUO组之间则没有统计学差异。此外,UUO21组与假手术组皮质和髓质f值差异有统计学意义(p<0.01)。尤其是,UUO21组和UUO组的皮质f值在阻塞时间较短(3、7、10、14天)时表现出显著差异(p<0.01)。
    在肾脏梗阻后的对侧肾脏中观察到明显的血液动力学改变。IVIM准确捕获通畅肾脏的变化。特别是,皮质f值显示出评估对侧肾脏修饰的最高潜力。
    UNASSIGNED: Most functional magnetic resonance research has primarily examined alterations in the affected kidney, often neglecting the contralateral kidney. Our study aims to investigate whether imaging parameters accurately depict changes in both the renal cortex and medulla in a unilateral ureteral obstruction rat model, thereby showcasing the utility of intravoxel incoherent motion (IVIM) in evaluating contralateral renal changes.
    UNASSIGNED: Six rats underwent MR scans and were subsequently sacrificed for baseline histological examination. Following the induction of left ureteral obstruction, 48 rats were scanned, and the histopathological examinations were conducted on days 3, 7, 10, 14, 21, 28, 35, and 42. The apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) values were measured using IVIM.
    UNASSIGNED: On the 10th day of obstruction, both cortical and medullary ADC values differed significantly between the UUO10 group and the sham group (p < 0.01). The cortical D values showed statistically significant differences between UUO3 group and sham group (p < 0.01) but not among UUO groups at other time point. Additionally, the cortical and medullary f values were statistically significant between the UUO21 group and the sham group (p < 0.01). Especially, the cortical f values exhibited significant differences between the UUO21 group and the UUO groups with shorter obstruction time (at time point of 3, 7, 10, 14 day) (p < 0.01).
    UNASSIGNED: Significant hemodynamic alterations were observed in the contralateral kidney following renal obstruction. IVIM accurately captures changes in the unobstructed kidney. Particularly, the cortical f value exhibits the highest potential for assessing contralateral renal modifications.
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  • 文章类型: Journal Article
    由于石头的异质性,石头的所有部分的石头密度(SD)都不相同,冲击波(SW)穿过许多不同密度的组织,直到到达石头。这些因素影响体外冲击波碎石术(ESWL)的成功。我们旨在评估结石密度变异系数(VCSD)和肾皮质斜度(RCT)对ESWL成功的影响。在2020年至2023年之间,将510名接受ESWL的患者分为2组治疗成功(n:304)和治疗失败(n:206)。肾积水程度的非对比计算机断层扫描(NCCT)成像值,石头位置,石头体积(SV),石皮距离(SSD),SD,石材密度的标准偏差(SDSD),VCSD,RCT,软组织厚度(STT),分析肌肉厚度(MT)。通过将SDSD除以SD获得VCSD值。沿着SW,组织分为三个组成部分:肾(肾皮质),肌肉和其他软组织。RCT,MT和SSD在三个不同的角度(0°,45°,和90°),并对这3种长度进行了平均。在单变量分析中,身体质量指数(BMI),SV,SD,VCSD,SSD,RCT和STT被证明会影响ESWL的成功。在多变量分析中,低BMI,SV,SD,RCT和大VCSD是ESWL成功的重要独立预测因子。在这些参数中,VCSD的预测精度最高,其次是SD,SV,RCT和BMI,分别。这项研究表明,VCSD值和RCT是确定尿路结石患者治疗方法和选择合适的ESWL候选人的预测参数。
    The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.
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  • 文章类型: Journal Article
    已经提出利尿剂可以通过抑制肾小管钠重吸收和减少代谢需求来改善肾组织氧合。然而,临床使用的利尿药对肾皮质和髓质微循环的影响尚不清楚.因此,我们检查了三种常用利尿剂的效果,在临床相关剂量下,非麻醉健康绵羊的肾皮质和髓质灌注和氧合。美利诺母羊接受乙酰唑胺(250毫克;n=9),呋塞米(20mg;n=10)或阿米洛利(10mg;n=7)静脉注射。全身和肾脏血流动力学,肾皮质和髓质组织灌注和PO2${P_{{\\mathrm{O}}_{\\mathrm{2}}}}$,然后在治疗后8小时内监测肾功能。利尿剂反应高峰出现在乙酰唑胺后2h(99.4±14.8mL/h),在该阶段皮质和髓质组织灌注和PO2${P_{{\\mathrm{O}}_{\\mathrm{2}}}}$与基线水平无显著差异。对呋塞米的利尿剂反应峰值出现在治疗后1小时(196.5±12.3mL/h),但在此期间皮质和髓质组织氧合没有显着变化。然而,皮质组织PO2${P_{{{\\mathrm{O}}_{\\mathrm{2}}}}$从基线时的40.1±3.8mmHg下降到3小时时的17.2±4.4mmHg和6小时后的20.5±5.3mmHg。阿米洛利不产生利尿反应,并且与皮质或髓质组织氧合的显着变化无关。总之,在8h实验期间,临床相关剂量的利尿剂并未改善健康动物的局部肾组织氧合。相反,呋塞米引起的利尿消散后,可能会出现反跳性肾皮质缺氧。
    It has been proposed that diuretics can improve renal tissue oxygenation through inhibition of tubular sodium reabsorption and reduced metabolic demand. However, the impact of clinically used diuretic drugs on the renal cortical and medullary microcirculation is unclear. Therefore, we examined the effects of three commonly used diuretics, at clinically relevant doses, on renal cortical and medullary perfusion and oxygenation in non-anaesthetised healthy sheep. Merino ewes received acetazolamide (250 mg; n = 9), furosemide (20 mg; n = 10) or amiloride (10 mg; n = 7) intravenously. Systemic and renal haemodynamics, renal cortical and medullary tissue perfusion and P O 2 ${P_{{{\\mathrm{O}}_{\\mathrm{2}}}}}$ , and renal function were then monitored for up to 8 h post-treatment. The peak diuretic response occurred 2 h (99.4 ± 14.8 mL/h) after acetazolamide, at which stage cortical and medullary tissue perfusion and P O 2 ${P_{{{\\mathrm{O}}_{\\mathrm{2}}}}}$ were not significantly different from their baseline levels. The peak diuretic response to furosemide occurred at 1 h (196.5 ± 12.3 mL/h) post-treatment but there were no significant changes in cortical and medullary tissue oxygenation during this period. However, cortical tissue P O 2 ${P_{{{\\mathrm{O}}_{\\mathrm{2}}}}}$ fell from 40.1 ± 3.8 mmHg at baseline to 17.2 ± 4.4 mmHg at 3 h and to 20.5 ± 5.3 mmHg at 6 h after furosemide administration. Amiloride did not produce a diuretic response and was not associated with significant changes in cortical or medullary tissue oxygenation. In conclusion, clinically relevant doses of diuretic agents did not improve regional renal tissue oxygenation in healthy animals during the 8 h experimentation period. On the contrary, rebound renal cortical hypoxia may develop after dissipation of furosemide-induced diuresis.
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