| Summary: | 碩士 === 高雄醫學大學 === 醫學研究所碩士班 === 92 === Purpose:
To investigate the sensitivity and specificity of resistive index (RI, obtained from color Doppler sonography) in patients with acute ureteral obstruction due to ureteral calculi. To study the resistive index and the hemodynamic change after various treatment modality. To clarify the difference of leukocytosis induced by infection or by acute ureteral obstruction due to ureteral calculi. To investigate the correlation of the resistive index with leukocytosis induced by acute ureteral obstruction. Urinary cytokines and urinary levels of mediators of inflammation are becoming increasingly important as markers for urologic diseases in the literature review. The urinary concentration of monocyte chemoattractant protein-1(MCP-1) correlates with the degree of obstruction and subsequent renal damage in hydronephrosis. MCP-1 is an important mediator of renal tubular injury. The elevation in interleukin-6 (IL-6) may be useful in the understanding of the pathogenesis of urolithiasis or as a potential marker for stone disease. Resistive index (RI) shows significant improvement after treatment for acute ureteral obstruction due to ureteral stone. The purpose of this study is to investigate the association of RI with MCP-1 & IL-6 in patients with acute ureteral obstruction due to ureteral calculi.
Materials and Methods:
From Aug. 2000, a total of 302 consecutive patients with ureteral stone were collected under thorough clinical diagnosis and image diagnosis including color Doppler sonography.The study is divided into four groups of patients with various urologic diseases. Group A: Ureteral stone group. Patients suffered from acute renal colic, diagnosed with unilateral ureteral stone and hydronephrosis. Group B: Renal stone group. Group C: Acute pyelonephritis (APN) group. Group D: Control healthy group. Exclusion criteria: hematological disease, chronic renal parenchymal disease, preexisting renal failure and bilateral ureteral stone. We perform color Doppler sonography and measure the RI for each patient. Color Doppler sonography (TOSHIBA model SSA-340A) and RI will be done. 154 Urine samples were obtained from renal pelvis urine and voided urine. The urine samples were kept at 4℃, centrifuged at 1000 g for 15 minutes and divided into smaller amounts which were then stored at -70℃. The divided samples were thawed for cytokine evaluation. (MCP-1 enzyme-linked immunosorbant assay and IL-6 Cytokine assays).
Results:
We performed color Doppler sonography and measure the RI for 60 normal healthy persons and total 120 kidneys. The normal mean RI value is 0.60 ±0.03 (RI range 0.53-0.69)。Besides, the RI sensitivity using the RI cutoff point 0.7 is 90﹪to detect the functional obstruction among those patients with acute ureteral obstruction stone due to ureteral calculi. Resistive index (RI) shows significant improvement after treatment for acute ureteral obstruction due to ureteral stone (p<0.01). A total of 154 cases were collected for urine cytokine evaluation and color Doppler sonography measuring RI. The resistive index (RI) and concentrations of MCP-1 and IL6 obtained from voided urine did not show significant change after ESWL for patients with renal stone (p=0.529, 0.073, 0.425). The RI showed significant improvement after treatment for acute ureteral obstruction due to ureteral stone (p<0.01), however the concentrations of MCP-1 and IL6 obtained from renal pelvic and bladder urine did not show significant change (p=0.759, 0.822). The resistive index (RI) and concentrations of MCP-1 and IL6 also shows significant correlation (p<0.05) among patients with acute ureteral obstruction. The RI and MCP-1 in the APN group showed significantly higher than those in the UTI group (p=0.001, p=0.025), but IL-6 showed no significant difference (p=0.701).
Conclusions:
In our study, The RI can provide us useful and sensitive information for clinical diagnosis in addition to stone location, stone size, and hydronephrosis. We suggest the use of RI in determining the treatment strategy and monitoring the renal function after treatment of ureteral obstruction. The resistive index (RI) correlates significantly with the leukocytosis induced by acute ureteral obstruction. The mean RI of the unaffected kidney in the leukocytosis group is relatively higher. Immune mediators induced by acute unilateral ureteral obstruction are suggested to affect kidneys bilaterally. In addition, we also find the positive correlation of resistive index with age. The resistive Index correlates significantly with urinary MCP-1 & IL-6 in patients with urolithiasis. Further study is needed to test if RI as an image marker for obstructive uropathy correlates with the biological markers (MCP-1 and IL6) for obstructive uropathy.
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