Clinical Study Of Real-time Shear Wave Elastography In Native Kidneys To Evaluate Early Renal Fibrosis In Patients With Chronic Kidney Disease

【Objective】1.Real-time shear wave elastography（RT-SWE）was used to quantitatively evaluate the young’s modulus of renal cortical hardness in normal adults,and to analyze the range of renal elasticity in normal adults,thus providing reference for the later evaluation of renal function and structure changes in patients with chronic kidney disease（CKD）.2.To preliminarily explore the potential application value of RT-SWE in early detection of renal fibrosis in patients with CKD.【Method】1.A total of 20 healthy subjects,aged 18-73 with an average of 41.3±18.2 years old,were selected from The Ultrasound department of Jiangsu Hospital of Traditional Chinese Medicine from August 2017 to December 2019,including 11 males（43.5±15.2 years old）and 9 females（41.6±19.8 years old）.There were 127patients with clinically diagnosed early chronic kidney disease,and all contraindications and related confounding factors were excluded.Finally,50 patients were enrolled,aged 18～70 years,with an average age of 39.1±19.2 years.There were22 males and 28 females.2.This study used the ultrasonic diagnostic instrument of French Super Sonic Aix-plorer,with the frequency of 3.5-5.5MHz（S6-1）,with RENAL mode.Renal vascular lesions and space-occupying lesions were excluded by conventional two-dimensional and color Doppler ultrasound,and then renal RT-SWE elastography was performed.3.RT-SWE technology was used to detect the E_mean value of bilateral renal cortex in healthy people,and data analysis and comparison were conducted from the perspectives of left and right sides,different ages,different genders,etc.The mean young’s modulus of renal cortex(E_mean)of stage 1-3 patients with chronic kidney disease was analyzed and compared with 24-hour urinary protein quantification（24h UTP）,serum creatinine（SCr）,renal biopsy pathology and interstitial fibrosis.4.Continuous variables were shown by mean±standard deviation.The comparison between groups was firstly tested for normal distribution.Mann-whitney U nonparametric test is used when the normal distribution is not consistent.Chi-square test was used for the comparison between groups of categorical variables.P<0.05was considered statistically significant.【Results】1.Relevant research results of healthy population:1.1 The mean value of E_mean in the left kidney is 4.2±2.3 k Pa,the mean value of E_meanin the right kidney is 4.3±2.5 k Pa,and the mean value of E_mean in both kidneys is4.3±2.4 k Pa in normal people.There was no significant difference between the mean value of E_mean in the left kidney and the right kidney（p=0.986）.1.2 There was no significant difference between the mean E_mean value of healthy male kidneys 4.4±2.1 k Pa and that of healthy female kidneys 4.2±2.6 k Pa（p=0.899）.c)The difference of renal E_mean value 4.4±2.8 k Pa between healthy 50-year-old adults and≥50-year-old adults 4.2±2.1 k Pa was statistically significant（p=0.041）.2.Results of the case group:2.1 There was no statistically significant difference in E_mean value between groups of patients with stage 1-3 chronic kidney disease（p>0.05）;2.2 There was still no significant difference between stage 1 CKD patients and stage 2patients in py E_mean values adjusted for patient age（p>0.05）,but there were significant statistical differences between stages 1,2 and 3（p<0.05）.【Conclusion】1.In this study,it was found that there was no significant difference in the mean elastic modulus of bilateral kidneys of normal people,and there was no significant correlation between the elastic modulus of kidneys in gender.In the normal population,according to age grouping,the difference between groups was statistically significant.2.py E_meanmay have important potential application value in comparing patients with stage 1,2 and 3 CKD,and RT-SWE can be applied to the early renal damage assessment of chronic kidney disease.