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���������������������� �������� ������� SAS Jump� �SAS Institute Inc, Cary, NC,USA� ����� �������������� �� ANOVA ���� ��!"#$%&� Welch����������� '(�)*��� Turkey-Kramer � HSD �������� P�0.05�%&����+,-���
� �
� �CKD 77�./0123 5��� 45�6,� 789:;./0<=>9:;�?�@A���CKD B��C��� D� 21�85 ��� 56.8�16.41�E� ��F� 54�� G� 23�� HIJKLM� �eGFR�3.28�97.5� �36.83�26.12�mlmin,NOPQRSTU �Cr� 0.60�13.66 �2.83�2.67�mgdl� VWX �UP� 0�12.7 �2.09�2.76�ggCr� YZ[\ 72.7�133.7 �104.4�11.58�mm�+]�� 9:;�?�� 74 ��^Y� 3 ��_Y��`��CKD B��ab� Mc�Yd�ef�/,g�hi!j`�`$B�� 26��� IgAYB 12�� kl�mnopqrsBt' 1�� �Vuv(wx
y 3�� ��z{�Y| 2�� ��YB 3�� Y}mB 1 �� ~�JKL}mB 1 �� ����B 1�� R�q�<r�� 1�� opqU� �medullarynephronophthisis� 1 ��+]�� Yd��@A�@A��� 51��� ������� �V�YB 25�� �JKLY| 14�� Y}mB 4�� �(wVuv| 4�-������ ��� 4�������]�� 123� 5 ��� D� 28�31 �29.8�1.64�E� F� 4�� G� 1��+]�� ����Y���)*�����-����� ������A�#�]���B��.`�� 78��/$����� �#¡� 78�¢�£ 3¤¥(�V�Y��xy�z¦�§�#�]��
� � ��������CKD B��Y¨©�ª`�«Y��!¬��®��`$���� 784�<=>���l�(¯��N�;°������+]�� ���� 78�����/]�� ���.`�l�(¯��N�;°��!±�-#]�� 789:;�?�²³��l�(¯�!��´�$µn�#�¶�� ·¸�CKD �¹rº 3 ./0�¹rº 5 B���»�Fig. 2 �����
Figure 1. The wave profile of color Doppler echography at the position of interlobular
artery. The parameters obtained from the wave profile of doppler echog-
raphy are illustrated. The points of peak systolic velocity �PSV� and enddiastolic velocity �EDV� are as shown in the figure. Velocity-time integral�VTI� denotes the area under the single wave.
YZ789:;�/$l�(¯��N� ¼ 437
51
�a� Normal �b� CKD Stage 3 �c� CKD Stage 5Figure 2. Representative serial enhancement images with early-phase real-time pulse inversion after a bolus injection
of ultrasound contrast agent in the control subject �a�, patients with CKD stage 3 �b�, and patient withCKD stage 5. Shortly after the injection of contrast agent, enhancement begun from the hilar portion of the
kidney, and then spread peripherally along the interlobar arteries, arcuate arteries, and interlobular arteries
in sequence. The interlobular arteries were visualized even in advanced CKD.
���� �� � �438
52
�� �������������� ���PSV, EDV, RI, VTI� � CKD ��������CKD �������� �ILA� ��� �� �ILBA� ������������ PSV�EDV� RI� VTI ����� Table 1 ����� � !� ILA "! PSV # 23.93� 9.72 cm� s�EDV # 6.80�3.57 cm�s "� ILBA "! PSV #15.57� 5.21 cm� s� EDV # 4.73� 2.20 cm� s $�ILBA "�� ! ILA �%�&'(� )*+��,��-./012"3� VTI!� ILA" 20154.6�8271.7� ILBA " 12933.2�5035.4� $� VTI 4ILBA #'(� )*+�� -5� RI !� ILA "0.71�0.10� ILBA " 0.70�0.07$ RI �67&!ILBA $ ILA "'(8!9��:*+��;�<���=>�?@A��� CKDBCDEF�%G�� �Fig. 3��PSV !� ILA ��� ILBA $4 CKD BCDE
�HI$$4�JKLM#N���� ILA "!
CKD BCDE 4A$BCDE 5A���9'(:8#N���#� ILBA ��7&!BCDE 1�2$O�P�BCDE 3A� 4A� 5A�� O�&BCDE 3A$BCDE 5A�'(:8#N����EDV 4 PSV $QR� CKD BCDE�HI$$4�JK#N��� ILA "!?@A$BCDE1�2A��7&4'(:8#N����RI !� ILA�ILBA ST$4� CKD BCDE�HI$$4�UV���� BCDE 4A���BCDE 5A!� ?@A� BCDE 1�2A� O�&3A�%�&� O�P�'(:UV#N����VTI !� ILA ��� ILBA $4 CKD BCDE
�HI$$4�WXLM����� ILA "!BCDE 5A#?@A���BCDE 1�2A�%�&'(�W�"3+�� -5� ILBA"! ILA "'(8�9���A��VY&� BCDE 1�2A"!BCDE 3A� 4A$%�&'(�Z�"3+��
Table 1. Average Value of the Doppler Parameter in Interlobar Arteries and Interlobular
Arteries in All CKD Cases
ILA: interlobar artery, ILBA: interlobular artery, PSV: peak systolic velocity, EDV:
end diastolic velocity, RI: resistive index, VTI: velocity-time integral �VTI�
Table 2. Coe$cient of Correlation Between the Doppler Parameters and eGFR, SBP, DBP, PP,
and UP.
eGFR: estimated glomerular filtration rate, SBP: systolic blood pressure, DBP: diastolic blood
pressure, PP: pulse pressure, UP: urinary
[\]^_`/��� ���a�bc 439
53
Figure 3. The Doppler parameters of interlobar arteries and interlobular arteries in the control and each CKD stage
group.
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�� �������������� ���PSV, EDV, RI, VTI� � eGFR� ��� �������������� ������ eGFR� �� � ��
�������� �Table 2�� eGFR �� ILA �� EDV ������ �r�0.60��� RI ������ �r�-0.69� ������ ILBA ��� eGFR� EDV !" VTI ������ �EDV: r�0.66� VTI: r�0.69� �� RI ������ �r�-0.60� �#$��%&'�� ()'����*�� ILA !
" ILBA +,� �*� -�������./0��123�� �2�4��� ILA !" ILBA�+,0 RI 55�������6����ILA-RI: r�0.56� ILBA-RI: r�0.49��7 � � ���� ILA !" ILBA ��8�
���09:7���.;723��
�� �������������� ���PSV, EDV, RI, VTI� ��������
<=>�?�!@A������� ILA ILBAB� EDV !" RI ��������.���EDV: r�0.75� RI: r�0.83� �Fig. 4�� C�� VTI��55������ �r�0.59� �#$�����PSV � DE���F23� �r�0.36��
� �
GHI��� JKLMNOP�QRSTUVWXYXZ[\�]^/E��!@� L_&�6��E`a�Lbcde�9/EOP� �*0fgBh4�ij/E��kc�lE�� C�� fgBh4� DE<=>��mno���� gBh4� DE��!@0JKLMN�pq�r�s'2�th/E��.���LMTUQRS�?�� ��C�0Luvwx10�, 11��yz�{�|}~��^���E0�Lmno��^;�*�E12��16�� �2�� ��C�]^;�*��� 1���QRSTUV�� �����!E�����*���$� �����7��q5��������/E�����l3
Figure 4. Correlation of the Doppler parameters between interlobar arteries and interlobular arteries.
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Abstract
Evaluation of Interlobular Artery Blood Flow by
Contrast-Enhanced Ultrasound with Perfluorobutane
as a Contrast Agent in Chronic Kidney Disease
Kayori Tsuruoka1, Takashi Yasuda1, Masahiko Yazawa1, Kenichirou Koitabashi1,
Minako Shimazaki1, Tsutomu Sakurada1, Sayuri Shirai1, Yugo Shibagaki1,
Kenjiro Kimura1, and Fumio Tsujimoto2
Continuous hypoxia due to hypoperfusion in peritubular capillaries is one of the factors aggravating
chronic kidney disease �CKD�, but evaluation of perfusion in kidney is di$cult using clinically availablemethods of imaging. The second-generation ultrasound contrast medium perfluorobutane �SonazoidTM�enables visualization of renal vasculature including identification of the interlobular arteries in patients with
renal dysfunction safely. We therefore evaluated the changes in the parameters obtained from the color
Doppler waves at the interlobular arteries identified by the contrast-enhanced ultrasound imaging �CEUI�with Perfluorobutane in patients with CKD.
Perfluorobutane was used in seventy-seven CKD patients and five control subjects, and peak systolic
velocity �PSV�, end diastolic flow velocity �EDV�, resistive index �RI�, and velocity-time integral �VTI� weremeasured from the color Doppler ultrasonography in the interlobar and interlobular arteries.
The interlobular arteries were identified in all cases by CEUI. In both interlobar and interlobular
arteries, significant increases in RI were observed only in the late stage of CKD. Another three Doppler
parameters, PSV, EDV, and VTI had significant di#erence between early and late stage of CKD and showed
a significant correlation with estimated glomerular filtration rate only at the interlobular arteries. No side
e#ects of the contrast agent were observed in any subjects.
In patients with CKD, the blood flow parameters at the interlobular arteries obtained from Doppler
ultrasonography reflex the renal function more accurately than those at the interlobar arteries.
1 Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine2 Department of Clinical Laboratory of Medicine, St. Marianna University School of Medicine
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