Strain wave elastography for evaluation of renal parenchyma in chronic kidney disease.

OBJECTIVE: Chronic kidney disease (CKD) is an important and costly health problem in developed countries and has a tendency to progress to end-stage renal disease regardless of the aetiology. This progress ends in interstitial fibrosis, which decreases the elasticity of tissue. Elastography is a developing technique to assess tissue elasticity. The aim of this study was to determine the difference of strain index (SI) value of renal parenchyma between patients with CKD and healthy individuals. In addition, SI differences of inter-stages were studied. METHODS: Toshiba (Toshiba Medical Systems Corporation, Otawara, Japan) Aplio™ 500 ultrasound device and 3.5- to 5.0-MHz convex probe were used for the elastography examinations. RESULTS: A total of 58 patients with CKD from nephrology and endocrinology clinics (30 males and 28 females; mean age, 56.14 ± 11.60 years) and 40 normal healthy individuals (19 males and 21 females; mean age, 51.70 ± 11.71 years) were included in this prospective study. The mean SI of normal healthy individuals and patients with CKD (regardless of stages) was 0.42 ± 0.30 and 1.81 ± 0.88, respectively (p < 0.001). SI values were not statistically significant among the CKD stages (except CKD Stages 1 and 3). The area under the receiver operating characteristic curve was 0.956 for SI. The optimal cut-off value for the prediction of CKD was 0.935 (sensitivity, 88% and specificity, 95%). CONCLUSION: SI value of sonoelastography can be used to differentiate patients with CKD and healthy individuals. Sonoelastography is an acceptable technique to approach patients with CKD, but we have not shown that it can reliably differentiate different stages. ADVANCES IN KNOWLEDGE: Determining a cut-off SI value between normal and diseased renal parenchyma can help in the diagnosis of CKD.

Evaluation of knowledge and behavior of and attitudes towards smoking cigarettes and using smokeless tobacco in patients with chronic renal failure.

BACKGROUND: Smoking can have negative effects on renal function in healthy individuals, which may result in kidney disease. To determine knowledge, behavior, and attitudes toward smoking cigarettes and using smokeless tobacco among patients with chronic renal failure, we sought to provide evidence for appropriate precautions and guidance for further research. METHODS: The study included 86.7% of 390 patients undergoing treatment for chronic renal failure who completed a 30-question instrument. RESULTS: Of the participants, 7.9% were smokers and 12.6% ex-smokers. Among the smokers, 61% said they wanted to quit and 45% said they needed help to quit. Of the participants, 9.5% were using Maras powder, a type of smokeless tobacco. Of the smokeless tobacco users, 55.6% noted that they wanted to give it up. The rate of the participants smoking cigarettes and/or using smokeless tobacco was 17.4%. In addition, 38.9% of the participants said that they started to use smokeless tobacco to quit smoking cigarettes. Of the participants, 62.6% thought smoking was harmful to the kidneys. The rate of the passive smokers was 30.2%. Of the participants, 66.3% explained that they were exposed to smoke at home. CONCLUSIONS: Appropriate interventions should begin to help patients with chronic renal failure stop smoking and to prevent them from exposure to cigarette smoke. Smokers should be informed that using smokeless tobacco is not a way to stop smoking cigarettes. Education programs should be conducted to prevent people from using smokeless tobacco and to help smokeless tobacco users to quit their habit.