Evaluation Of Renal Changes for Hypertensive Patients In High Altitude Using Ultrasonography

Abstract

The normal size of a kidney is variable and is affected by age, gender and body mass index. Renal artery stenosis (RAS) is the commonest secondary cause of hypertension and may result in renal ischemia with resultant renal failure. Natives of high altitude are known to have a low oxygen supply in the tissues and the kidneys play a crucial role in acclimatization because they regulate body fluids, electrolytes and acid base homeostasis. Gray scale and Doppler ultrasound were used to depict the renal size and to detect (RAS) among hypertensive patients. In this thesis, measurement of renal volume was studied by ultrasound in term of length, width and thickness for patients living in high altitude. Renal volume was also calculated for hypertensive patients. The usefulness of gray scale and Doppler ultrasound in detecting renal volume was evaluated. The study intended to establish a reference values for renal size and volume. The incidence of (RAS) among hypertension group was also evaluated. Extrarenal Doppler parameters are used to detect (RAS). The study describe the progression of (RAS) and also measure the volume kidneys with (RAS) and compare it with volume of other hypertension patients without (RAS). The present work has two major parts; measurement of renal size in normal population and measurement of the size in hypertensive patients living in high altitude by gray scale and Doppler U/S. The study is prospective one, in which a standard technique of U/S with the patients supine are used. Logic 3 U/S machine with 3.5 MHZ transducer is used. The study sample is population living in Aseer region at (2400m) altitude. For the first part of the study, a total of 325 patients were investigated. The mean volume were range from 57.1 to 147.78 cm³ for right and 57.46 to 147.83 cm³ for left kidney. The cortical size was 1.8 to cm in both side. For the second group, (175) hypertensive patients were investigated by gray scale and Doppler U/S. The mean volume were 85.65±1.3 and 87.38±1.8 cm³ for right and left kidney respectively. The incidence of (RAS) was 13.14%. The mean volume in (RAS) group was 57.08 and 65.17 cm³ for the right and left respectively. The cortical size in both side was 1.5cm. The study showed the important of ultrasound as a useful tool to measure renal volume and to detect (RAS). Considerable variation were observed among renal volume between male and female, age group and the side. The extrarenal parameters are considered as a good standard technique for detection of RAS). The study established a reference values for renal volume in normal and hypertensive patients living in high altitude. However, additional studies are necessary to improve statistical information by including parts from different high altitude areas.