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Wu J, Liu J, Li G, Sun W, Liu J, Li W, Wang H, Zheng M. Research on the correlation between the renal resistive index, renal microvessel density, and fibrosis. Ren Fail 2023; 45:2273423. [PMID: 37873973 PMCID: PMC11001374 DOI: 10.1080/0886022x.2023.2273423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study was designed to investigate the relationship between the renal resistive index (RRI), renal microvessel density (RMD), and fibrosis in patients with chronic kidney disease (CKD). METHODS A total of 73 CKD patients were included in the study. Prior to kidney biopsy, we recorded the RRI of the interlobar artery and the estimated glomerular filtration rate (eGFR). Immunohistochemical analysis was performed to assess CD34 expression, and Masson staining was used to evaluate histopathological specimens for RMD and the degree of fibrosis. The percentage of the positive area (PPA) was recorded. Subsequently, we investigated the correlation between RRI, RMD, and kidney fibrosis. RESULTS RMD (CD34 PPA-total and CD34 PPA-peritubular capillary) showed a slight increase in early CKD stages (1-2) and gradually declined from CKD stages 2 to 5. No correlation was observed between the RRI and RMD or between the RRI and fibrosis across CKD stages 1 to 5. However, across CKD stages 2 to 5, RRI negatively correlated with CD34 PPA-glomerulus (r = -0.353, p = 0.022), but no correlation was found with CD34 PPA-total, CD34 PPA-peritubular capillary, or kidney fibrosis. eGFR showed a positive correlation with RMD (CD34 PPA-total, CD34 PPA-peritubular capillary, and CD34 PPA-glomerulus) across CKD stages 2 to 5, while no correlation was found from CKD stages 1 to 5. CONCLUSION There was no correlation between RRI and RMD or between RRI and fibrosis across CKD stages 1 to 5 (RRI ≤ 0.7).
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jian Liu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Guanghan Li
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weiliang Sun
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Jiang Liu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Wenge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Hao Wang
- Department of Radiation Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Min Zheng
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
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Darabont R, Mihalcea D, Vinereanu D. Current Insights into the Significance of the Renal Resistive Index in Kidney and Cardiovascular Disease. Diagnostics (Basel) 2023; 13:diagnostics13101687. [PMID: 37238172 DOI: 10.3390/diagnostics13101687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Initially, the renal resistive index (RRI) was investigated with the aim of improving diagnosis in kidney diseases, but this goal was not met. Recently, many papers have highlighted the prognostic significance of the RRI in chronic kidney disease: specifically, in estimating the revascularization success of renal artery stenoses or the evolution of the graft and the recipients in renal transplantation. Moreover, the RRI has become significant in the prediction of acute kidney injury in critically ill patients. Studies in renal pathology have revealed correlations of this index with parameters of systemic circulation. The theoretical and experimental premises of this connection were then reconsidered, and studies analyzing the link between RRI and arterial stiffness, central and peripheral pressure, and left ventricular flow were conducted with this purpose. Many data currently indicate that RRI is influenced more by pulse pressure and vascular compliance than by renal vascular resistance-assuming that RRI reflects the complex interplay between systemic circulation and renal microcirculation and should be considered a marker of systemic cardiovascular risk beyond its prognostic relevance for kidney disease. In this review, we overview the clinical research that reveals the implications of RRI in renal and cardiovascular disease.
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Affiliation(s)
- Roxana Darabont
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Diana Mihalcea
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Dragos Vinereanu
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
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Terukina H, Morita T, Yamasaki M. The repeatability, reproducibility, and influencing factors of intrarenal Doppler ultrasonography in dogs without heart disease. Vet Radiol Ultrasound 2023; 64:337-344. [PMID: 36447301 DOI: 10.1111/vru.13194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022] Open
Abstract
Renal impairment is concurrent with adverse outcomes such as heart disease in humans and dogs. Intrarenal Doppler ultrasonography (IRD) is used to assess intrarenal hemodynamics, and resistance index (RI) and venous impedance index (VII) are used to evaluate intrarenal hemodynamics in humans with heart failure. However, only a few studies have assessed the efficacy of IRD, especially VII, in dogs, and the methods differ between studies. Additionally, repeatability, reproducibility, and factors influencing IRD values have not been validated in dogs. This prospective, analytical study aimed to assess repeatability and reproducibility of IRD, and to clarify influencing factors of IRD in dogs without heart disease. We enrolled 78 dogs without heart disease. The RI and VII were highly reproducible, and the reference intervals for VII were 0.13-0.37. Differences in transducer (sector and convex) and posture (right lateral and supine decubitus position) had no effect on the IRD values. In contrast, RI and VII were higher in the renal vessels than in interlobar vessels. Age affected RI values (r = 0.39, P < 0.001), but there was no correlation between age, body weight, and VII. In conclusion, IRD is a repeatable and reproducible method to assess intrarenal hemodynamics in dogs. The findings also suggest that age should be considered while interpreting RI.
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Affiliation(s)
- Hiroki Terukina
- Department of Veterinary Internal Medicine, Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Morioka, Japan
| | - Tomoya Morita
- Veterinary Teaching Hospital, Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Morioka, Japan
| | - Masahiro Yamasaki
- Department of Veterinary Internal Medicine, Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Morioka, Japan
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Liu KH, Lee MC, Kong APS, Chen L, Chan JCN, Wing Chu WC. Associations of Renal Augmented Velocity Index with Arterial Stiffness, Carotid Intima-Media Thickness and Blood Pressure, in Comparison with Renal Resistive Index. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1279-1288. [PMID: 33551242 DOI: 10.1016/j.ultrasmedbio.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima-media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid-femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.
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Affiliation(s)
- Kin Hung Liu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ming Chung Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ling Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Szczepankiewicz B, Pasławska U, Siwińska N, Plens K, Pasławski R. Evaluation of the diagnostic value of the renal resistive index as a marker of the subclinical development of cardiorenal syndrome in MMVD dogs. J Renin Angiotensin Aldosterone Syst 2021; 22:1470320321995082. [PMID: 33730896 PMCID: PMC8010829 DOI: 10.1177/1470320321995082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Myxomatous mitral valve disease (MMVD) in dogs inevitably causes renal
dysfunction. These interactions are known as the cardiorenal syndrome (CRS).
The main aims of the study were to evaluate whether renal resistive index
(RRI) may be useful as a non-invasive marker in subclinical stage of kidney
injury in dogs with MMVD and to compare RRI with SDMA and Cyst C. Methods: Forty-four dogs were divided into two groups: control—15 healthy dogs
and the heart group—29 dogs with MMVD (ACVIM class Cc). Study
protocol included: anamnesis, clinical examination, electrocardiography,
echocardiography, chest radiography, abdominal ultrasonography with
measurements of the renal resistive index (RRI), urine, and blood
analysis. Results: The RRI in the heart group was significantly higher
0.725 ± 0.035 versus control group
0.665 ± 0.028
(p < 0.00085). The RRI cut-off
point in dogs with stable chronic heart failure (CHF) under 8 years
is 0.775, in older 0.64. RRI was similar in MMVD dogs treated with
ACE-I + furosemide and dogs treated
ACE-I + torasemide + pimobendan + spironolactone.
There was no correlation between RRI and SDMA or Cyst C. Conclusion: RRI is more sensitive than creatinine, SDMA and Cyst C to reveal kidney
injury in MMVD dogs class Cc younger than 8 years.
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Affiliation(s)
- Barbara Szczepankiewicz
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | - Urszula Pasławska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland.,Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Natalia Siwińska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | | | - Robert Pasławski
- Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
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Krishnan V, Malik A. Role of intrarenal resistive index and ElastPQ® renal shear modulus in early diagnosis and follow-up of diabetic nephropathy: A prospective study. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:246-254. [PMID: 36959891 PMCID: PMC10028382 DOI: 10.1177/1742271x20942249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
Introduction We aimed to establish baseline normal values of ElastPQ® (Philips Healthcare, Bothell, Washington, USA) renal shear modulus, evaluate changes in intrarenal resistive index and renal shear modulus in various stages of diabetic nephropathy, their diagnostic potential and role in follow-up. Methods Our prospective observational study was performed over two years. In total, 130 adult cases with diabetic nephropathy and 130 normal adult controls were selected. Diabetic nephropathy was confirmed by persistent albuminuria on 24-hour urinary albumin testing at three month intervals and staged by albuminuria quantification. Measurement of intrarenal resistive index and renal shear modulus in all subjects was performed and their variation with stage of nephropathy was statistically analyzed using Pearson's correlation. Receiver operating characteristic curves were plotted and their individual and combined diagnostic potentials were assessed. Statistical significance was tested using t tests and analysis of variance. Interrater agreement was tested using Cohen's kappa coefficient. Results Mean intrarenal resistive index was significantly higher for cases (mean 0.72 ± 0.05) than controls (mean 0.62 ± 0.04) and showed significant age variation (p < 0.05). Normal values of ElastPQ® renal shear modulus ranged from 3.87 to 4.72 kPa and was significantly higher for cases (mean 8.59 ± 1.77 kPa) than controls (mean 4.32 ± 0.45 kPa) and showed significant differences between each stage of nephropathy, being highest in stage 2. Maximum diagnostic accuracy was at 0.65 (sensitivity 90%, specificity 76.2%, area under curve 0.916) for intrarenal resistive index and at 5.31 kPa (sensitivity 90.8%, specificity 84.6%, area under curve 0.923) for renal shear modulus. Combination of the two further improved diagnostic performance (highest accuracy of 89%, sensitivity 81.7%, specificity 96.3%). Conclusions Normal range of ElastPQ® renal shear modulus values could be established. Intrarenal resistive index and renal shear modulus can be used as imaging parameters for early diagnosis and follow-up of diabetic nephropathy.
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Affiliation(s)
| | - Amita Malik
- Amita Malik, Vardhman Mahavir Medical
College and Safdarjung Hospital, New Delhi 110029, India.
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Bedside Renal Doppler Ultrasonography and Acute Kidney Injury after TAVR. J Clin Med 2020; 9:jcm9040905. [PMID: 32218228 PMCID: PMC7230258 DOI: 10.3390/jcm9040905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/24/2022] Open
Abstract
Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is associated with a dismal prognosis. Elevated renal resistive index (RRI), through renal Doppler ultrasound (RDU) evaluation, has been associated with AKI development and increased systemic arterial stiffness. Our pilot study aimed to investigate the performance of Doppler based RRI to predict AKI and outcomes in TAVR patients. From May 2018 to May 2019, 100 patients with severe aortic stenosis were prospectively enrolled for TAVR and concomitant RDU evaluation at our institution (Nouvel Hôpital Civil, Strasbourg University, France). AKI by serum Creatinine (sCr-AKI) was defined according to the VARC-2 definition and AKI by serum Cystatin C (sCyC-AKI) was defined as an sCyC increase of greater than 15% with baseline value. Concomitant RRI measurements as well as renal and systemic hemodynamic parameters were recorded before, one day, and three days after TAVR. It was found that 10% of patients presented with AKIsCr and AKIsCyC. The whole cohort showed higher baseline RRI values (0.76 ± 0.7) compared to normal known and accepted values. AKIsCyC had significant higher post-procedural RRI one day (Day 1) after TAVR (0.83 ± 0.1 vs. 0.77 ± 0.6, CI 95%, p = 0.005). AUC for AKIsCyC was 0.766 and a RRI cut-off value of ≥ 0.795 had the most optimal sensitivity/specificity (80/62%) combination. By univariate Cox analysis, Mehran Risk Score, higher baseline right atrial pressure at baseline > 0.8 RRI values one day after TAVR (HR 6.5 (95% CI 1.3-32.9; p = 0.021) but not RRI at baseline were significant predictors of AKIsCyC. Importantly, no significant impact of baseline biological parameters, renal or systemic parameters could be demonstrated. Doppler-based RRI can be helpful for the non-invasive assessment of AKI development after TAVR.
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An assessment of the utility and repeatability of the renal resistive index in horses. PLoS One 2019; 14:e0226941. [PMID: 31877188 PMCID: PMC6932750 DOI: 10.1371/journal.pone.0226941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to establish the value of the renal resistive index (RI) of intrarenal arteries in healthy warmblood non-racing horses of different ages to assess the influence of physiologic factors and repeatability of measurement. The kidney ultrasonography examination was performed in three age groups: 15 foals, 15 adults and 15 elderly horses. The procedure was performed in unsedated standing animals. RI values were measured using pulsed-wave Doppler at the medial part of each kidney in the intrarenal arteries. To evaluate repeatability, all measurements were repeated two hours after the first examination. Statistical analysis of the relationship between groups was carried out using Fisher’s test. The relationship between the RI value and the physiological parameters was evaluated using linear regression. Repeatability of measurements was determined based on the Bland-Altman plot. The mean RI value in the studied horses was 0.48 ± 0.05 in the left kidney and 0.49 ± 0.05 in the right kidney. There were no statistically significant differences between the RI values in foals and adult horses. The elderly horses had a significantly higher RI value. Pulse pressure was the only physiological parameter affecting the RI value. The repeatability coefficient was 0.089 for the right kidney and 0.09 for the left kidney. The presented result suggest that elderly healthy horses have higher RI values than younger animals, which should be taken into account in clinical practice. The arterial pulse pressure should also be considered when interpreting RI values. The measurements have high repeatability, but in the authors’ opinion, this procedure is time consuming and requires experience.
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Ștefan G, Florescu C, Sabo AA, Stancu S, Mircescu G. Intrarenal resistive index conundrum: systemic atherosclerosis versus renal arteriolosclerosis. Ren Fail 2019; 41:930-936. [PMID: 31599199 PMCID: PMC6807913 DOI: 10.1080/0886022x.2019.1674159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: We aimed to evaluate the relationship between biopsy-proven kidney lesions, subclinical markers of atherosclerosis and intrarenal resistive index (RRI) in chronic kidney disease (CKD) patients. Methods: This cross-sectional, single-center study prospectively enrolled 44 consecutive CKD patients (57% male gender, 54.1 (95%CI, 49.7–58.6) years, median eGFR 28.1 (15.0–47.7) mL/min) diagnosed by renal biopsy during 6 months in our clinic. RRI, carotid intima-media thickness (IMT), Kauppila score for abdominal aortic calcification (AACs) were assessed. Traditional and nontraditional atheroscleosis risk factors were also evaluated. Results: Most of the patients had a diagnosis of glomerular nephropathy, with IgA nephropathy and diabetic nephropathy being the most frequent. RRI increased proportionally with CKD stages. Patients with RRI >0.7 (39%) were older, had diabetic and vascular nephropathies more frequently, higher mean arterial blood pressure, increased systemic atherosclerosis burden (IMT and AACs), higher percentage of global glomerulosclerois, GBM thickness, arteriolosclerosis and interstitial fibrosis/tubular atrophy. RRI directly correlated with age (rs = 0.55, p < 0.001) and with all the studied atherosclerosis markers (clinical atherosclerosis score rs = 0.50, p = 0.02; AACs rs = 0.50, p < 0.01; IMT rs = 0.34, p = 0.02). Also, global glomerulosclerosis (rs = 0.31, p = 0.03) and interstitial fibrosis/tubular atrophy (rs = 0.35, p = 0.01) were directly correlated with RRI. In multivariable adjusted binomial logistic regression models, only arteriolosclerosis was retained as independent predictor of RRI >0.7. Conclusion: The analysis of RRI may be useful in the evaluation of the general vascular condition of the patient with CKD, supplying information about both microvascular and macrovascular impairment. Moreover, RRI correlates well with renal histopathologic characteristics, particularly with arteriolosclerosis.
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Affiliation(s)
- Gabriel Ștefan
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Cosmin Florescu
- Department of Anatomic and Molecular Pathology, Laboratoire National de Santé , Dudelange , Luxembourg
| | - Alexandru-Anton Sabo
- Nephrology Department, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Simona Stancu
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Gabriel Mircescu
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
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Oliveira RAG, Mendes PV, Park M, Taniguchi LU. Factors associated with renal Doppler resistive index in critically ill patients: a prospective cohort study. Ann Intensive Care 2019; 9:23. [PMID: 30706172 PMCID: PMC6355884 DOI: 10.1186/s13613-019-0500-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background The renal Doppler resistive index (renal RI) is a noninvasive tool that has been used to assess renal perfusion in the intensive care unit (ICU) setting. However, many parameters have been described as influential on the values of renal RI. Therefore, we proposed this study to evaluate the variables that could impact renal RI in critically ill patients. Methods A prospective observational study was performed in a 14-bed medical–surgical adult ICU. All consecutive patients admitted to the ICU during the study period were evaluated for eligibility. Renal RI was performed daily until the third day after ICU admission, death, or renal replacement therapy (RRT) requirement. Clinical and blood test data were collected throughout this period. Acute kidney injury (AKI) reversibility was categorized as transient (normalization of renal function within 3 days of AKI onset) or persistent (non-resolution of AKI within 3 days of onset or need for RRT). A linear mixed model was applied to evaluate the factors that could influence renal RI. Results Eighty-three consecutive patients were included. Of these, 65% were male and 50.6% were medical admissions. Mean SAPS 3 was 47 ± 16. Renal RI was significantly different between no-AKI (0.64 ± 0.06), transient AKI (0.64 ± 0.07), and persistent AKI groups (0.70 ± 0.08, p < 0.01). Variables associated with renal RI variations were mean arterial pressure, lactate, age, and persistent AKI (p < 0.05). No association between serum chloride and renal RI was observed (p = 0.868). Conclusions Mean arterial pressure, lactate, age, and type of AKI might influence renal RI in critically ill patients.
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Affiliation(s)
- Raphael A G Oliveira
- Surgical Emergencies and Trauma ICU, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Enéas de Carvalho Aguiar 255, São Paulo, SP, Postal Code: 05403-000, Brazil.,Hospital Sirio Libanes, Rua Daher Cutait 69, São Paulo, SP, Postal Code: 01308-060, Brazil
| | - Pedro V Mendes
- Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, São Paulo, SP, Postal Code: 05403-000, Brazil.,Hospital Sirio Libanes, Rua Daher Cutait 69, São Paulo, SP, Postal Code: 01308-060, Brazil
| | - Marcelo Park
- Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, São Paulo, SP, Postal Code: 05403-000, Brazil
| | - Leandro U Taniguchi
- Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, São Paulo, SP, Postal Code: 05403-000, Brazil. .,Hospital Sirio Libanes, Rua Daher Cutait 69, São Paulo, SP, Postal Code: 01308-060, Brazil.
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Cauwenberghs N, Kuznetsova T. Determinants and Prognostic Significance of the Renal Resistive Index. Pulse (Basel) 2016; 3:172-8. [PMID: 27195237 DOI: 10.1159/000442445] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The noninvasive assessment of renal hemodynamics is currently possible by assessing the renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as (peak systolic velocity - end-diastolic velocity)/peak systolic velocity. In this review, we outline the important determinants of the RRI to clarify the true identity of the RRI and highlight its potential diagnostic and prognostic value in renal and cardiovascular pathology. SUMMARY Although the RRI was initially considered to reflect intrarenal vascular pathological processes, this index is actually a product of a complex interaction between renal and systemic vascular wall properties and hemodynamic factors. Indeed, studies in patients and general populations consistently demonstrated a significant and direct association between the RRI and central or peripheral pulse pressure independent of other covariables. Moreover, studies in renal transplant patients also showed that the RRI mainly reflects characteristics of the recipient but not those of the graft. Thus, the major influence of the systemic hemodynamics on the intrarenal arterial waveforms excludes RRI as a specific marker of renal vascular pathology. On the other hand, because the RRI reflects pulsatility in renal arteries, it might be useful for the early detection of renal microvascular damage. Future longitudinal studies are still needed to clarify whether the detection of Doppler changes in intrarenal arteries might yield an improvement in the adverse cardiovascular and renal outcome. CONCLUSION Published studies on RRI imply that the interaction between the systemic hemodynamics and peripheral circulation in the kidney is a complex physiological phenomenon. In addition to renal vascular properties, the central hemodynamic factors significantly influence the intrarenal arterial Doppler waveform patterns. Previous research also suggested an important role of the RRI for the evaluation of renal target organ damage, particularly in patients with increased pulsatility of the intrarenal blood flow.
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Affiliation(s)
- Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Renal Doppler Resistive Index as a Marker of Oxygen Supply and Demand Mismatch in Postoperative Cardiac Surgery Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:763940. [PMID: 26605339 PMCID: PMC4641959 DOI: 10.1155/2015/763940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/28/2015] [Indexed: 12/02/2022]
Abstract
Background and Objective. Renal Doppler resistive index (RDRI) is a noninvasive index considered to reflect renal vascular perfusion. The aim of this study was to identify the independent hemodynamic determinants of RDRI in mechanically ventilated patients after cardiac surgery. Methods. RDRI was determined in 61 patients by color and pulse Doppler ultrasonography of the interlobar renal arteries. Intermittent thermodilution cardiac output measurements were obtained and blood samples taken from the tip of pulmonary artery catheter to measure hemodynamics and mixed venous oxygen saturation (SvO2). Results. By univariate analysis, RDRI was significantly correlated with SvO2, oxygen extraction ratio, left ventricular stroke work index, and cardiac index, but not heart rate, central venous pressure, mean artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, oxygen delivery index, oxygen consumption index, arterial lactate concentration, and age. However, by multivariate analysis RDRI was significantly correlated with SvO2 only. Conclusions. The present data suggests that, in mechanically ventilated patients after cardiac surgery, RDRI increases proportionally to the decrease in SvO2, thus reflecting an early vascular response to tissue hypoxia.
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Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, Rousson V, Mohaupt MG, Alwan H, Ehret G, Pechere-Bertschi A, Paccaud F, Staessen JA, Vogt B, Burnier M, Martin PY, Bochud M. Reference Values and Factors Associated With Renal Resistive Index in a Family-Based Population Study. Hypertension 2014; 63:136-42. [DOI: 10.1161/hypertensionaha.113.02321] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Increased renal resistive index (RRI) has been recently associated with target organ damage and cardiovascular or renal outcomes in patients with hypertension and diabetes mellitus. However, reference values in the general population and information on familial aggregation are largely lacking. We determined the distribution of RRI, associated factors, and heritability in a population-based study. Families of European ancestry were randomly selected in 3 Swiss cities. Anthropometric parameters and cardiovascular risk factors were assessed. A renal Doppler ultrasound was performed, and RRI was measured in 3 segmental arteries of both kidneys. We used multilevel linear regression analysis to explore the factors associated with RRI, adjusting for center and family relationships. Sex-specific reference values for RRI were generated according to age. Heritability was estimated by variance components using the ASSOC program (SAGE software). Four hundred women (mean age±SD, 44.9±16.7 years) and 326 men (42.1±16.8 years) with normal renal ultrasound had mean RRI of 0.64±0.05 and 0.62±0.05, respectively (
P
<0.001). In multivariable analyses, RRI was positively associated with female sex, age, systolic blood pressure, and body mass index. We observed an inverse correlation with diastolic blood pressure and heart rate. Age had a nonlinear association with RRI. We found no independent association of RRI with diabetes mellitus, hypertension treatment, smoking, cholesterol levels, or estimated glomerular filtration rate. The adjusted heritability estimate was 42±8% (
P
<0.001). In a population-based sample with normal renal ultrasound, RRI normal values depend on sex, age, blood pressure, heart rate, and body mass index. The significant heritability of RRI suggests that genes influence this phenotype.
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Affiliation(s)
- Belén Ponte
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Menno Pruijm
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Daniel Ackermann
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Philippe Vuistiner
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Ute Eisenberger
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Idris Guessous
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Valentin Rousson
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Markus G. Mohaupt
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Heba Alwan
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Georg Ehret
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Antoinette Pechere-Bertschi
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Fred Paccaud
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Jan A. Staessen
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Bruno Vogt
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Michel Burnier
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Pierre-Yves Martin
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
| | - Murielle Bochud
- From the Division of Nephrology (B.P., P.-Y.M.), Division of Cardiology (G.E.), Unit of Populational Epidemiology, Division of Primary Care Medicine (I.G.), and Hypertension Unit (A.P.-B.), University Hospital of Geneva, Switzerland; Institute of Social and Preventive Medicine (B.P., P.V., I.G., V.R., H.A., F.P., M.B.) and Division of Nephrology (M.P., M.B.), University Hospital of Lausanne, Lausanne, Switzerland; Department of Nephrology, Hypertension, and Clinical Pharmacology, Inselspital, Bern
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Winther SO, Thiesson HC, Poulsen LN, Chehri M, Agerskov H, Tepel M. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft. PLoS One 2012; 7:e51772. [PMID: 23272164 PMCID: PMC3522700 DOI: 10.1371/journal.pone.0051772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/07/2012] [Indexed: 11/24/2022] Open
Abstract
Objective The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft. Methods In a cross-sectional study the renal arterial resistive index were obtained in interlobar arteries by Doppler ultrasonography in 78 patients with renal allograft. The stage of chronic kidney disease was determined by the estimated glomerular filtration rate equation. Results The median renal arterial resistive index was 0.61 (interquartile range, 0.56 to 0.66). We observed a significant association between renal arterial resistive index above the upper quartile and chronic kidney disease stage 4 or higher (relative risk, 4.64; 95% confidence interval, 1.71 to 12.55; p = 0.003 by Fisher’s exact test). Multivariate logistic regression analysis showed that renal arterial resistive indices (p = 0.02) and time since transplantation (p = 0.04), but not age, gender, or blood pressure were significantly associated with chronic kidney disease stage 4 or higher. Conclusion A renal arterial resistive index higher than 0.66 may determine the threshold value of chronic kidney disease stage 4 or higher in patients with renal allograft.
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Affiliation(s)
- Stine O. Winther
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Helle C. Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Lene N. Poulsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Mahtab Chehri
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Martin Tepel
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Institute of Molecular Medicine, Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
- * E-mail:
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15
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Bigé N, Lévy PP, Callard P, Faintuch JM, Chigot V, Jousselin V, Ronco P, Boffa JJ. Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease. BMC Nephrol 2012; 13:139. [PMID: 23098365 PMCID: PMC3531254 DOI: 10.1186/1471-2369-13-139] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 09/25/2012] [Indexed: 12/26/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a growing public health problem and end stage renal disease (ESRD) represents a large human and economic burden. It is important to identify patients at high risk of ESRD. In order to determine whether renal Doppler resistive index (RI) may discriminate those patients, we analyzed whether RI was associated with identified prognosis factors of CKD, in particular histological findings, and with renal outcome. Methods RI was measured in the 48 hours before renal biopsy in 58 CKD patients. Clinical and biological data were collected prospectively at inclusion. Arteriosclerosis, interstitial fibrosis and glomerulosclerosis were quantitatively assessed on renal biopsy in a blinded fashion. MDRD eGFR at 18 months was collected for 35 (60%) patients. Renal function decline was defined as a decrease in eGFR from baseline of at least 5 mL/min/ 1.73 m2/year or need for chronic renal replacement therapy. Pearson’s correlation, Mann–Whitney and Chi-square tests were used for analysis of quantitative and qualitative variables respectively. Kaplan Meier analysis was realized to determine renal survival according to RI value using the log-rank test. Multiple logistic regression was performed including variables with p < 0.20 in univariate analysis. Results Most patients had glomerulonephritis (82%). Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m2 [5–130], percentage of interstitial fibrosis 10% [0–90], glomerulosclerosis 13% [0–96] and RI 0.63 [0.31-1.00]. RI increased with age (r = 0.435, p = 0.0063), pulse pressure (r = 0.303, p = 0.022), renal atrophy (r = −0.275, p = 0.038) and renal dysfunction (r = −0.402, p = 0.0018). Patients with arterial intima/media ratio ≥ 1 (p = 0.032), interstitial fibrosis > 20% (p = 0.014) and renal function decline (p = 0.0023) had higher RI. Patients with baseline RI ≥ 0.65 had a poorer renal outcome than those with baseline RI < 0.65 (p = 0.0005). In multiple logistic regression, RI≥0.65 was associated with accelerated renal function decline independently of baseline eGFR and proteinuria/creatininuria ratio (OR=13.04 [1.984-85.727], p = 0.0075). Sensitivity, specificity, predictive positive and predictive negative values of RI ≥ 0.65 for renal function decline at 18 months were respectively 77%, 86%, 71% and 82%. Conclusions Our results suggest that RI ≥ 0.65 is associated with severe interstitial fibrosis and arteriosclerosis and renal function decline. Thus, RI may contribute to identify patients at high risk of ESRD who may benefit from nephroprotective treatments.
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Affiliation(s)
- Naïke Bigé
- Department of Nephrology, AP-HP, Hôpital Tenon, 4 rue de la Chine, Paris, F-75020, France.
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Schiemann U, Kaiser HC, Götzberger M, Schmidmaier R, Bantle F, Straka C. Determination of intrarenal resistance index (RI) in patients with multiple myeloma. Eur J Med Res 2010; 15:210-3. [PMID: 20562060 PMCID: PMC3352010 DOI: 10.1186/2047-783x-15-5-210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Renal impairment is a common complication of multiple myeloma occuring in up to 50% of patients at some stage in their disease. Due to occurrence of cast nephropathies we hypothesized circulatory dysregulation (vasoconstriction) in the kidneys with measurable elevation of the resistance index among these patients which would have a diagnostic impact. Subjects and methods 36 patients with treated multiple myeloma (21 females, 15 males, mean age 61.6 ± 8.5 years) were prospectively examined by conventional abdominal ultrasound with focussed investigation of the kidneys. First, length of the organs, parenchymal width and characterization of parenchymal echogenicity were determined. Then, intrarenal RI values were measured in segmental and arcuate arteries, respectively, in both kidneys. Additionally, serum creatinine, BUN and GFR of each patient were evaluated. RI values were compared to values of 78 healthy control subjects. Results Mean renal RI was 0.68 ± 0.07 which was slightly higher than in controls with 0.62 ± 0.05, but without statistical significance. Due to the laboratory analyses patients were subdivided in those with normal (group 1, n = 21) and those with impaired (group 2, n = 15) renal function. In both groups kidney size and parenchymal width were normal. Significant more group 2 patients (60%) revealed hyperechogenic par enchyma than group 1 patients (24%) (p < 0.01). Mean renal RI indices were 0.67 ± 0.06 (right) and 0.69 ± 0.06 (left) in group 1 patients and 0.71 ± 0.08 (right) and 0.71 ± 0.07 (left) in group 2 patients and showed no significant difference (p = 0.06 and 0.15). Conclusion Renal RI values are not significantly elevated in patients with multiple myeloma even in those with renal impairment so that no hints to a relevant vasoconstriction could be evaluated. RI seems not to be a relevant parameter for the diagnosis of cast nephro pathy of multiple myeloma patients. Routinely performed ultrasound examination should be more focussed on the qualification of parenchymal echogenicity.
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Affiliation(s)
- U Schiemann
- Klinik für Allgemeine Innere Medizin/ Notfallzentrum, Inselspital Bern (Universitätsspital), Freiburgstrasse, Bern, Switzerland.
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