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Rashed AO, Gameraddin M, Fadulelmulla IA, Khardali AH, Alhazmi SA, Daghriri SH, Hakami LH, Madkhali AH, Foud AA, Alyami AS, Ageeli WA, Hendi AM, Madkhali Y, Alwadani B, Refaee TA, Majrashi NA. Sonographic Assessment of Renal Transplantation in Adult Saudi Patients: A Cross-Sectional Retrospective Study. Transplant Proc 2024; 56:75-81. [PMID: 38238237 DOI: 10.1016/j.transproceed.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
Kidney transplantation stands as a practical and cost-effective treatment option for end-stage renal disease patients, offering an improved quality of life with reduced morbidity when compared with hemodialysis. To evaluate the status of transplanted kidneys in Saudi patients, we conducted a retrospective single-center study at Jazan, Saudi Arabia, involving 46 adult renal recipients enrolled randomly from 2015 to December 2022. Using high-frequency ultrasound, we performed Duplex ultrasound examinations to assess renal allografts. The study revealed that the renal grafts exhibited normal length, with preserved cortical medullary differentiation (CMD) in 84.8% of cases and poor CMD in 15.2%. The echogenicity of the grafts remained normal in 69.6% of instances. Interestingly, we observed a significant rise in resistance index values as the graft duration increased (P = .04), whereas patients with abnormal creatinine levels displayed decreased peak systolic velocity and end-diastolic velocity. Notably, sonographic graft assessments unveiled complications, including perinephric fluid accumulation (8.7%), simple renal cysts (10.86%), hydronephrosis (8.7%), and one case of graft rejection. Receiver operating characteristics analysis for serum blood creatinine levels and abnormal parenchymal findings yielded fair to poor predictive accuracy, with varying sensitivity and specificity measures that lacked statistical significance. In conclusion, our study revealed that most Saudi renal transplant recipients exhibited grafts with normal echogenicity, preserved CMD, and limited perinephric fluid. This investigation provides valuable insights into sonographic changes and Doppler parameters of renal grafts, potentially aiding in the early detection of graft rejection and facilitating diagnostic and therapeutic planning.
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Affiliation(s)
- Altaf O Rashed
- Radiology Department, Samtah General Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Al-Madinah, Saudi Arabia
| | - Ibtisam A Fadulelmulla
- Department of Diagnostic Radiology, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Abdullah H Khardali
- Radiology Department, King Fahad Central Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Samar A Alhazmi
- Radiology Department, Mohmmed Bin Nasser Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Sameerah H Daghriri
- Radiology Department, Samtah General Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Laila H Hakami
- Radiology Department, Samtah General Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Amaal H Madkhali
- Radiology Department, Samtah General Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Afaf A Foud
- Radiology Department, Samtah General Hospital, Ministry of Health, Jazan Health Affairs, Jazan, Saudi Arabia
| | - Ali S Alyami
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Wael A Ageeli
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ali M Hendi
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; Department of Radiology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Yahia Madkhali
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Bandar Alwadani
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Turkey A Refaee
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Naif A Majrashi
- Diagnostic Radiography Technology (DRT) Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
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Wei L, Wahyulaksana G, Te Lintel Hekkert M, Beurskens R, Boni E, Ramalli A, Noothout E, Duncker DJ, Tortoli P, van der Steen AFW, de Jong N, Verweij M, Vos HJ. High-Frame-Rate Volumetric Porcine Renal Vasculature Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2476-2482. [PMID: 37704558 DOI: 10.1016/j.ultrasmedbio.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/02/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility and imaging options of contrast-enhanced volumetric ultrasound kidney vasculature imaging in a porcine model using a prototype sparse spiral array. METHODS Transcutaneous freehand in vivo imaging of two healthy porcine kidneys was performed according to three protocols with different microbubble concentrations and transmission sequences. Combining high-frame-rate transmission sequences with our previously described spatial coherence beamformer, we determined the ability to produce detailed volumetric images of the vasculature. We also determined power, color and spectral Doppler, as well as super-resolved microvasculature in a volume. The results were compared against a clinical 2-D ultrasound machine. RESULTS Three-dimensional visualization of the kidney vasculature structure and blood flow was possible with our method. Good structural agreement was found between the visualized vasculature structure and the 2-D reference. Microvasculature patterns in the kidney cortex were visible with super-resolution processing. Blood flow velocity estimations were within a physiological range and pattern, also in agreement with the 2-D reference results. CONCLUSION Volumetric imaging of the kidney vasculature was possible using a prototype sparse spiral array. Reliable structural and temporal information could be extracted from these imaging results.
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Affiliation(s)
- Luxi Wei
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Geraldi Wahyulaksana
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Robert Beurskens
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Enrico Boni
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Alessandro Ramalli
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Emile Noothout
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Piero Tortoli
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Antonius F W van der Steen
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Nico de Jong
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Martin Verweij
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Hendrik J Vos
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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Araújo NC, Suassuna JHR, Fernandes RDCL. Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin. BMC Nephrol 2022; 23:108. [PMID: 35300603 PMCID: PMC8931960 DOI: 10.1186/s12882-022-02741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD. METHODS In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed. RESULTS RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations. CONCLUSION RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.
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Affiliation(s)
- Nordeval Cavalcante Araújo
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil.
| | - José Hermógenes Rocco Suassuna
- Division of Nephrology, University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro-RJ, 20551-030, Brazil
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Moura-Neto JA, Moura AF, Suassuna JHR, Araújo NC. Determinants of the serial changes in measurements of renal allograft Doppler resistive index in the first postoperative month. ACTA ACUST UNITED AC 2021; 42:461-466. [PMID: 32459281 PMCID: PMC7860640 DOI: 10.1590/2175-8239-jbn-2018-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/01/2020] [Indexed: 12/23/2022]
Abstract
Introduction: The role of single Doppler-derived renal resistive index (RI) in renal allograft management is still a controversial issue, however detection of changes in serial duplex scanning has been reported as more valuable. This study aimed to test the hypothesis that early change in RI following transplantation may be related to factors associated with delayed graft function (DGF). Material and methods: 113 patients were included, in whom two RI measurements were performed within 30 days post-transplant. According to an RI change (equal to or more than 10%) in the second measurement, patients were assigned to decrease (Group I), no change (Group II), or increase (Group III) group. Results: 30 subjects had a decrease, 55 had no change, and 28 had an increase in the second RI measurement. The donors were younger in Group III in comparison to Group II. In comparison to Group I, Group III had a higher frequency of deceased donor, DGF, and presence of tubular necrosis and tubular vacuolization in peri-implantation biopsies. Conclusion: the increase of RI during the first weeks of the postoperative period seems to be associated with DGF and with tubular necrosis / tubular vacuolization in peri-implantation biopsies, likely related to ischemia reperfusion injury.
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Affiliation(s)
- José A Moura-Neto
- Universidade do Estado do Rio de Janeiro, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil.,Grupo CSB, Salvador, BA, Brasil
| | - Ana Flávia Moura
- Universidade do Estado do Rio de Janeiro, Divisão de Nefrologia, Rio de Janeiro, RJ, Brasil.,Grupo CSB, Salvador, BA, Brasil
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Jeong DS, He W, Shin MH, Choi NK. Resistive index as a predictor of early failure of kidney transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:55-59. [PMID: 35769409 PMCID: PMC9188929 DOI: 10.4285/jkstn.2019.33.3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Ultrasonography is a simple and noninvasive examination that can be easily performed after renal transplantation because of the lack of toxicity. The resistive index (RI) was measured using Doppler ultrasound at 7 days postoperatively in patients who underwent renal transplantation. The study aimed to determine the risk of graft loss and premature death within 1 year after transplantation. Methods This study was conducted from January 2011 to October 2017 and involved 97 patients who underwent renal transplantation at the Chosun University Hospital, Kwangju, Korea. Brain-dead donors were selected. Several parameters were assessed as recipient variables. In addition, postoperative delayed renal function and complications were examined. At 7 days after surgery, the RI was measured in all patients (the mean value of three measurements taken at different positions was used). Results Of the 97 patients, 40 had an RI of ≥0.8 or greater. Of these, four patients died, and a total of seven developed transplant failure. Logistic regression analysis was conducted to predict the risk of transplant failure and mortality based on complex influences of the relevant variables. The RI showed a relative risk value of 12.711 for transplant failure (P=0.003) and was significantly associated with mortality (P=0.001). Conclusions The RI was highly correlated with graft loss and recipient mortality after renal transplantation. Measurement of the RI after renal transplantation may lead to a more aggressive management of high-risk patients, and consequently improve the post-transplantation outcome.
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Affiliation(s)
- Dai Sik Jeong
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - WeiJie He
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Min Ho Shin
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam Kyu Choi
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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Preuss S, Rother C, Renders L, Wagenpfeil S, Büttner-Herold M, Slotta-Huspenina J, Holtzmann C, Kuechle C, Heemann U, Stock KF. Sonography of the renal allograft: Correlation between doppler sonographic resistance index (RI) and histopathology. Clin Hemorheol Microcirc 2019; 70:413-422. [PMID: 30562894 DOI: 10.3233/ch-189306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Allograft rejection (AR), chronic allograft injury (CAI) and acute tubular necrosis (ATN) can lead to renal allograft dysfunction after kidney transplantation. Interstitial fibrosis/tubular atrophy (Banff classification 2005) describes chronic allograft injury with no specific etiology, thus explaining the common final endpoint of various (immunologic and non immunologic) etiologies. The aim of this study was to evaluate correlations between the Doppler sonographic RI-values and histopathological changes of renal allografts biopsies during rejection, acute tubular necrosis and chronic allograft injury as well as the influence of donor and recipient features on the intrarenal RI-values. METHODS 102 allograft biopsies and ultrasound reports of 69 patients with kidney transplantation performed at the hospital Klinikum rechts der Isar (Technische Universität München, Germany) between 2009 and 2013 were analyzed retrospectively (41 biopsies of living donors, 61 biopsies of deceased donors). Chronic allograft injury was described using the IFTA (interstitial fibrosis and tubular atrophy) or the ECAI score (extended chronic allograft injury score). The ECAI score was built out of the chronic histological lesions glomerulopathy, interstitial fibrosis, tubular atrophy and fibrous intimal thickening (cg + ci + ct + cv) of the BANFF scoring. RESULTS Intrarenal RI-values were significantly higher in patients with allograft rejection than without rejection (median 0,79 vs. 0,73; inter quartile range: 0,20 vs. 0,13; p = 0,018). The same was found for T-and non-T cell mediated rejection (median 0,78 vs. 0,73; inter quartile range 0,20 vs. 0,13; p = 0,039). There were no significant differences in the RI-values between the subtypes of T-cell mediated rejection (type IA-IIB). Furthermore, there were no significant differences of RI-values regarding antibody-mediated rejection (present vs. not present) or type of rejection (T-cell- vs. antibody mediated rejection). Patients with rejection and simultaneously chronic allograft injury showed significantly higher RI-values than patients with only chronic allograft injury. Analyses using the IFTA or the ECAI score showed comparable results (IFTA p = 0,043; Score p = 0,021). The intrarenal RI-value was neither able to detect chronic allograft injury nor to distinguish between acute tubular necrosis and rejection. The intrarenal RI-value showed a significant correlation with recipient age (p < 0,001) but not with donor features. CONCLUSION In summary, the intrarenal RI-value can indicate a rejection but gives no clear hint to acute tubular necrosis and cannot differentiate from it. Since patients with rejection can have normal RI-values, a biopsy should always be performed in case of suspected rejection. The intrarenal RI-value has no unambiguous validity to determine intrinsic values of the renal allograft, but should rather be understood and interpreted as a systemic parameter influenced by multiple factors.
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Affiliation(s)
- Stephanie Preuss
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Charlotte Rother
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Stefan Wagenpfeil
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (IMBEI), Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland, Germany
| | | | | | - Christopher Holtzmann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Claudius Kuechle
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Konrad Friedrich Stock
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
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Di Nicolò P, Granata A. Renal intraparenchymal resistive index: the ultrasonographic answer to many clinical questions. J Nephrol 2018; 32:527-538. [PMID: 30539416 DOI: 10.1007/s40620-018-00567-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
The use of renal resistive indices (RRIs) for the study of renal microcirculation has in the past been proposed for the identification of renal organ damage or even to specifically identify injury to some areas of the renal parenchyma. Nevertheless, according to the most recent evidences from literature this organ-based conception of RRIs has been proven to be partial and unable to explain the RRIs variations in clinical settings of sepsis or combined organ failure of primitively extrarenal origin or, more generally, the deep connection between RRIs and hemodynamic factors such as compliance and pulsatility of the large vessels. The aim of this review is to explain the physiopathological basis of RRIs determination and the most common interpretative errors in their analysis. Moreover, through a comprehensive vision of these Doppler indices, the traditional and emerging clinical application fields for RRIs are discussed.
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Affiliation(s)
- Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, "S. Maria della Scaletta" Hospital, Via Montericco n. 4, 40026, Imola, BO, Italy.
| | - Antonio Granata
- Nephrology and Dialysis Unit, "S. Giovanni di Dio" Hospital, Agrigento, Italy
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Merkus JWS, Hilbrands LB, Hoitsma AJ, van Asten WNJC, Koene RAP, Skotnicki SH. Haemodynamic changes in human kidney allografts following administration of nifedipine: assessment with doppler spectrum analysis. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meier M, Fricke L, Eikenbusch K, Smith E, Kramer J, Lehnert H, Nitschke M. The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1607-1615. [PMID: 28370148 DOI: 10.7863/ultra.16.07032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Renal duplex sonography represents a standard noninvasive diagnostic procedure to demonstrate morphologic changes in acute kidney transplant dysfunction. We investigated whether a newly developed serial duplex index (SDI) can differentiate between acute cellular rejection and acute vascular rejection more effectively than the established Doppler parameters of the resistive index (RI) and pulsatility index (PI) in recently transplanted patients. METHODS Serial duplex scans of patients with histologically proven acute tubular necrosis (n = 25), acute cellular rejection (n = 28), acute vascular rejection (n = 18), and normal graft function (n = 50, partially protocol biopsied) were retrospectively analyzed. For each patient, the RI, PI, and cortex-pelvis proportion (CPP) were included from the day of biopsy (t0) and 3 to 7 days before biopsy (t-1). The sequential CPP ratio (CPPt0 /CPPt-1 ), RI ratio (RIt0 /RIt-1 ), and PI ratio (PIt0 /Pit-1 ) were determined. The SDI was calculated as: RI ratio × PI ratio/CPP ratio. The diagnostic accuracy of the SDI was compared with that of the RI and PI ratios. RESULTS Selected groups were statistically comparable in all routinely determined transplant parameters. The SDI was significantly different between patients with normal graft function, acute cellular rejection, and acute vascular rejection (P < .01, analysis of variance on ranks), whereas the RI and PI ratios were only significantly different between patients with normal graft function and acute vascular rejection (P < .05, analysis of variance on ranks). The indices' ranges were defined by the 95% confidence intervals between the allograft functions. CONCLUSIONS The developed SDI was able to detect acute renal transplant rejection with greater sensitivity and specificity than the RI and PI ratios. Since the SDI distinguishes between acute tubular necrosis, acute cellular rejection, and acute vascular rejection, it might be a supportive tool to indicate renal biopsy.
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Affiliation(s)
- Markus Meier
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Lutz Fricke
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
- Nephrology Center of Reinbek and Geesthacht, Reinbek, Germany
| | - Katrin Eikenbusch
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Emma Smith
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Jan Kramer
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
- LADR Zentrallabor Dr Kramer & Kollegen, Geesthacht, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Martin Nitschke
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
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Mallek R, Mostbeck GH, Kain R, Sunder-Plassmann G, Helbich T, Tscholakoff D. Polyetiology of Renal Allograft Dysfunction. Acta Radiol 2016. [DOI: 10.1177/028418519203300511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 101 consecutive patients with renal allograft dysfunction a correlation of Duplex Doppler sonography (DDS) with histopathologic reports of simultaneously performed biopsies was made. Renal vascular impedance was estimated by calculating the resistive index (RI). A total of 290 different specific histologic diagnoses (mean 2.1 ± 0.84 diagnoses/biopsy) was noted. With increasing time interval to transplantation, single diagnoses as cause of allograft dysfunction decreased. DDS could not reliably differentiate, exclude, or grade any of the common causes of renal allograft dysfunction like vascular and/or cellular rejection, chronic rejection, acute tubular necrosis, cyclosporin nephrotoxicity, relapse of glomerulonephritis and infection. Follow-up studies after established histologic diagnosis in 19 patients with persisting allograft dysfunction demonstrated a lack of sensitivity of DDS to significant superimposed causes of transplant malfunction. We conclude that biopsy is still necessary to direct proper therapy of renal allograft dysfunction.
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11
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Sung CK, Lee KH, Kim SH. Evaluation of factors influencing arterial Doppler waveforms in an in vitro flow phantom. Ultrasonography 2016; 36:39-52. [PMID: 27784154 PMCID: PMC5207360 DOI: 10.14366/usg.15055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to investigate factors that influence arterial Doppler waveforms in an in vitro phantom to provide a more accurate and comprehensive explanation of the Doppler signal. Methods A flow model was created using a pulsatile artificial heart, rubber or polyethylene tubes, a water tank, and a glass tube. Spectral Doppler tracings were obtained in multiple combinations of compliance, resistance, and pulse rate. Peak systolic velocity, minimum diastolic velocity, resistive index (RI), pulsatility index, early systolic acceleration time, and acceleration index were measured. On the basis of these measurements, the influences of the variables on the Doppler waveforms were analyzed. Results With increasing distal resistance, the RI increased in a relatively linear relationship. With increasing proximal resistance, the RI decreased. The pulsus tardus and parvus phenomenon was observed with a small acceleration index in the model with a higher grade of stenosis. An increase in the distal resistance masked the pulsus tardus and parvus phenomenon by increasing the acceleration index. Although this phenomenon occurred independently of compliance, changes in the compliance of proximal or distal tubes caused significant changes in the Doppler waveform. There was a reverse relationship between the RI and the pulse rate. Conclusion Resistance and compliance can alter the Doppler waveforms independently. The pulse rate is an extrinsic factor that also influences the RI. The compliance and distal resistance, as well as proximal resistance, influence the pulsus tardus and parvus phenomenon.
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Affiliation(s)
- Chang Kyu Sung
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Hyup Kim
- Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Determinant Variables of Resistive Index in Early Renal Transplant Recipients. Transplant Proc 2016; 48:1955-61. [DOI: 10.1016/j.transproceed.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
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Yang C, Hu M, Zhu T, He W. Evaluation of kidney allograft status using novel ultrasonic technologies. Asian J Urol 2015; 2:142-150. [PMID: 29264134 PMCID: PMC5730712 DOI: 10.1016/j.ajur.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 01/26/2023] Open
Abstract
Early diagnosis of kidney allograft injury contributes to proper decisions regarding treatment strategy and promotes the long-term survival of both the recipients and the allografts. Although biopsy remains the gold standard, non-invasive methods of kidney allograft evaluation are required for clinical practice. Recently, novel ultrasonic technologies have been applied in the evaluation and diagnosis of kidney allograft status, including tissue elasticity quantification using acoustic radiation force impulse (ARFI) and contrast-enhanced ultrasonography (CEUS). In this review, we discuss current opinions on the application of ARFI and CEUS for evaluating kidney allograft function and their possible influencing factors, advantages and limitations. We also compare these two technologies with other non-invasive diagnostic methods, including nuclear medicine and radiology. While the role of novel non-invasive ultrasonic technologies in the assessment of kidney allografts requires further investigation, the use of such technologies remains highly promising.
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Affiliation(s)
- Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Mushuang Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Imaging Medicine, Shanghai, China
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Comparison of Renal Transplant Scintigraphy With Renal Resistance Index for Prediction of Early Graft Dysfunction and Evaluation of Acute Tubular Necrosis and Acute Rejection. Clin Nucl Med 2013; 38:931-5. [DOI: 10.1097/rlu.0000000000000271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Performance of Polymerase Chain Reaction Techniques Detecting Granzyme B in the Diagnosis of Acute Renal Rejection. Transplantation 2013; 95:1105-12. [DOI: 10.1097/tp.0b013e318287d818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Ultrasonography Parameters and Histopathology Findings in Transplanted Kidney. Transplant Proc 2013; 45:1630-4. [DOI: 10.1016/j.transproceed.2013.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/15/2013] [Indexed: 11/22/2022]
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17
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Schnell D, Darmon M. Renal Doppler to assess renal perfusion in the critically ill: a reappraisal. Intensive Care Med 2012; 38:1751-60. [DOI: 10.1007/s00134-012-2692-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/20/2012] [Indexed: 01/20/2023]
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18
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Shang Y, Ju W, Kong Y, Schroder PM, Liang W, Ling X, Guo Z, He X. Performance of polymerase chain reaction techniques detecting perforin in the diagnosis of acute renal rejection: a meta-analysis. PLoS One 2012; 7:e39610. [PMID: 22768097 PMCID: PMC3387236 DOI: 10.1371/journal.pone.0039610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 05/23/2012] [Indexed: 11/18/2022] Open
Abstract
Background Studies in the past have shown that perforin expression is up-regulated during acute renal rejection, which provided hopes for a non-invasive and reliable diagnostic method to identify acute rejection. However, a systematic assessment of the value of perforin as a diagnostic marker of acute renal rejection has not been performed. We conducted this meta-analysis to document the diagnostic performance of perforin mRNA detection and to identify potential variables that may affect the performance. Methodology/Principal Findings Relevant materials that reported the diagnostic performance of perforin mRNA detection in acute renal rejection patients were extracted from electronic databases. After careful evaluation of the studies included in this analysis, the numbers of true positive, true negative, false positive and false negative cases of acute renal rejection identified by perforin mRNA detection were gathered from each data set. The publication year, sample origin, mRNA quantification method and housekeeping gene were also extracted as potential confounding variables. Fourteen studies with a total of 501 renal transplant subjects were included in this meta-analysis. The overall performance of perforin mRNA detection was: pooled sensitivity, 0.83 (95% confidence interval: 0.78 to 0.88); pooled specificity, 0.86 (95% confidence interval: 0.82 to 0.90); diagnostic odds ratio, 28.79 (95% confidence interval: 16.26 to 50.97); and area under the summary receiver operating characteristic curves value, 0.9107±0.0174. The univariate analysis of potential variables showed some changes in the diagnostic performance, but none of the differences reached statistical significance. Conclusions/Significance Despite inter-study variability, the test performance of perforin mRNA detected by polymerase chain reaction was consistent under circumstances of methodological changes and demonstrated both sensitivity and specificity in detecting acute renal rejection. These results suggest a great diagnostic potential for perforin mRNA detection as a reliable marker of acute rejection in renal allograft recipients.
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Affiliation(s)
- Yushu Shang
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Kong
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Paul M. Schroder
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine, Toledo, Ohio, United States of America
| | - Wenhua Liang
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoting Ling
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (ZG); (XH)
| | - Xiaoshun He
- Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (ZG); (XH)
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McArthur C, Geddes CC, Baxter GM. Early Measurement of Pulsatility and Resistive Indexes: Correlation with Long-term Renal Transplant Function. Radiology 2011; 259:278-85. [DOI: 10.1148/radiol.10101329] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival. World J Urol 2011; 29:547-53. [DOI: 10.1007/s00345-011-0666-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022] Open
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Sutherland T, Temple F, Chang S, Hennessy O, Lee WK. Sonographic evaluation of renal transplant complications. J Med Imaging Radiat Oncol 2010; 54:211-8. [DOI: 10.1111/j.1754-9485.2010.02161.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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22
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Role of resistive index measurement in diagnosis of acute rejection episodes following successful kidney transplantation. Transplant Proc 2010; 41:2805-7. [PMID: 19765440 DOI: 10.1016/j.transproceed.2009.07.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was performed to evaluate the role of resistive index (RI) in the diagnosis of rejection episodes following successful kidney transplantation. MATERIALS AND METHODS One hundred and one unrelated living first kidney allograft adult recipients (75 males and 26 females) of overall mean age of 39 years were enrolled and prospectively followed for 6 months. The measurement of RI by Doppler ultrasonography was performed in all patients on days 3 and 7 as well as at months 1, 3, and 6 in addition to when there was graft dysfunction. We determined serum creatinine and cyclosporine levels. RESULTS Twenty-seven patients (26.7%) experienced 33 acute rejection episodes during the follow-up. There were significant differences between mean RI among patients with normal function vs rejection: 0.606 +/- 0.065 vs 0.866 +/- 0.083 (P < .05), respectively. Overall, elevated levels of cyclosporine, ischemic acute tubular necrosis (ATN), and renal artery thrombosis were observed in 8, 5, and 3 patients, respectively. No association was observed between these factors and RI. CONCLUSIONS RI was significantly higher in patients with acute rejection episodes. It had no association with ATN or cyclosporine toxicity. Hence, RI may be useful to diagnose acute renal allograft rejection following renal transplantation.
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Darmon M, Schnell D, Zeni F. Doppler-Based Renal Resistive Index: A Comprehensive Review. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Umgelter A, Reindl W, Franzen M, Lenhardt C, Huber W, Schmid RM. Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites. Intensive Care Med 2008; 35:152-6. [DOI: 10.1007/s00134-008-1253-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 08/17/2008] [Indexed: 12/31/2022]
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25
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Nezami N, Tarzamni M, Argani H, Nourifar M. Doppler Ultrasonographic Indices After Renal Transplantation as Renal Function Predictors. Transplant Proc 2008; 40:94-9. [DOI: 10.1016/j.transproceed.2007.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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26
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Mahmoud K, Opelz G, Pelzl S, Daniel V, Sommerer C, Zeier M, Schmidt J, Schönemann C, Schnülle P, Süsal C. Evaluation of hepatocyte growth factor as a sensitive marker for early detection of acute renal allograft rejection. Transplantation 2007; 83:1035-40. [PMID: 17452892 DOI: 10.1097/01.tp.0000259653.41436.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been shown that hepatocyte growth factor (HGF), besides its well-established hepatotrophic effect in liver regeneration, is involved in the regeneration of the kidney after injury. In the present study we investigated whether HGF can serve as a marker for detection of acute rejection in the early posttransplantation period. METHODS HGF levels were determined in pre- and posttransplant sera (up to day 21) of 26 recipients with biopsy-proven acute rejection, 30 recipients with acute tubular necrosis (ATN), and 32 recipients without posttransplant complications. RESULTS Although no association was found between pretransplant HGF and death-censored functional graft survival, receiver operating characteristic (ROC) curves demonstrated that HGF measured during the entire posttransplant study period, and especially on days 3 to 5, was a good marker for differentiating recipients who subsequently developed acute rejection from recipients with an uncomplicated course (P<0.0001, specificity 87%, sensitivity 84%). HGF measured from day 3 until day 21 posttransplantation, and especially on days 7 to 9, was also a sensitive marker for differentiating recipients with ATN from recipients with an uncomplicated course (P<0.0001). If considered in combination with sCD30, the diagnostic value of HGF was further improved. While 73% of samples from patients with impending rejection were positive for both HGF and sCD30, 94% of samples from nonrejecting patients were double-negative and none of the samples from this group fell into the double-positive category (P<0.0001). CONCLUSIONS Our data suggest that HGF measured during the early posttransplant period might be a useful parameter for early detection of acute renal allograft rejection.
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Affiliation(s)
- Khaled Mahmoud
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany
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Park SB, Kim JK, Cho KS. Complications of renal transplantation: ultrasonographic evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:615-33. [PMID: 17460004 DOI: 10.7863/jum.2007.26.5.615] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the ultrasonographic findings of complications of renal transplantation. METHODS We reviewed the ultrasonographic findings of complications of renal transplantation, including urologic complications, fluid collections, graft dysfunction, vascular complications, neoplasms, and recurrent native renal disease. RESULTS Specific ultrasonographic features of complications of renal transplantation have been illustrated. CONCLUSIONS Familiarity with the clinical setting and the appearance of potential renal transplant complications as depicted with the most commonly used modality, ultrasonography, will facilitate prompt, accurate diagnosis and treatment.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
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Saracino A, Santarsia G, Latorraca A, Gaudiano V. Early assessment of renal resistance index after kidney transplant can help predict long-term renal function. Nephrol Dial Transplant 2006; 21:2916-20. [PMID: 16891640 DOI: 10.1093/ndt/gfl203] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Color Doppler ultrasonography of intrarenal arterial resistance index (RI), performed early after kidney transplant, has proven to reliably predict short-term allograft function. The aim of this study was to assess whether it could also predict long-term renal function. METHODS We retrospectively analysed 76 kidney transplant patients who underwent RI assessment within 1 month after the transplant, subdivided into two groups according to RI values, lower (group A) or higher (group B) than its median value (0.635). RESULTS Compared with group A subjects, the patients of group B were older at the time of transplant (42 +/- 9 vs 35 +/- 8 years; P = 0.001), the donor age was also older (41 +/- 16 vs 33 +/- 13 years; P = 0.02) and had a slightly higher proteinuria (0.54 +/- 0.5 vs 0.32 +/- 0.2 g/24 h; P = 0.02). Serum creatinine, ciclosporin or tacrolimus trough level, arterial blood pressure, number of human leukocyte antigen (HLA) mismatches, anti-hypertensive medications and incidence of delayed graft function were not significantly different between the two groups. By univariate analysis, RI turned out to directly correlate with the recipient age, donor age and daily proteinuria (P = 0.007, P = 0.0007 and P = 0.02, respectively). Multivariate analysis showed that only donor and recipient age maintained their independent predictive value on RI. Kaplan-Meier analysis, considering a serum creatinine increase >50% as the endpoint of the study, showed a statistically significant different graft survival in the two groups (log-rank test = 5.489; P = 0.01). The univariate relative risk of deterioration of graft function among patients with higher RI was 3.77. Proteinuria and recipient age increased the risk as well. CONCLUSIONS Our data seem to suggest that early determination of RI can help predict long-term graft function in kidney transplant recipients.
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Affiliation(s)
- Angelo Saracino
- Centro Regionale Trapianti, Ospedale Madonna delle Grazie, Contrada cattedra ambulante, 75100 Matera, Italy.
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Schwenger V, Hinkel UP, Nahm AM, Morath C, Zeier M. Color Doppler Ultrasonography in the Diagnostic Evaluation of Renal Allografts. ACTA ACUST UNITED AC 2006; 104:c107-12. [PMID: 16837783 DOI: 10.1159/000094445] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Color Doppler ultrasonography of large allograft vessels and renal parenchyma is established firmly in the diagnosis of renal allograft perfusion. While conventional color Doppler ultrasonography has proven itself to be an indispensable, rapid, highly valid and practicable method, e.g. in the diagnosis of allograft artery stenosis or allograft vein thrombosis, the diagnostic usefulness of this method with regard to allograft perfusion is considerably limited. With contrast-enhanced sonography, a simple and readily implementable method that enables the early diagnosis of chronic allograft nephropathy is now available. The timely diagnosis of vascular damage prior to a rise in S-creatinine offers the possibility of early therapeutic intervention and thus at least the potential for the improvement of allograft survival.
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Affiliation(s)
- Vedat Schwenger
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany.
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Datta R, Sandhu M, Saxena AK, Sud K, Minz M, Suri S. Role of duplex Doppler and power Doppler sonography in transplanted kidneys with acute renal parenchymal dysfunction. ACTA ACUST UNITED AC 2005; 49:15-20. [PMID: 15727604 DOI: 10.1111/j.1440-1673.2005.01350.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The limited work published on the comparison of power Doppler sonography (PDS) and duplex Doppler sonography (DDS) in the assessment of acute renal allograft dysfunction has shown contradictory results. We compared the role of DDS and PDS in renal transplant recipients developing acute renal parenchymal dysfunction and correlated these findings with kidney biopsy, which was taken as the gold standard. Thirty post-renal transplant patients with acute graft dysfunction underwent Doppler sonography, DDS and PDS using an HDI 5000 ATL machine. Patients who developed graft dysfunction as a result of vascular, obstructive or other non-parenchymal causes were excluded. All patients underwent an allograft biopsy within 72 h of the sonography. Based on the biopsy findings, 24 patients were categorized as having acute rejection, and six patients as having no rejection. The overall sensitivity, specificity and accuracy of DDS for evaluation of graft dysfunction were 54.17, 33.33, and 50.00%, respectively, and that for PDS were superior with 87.50, 33.30, and 76.67%, respectively. The low specificity can be partially attributed to the small number of cases without rejection in our study population. We conclude that PDS is superior to DDS in screening patients with acute parenchymal renal dysfunction post-transplant. However, a normal PDS examination does not exclude the presence of acute rejection. Power Doppler sonography is a useful screening test for diagnosing acute rejection but a renal allograft biopsy remains the gold standard for diagnosis of this condition.
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Affiliation(s)
- R Datta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160-012, India
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31
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McNamara MM, Lockhart ME, Robbin ML. Emergency Doppler evaluation of the liver and kidneys. Radiol Clin North Am 2004; 42:397-415. [PMID: 15136024 DOI: 10.1016/j.rcl.2003.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Doppler ultrasound is useful in the emergent evaluation of the liver and kidney transplant patient. Arterial stenosis, pseudoaneurysm, and venous thrombosis are treatable causes of allograft failure that can be detected easily with color and spectral Doppler. Doppler has a limited but important role in the emergent evaluation of the native liver and kidneys, usually involving prior biopsy or instrumentation.
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Affiliation(s)
- Michelle M McNamara
- Abdominal Imaging Section, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 353, Birmingham, AL 35249-6830, USA.
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King BF, Torres VE, Brummer ME, Chapman AB, Bae KT, Glockner JF, Arya K, Felmlee JP, Grantham JJ, Guay-Woodford LM, Bennett WM, Klahr S, Hirschman GH, Kimmel PL, Thompson PA, Miller JP. Magnetic resonance measurements of renal blood flow as a marker of disease severity in autosomal-dominant polycystic kidney disease11Thomas Andreoli, M.D., served as Guest Editor for this paper. Kidney Int 2003; 64:2214-21. [PMID: 14633145 DOI: 10.1046/j.1523-1755.2003.00326.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Autosomal-dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal cyst growth, early development of hypertension, and late occurrence of renal insufficiency. Despite evidence for the importance of nephroangiosclerosis in the progression of renal insufficiency in ADPKD, evaluation of renal blood flow (RBF) as a surrogate marker of disease severity has received little attention. METHODS Flow phantoms and repeat RBF measurements assessed accuracy and reproducibility. One hundred twenty-seven ADPKD subjects with creatinine clearances >70 mL/min underwent measurements of RBF, total, and cyst renal volumes, and % cyst volumes by magnetic resonance (MR) and of glomerular filtration rate (GFR). Renal vascular resistance (RVR) was calculated. MR blood flow sequences utilized a two-dimensional cine phase-contrast breath-hold pulse sequence perpendicular to the renal arteries. Flow rates were calculated utilizing FLOW software. Volumetric analysis was performed using stereology and region-based thresholding. RESULTS Excellent accuracy and intraobserver and interobserver reproducibility were demonstrated. Anatomic (total kidney volume, total cyst volume, and % cyst volume), hemodynamic (RBF and RVR), and functional (GFR) parameters were strongly correlated. Left polycystic kidneys were larger and had more severe disease. Regression analysis showed that age, diagnosis of hypertension, anatomic parameters and hemodynamic parameters were significant predictors of GFR. Multiple linear regression analysis identified age and hemodynamic parameters only as separate predictors of GFR. Anatomic, hemodynamic, and functional parameters discriminated between normotensive and hypertensive subjects despite antihypertensive treatments. CONCLUSION Renal hemodynamic parameters measured by MR correlate with anatomic and functional indices of disease severity, are the strongest predictors of renal function, and deserve further consideration as an outcome measure in clinical trials to guide therapy in ADPKD.
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Affiliation(s)
- Bernard F King
- Department of Medicine (Renal Division), University of Alabama, Birmingham, Alabama, USA
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Halling KB, Graham JP, Newell SP, Ellison GW, Detrisac CJ, Martin FG, VanGilder JM, Grossman D. SONOGRAPHIC AND SCINTIGRAPHIC EVALUATION OF ACUTE RENAL ALLOGRAFT REJECTION IN CATS. Vet Radiol Ultrasound 2003; 44:707-13. [PMID: 14703255 DOI: 10.1111/j.1740-8261.2003.tb00535.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The sonographic features of acute renal allograft rejection in humans and dogs are manifested by increase in renal cross-sectional area and reduction in renal cortical blood flow. These changes have not been investigated in cats. The objectives of this study were to evaluate sonographic and scintigraphic changes during acute renal allograft rejection in cats. Eight SPF, intact, adult, male cats received heterotopic renal allotransplantations. Immunosuppressive doses of cyclosporine and prednisolone were administered for 14 days and then discontinued to allow acute allograft rejection to occur. Serial measurements of renal cross-sectional area, resistive index (RI), echogenicity, and glomerular filtration rate (GFR) were performed to evaluate changes during acute rejection. Upon sonographic confirmation of absent diastolic blood flow or a 20% increase in cross-sectional area of the allograft, a nephrectomy and histopathologic evaluation were performed. Acute allograft rejection was confirmed histologically in all cats. Significant increases in renal cross-sectional area (P < 0.001) occurred postoperatively and during rejection. There were no significant changes in RI (P = 0.43) at any time. A subjective increase in medullary echogenicity and a decrease in corticomedullary demarcation were observed in the rejection period. While GFR decreased significantly in the immediate postoperative period (P < 0.001), no further change occurred during rejection (P = 0.42). Changes in RI and GFR do not appear to be sensitive indicators of acute renal allograft rejection in cats. Serial measurements of renal cross-sectional area appear to be a sensitive method for the early diagnosis of allograft rejection in feline renal transplant recipients.
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Affiliation(s)
- Krista B Halling
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Dupont PJ, Dooldeniya M, Cook T, Warrens AN. Role of duplex Doppler sonography in diagnosis of acute allograft dysfunction-time to stop measuring the resistive index? Transpl Int 2003. [DOI: 10.1111/j.1432-2277.2003.tb00365.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Simon T, Opelz G, Wiesel M, Ott RC, Süsal C. Serial peripheral blood perforin and granzyme B gene expression measurements for prediction of acute rejection in kidney graft recipients. Am J Transplant 2003; 3:1121-7. [PMID: 12919092 DOI: 10.1034/j.1600-6143.2003.00187.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the present study we investigated whether peripheral blood gene expression measurements may serve as an early and non-invasive tool to predict renal allograft rejection. Peripheral blood was collected twice weekly after transplantation and gene expression was measured using real-time polymerase chain reaction (PCR). Recipients with acute rejection (n = 17) had higher levels of perforin and granzyme B transcript on days 5-7, 8-10, 11-13, 17-19, 20-22, and 26-29, as compared to patients without rejection (n = 50, p < 0.05 in all cases). Rejection diagnosis using gene expression criteria, determined with receiver operating characteristic (ROC) curves, was possible 2-30 days before traditional diagnosis (median 11 days). The best diagnostic result was obtained from samples taken on days 8-10, with a specificity of 90% and a sensitivity of 82% for perforin, and a specificity of 87% and sensitivity of 72% for granzyme B. Decreases in perforin (p < 0.01) and granzyme B expression (p < 0.05) were observed after initiation of anti-rejection therapy. Our data indicate that gene expression measurement is a useful tool for the recognition of graft rejection in its earliest stages. Serial measurements could be implemented as a monitoring system to highlight patients at higher risk of rejection, making them candidates for biopsy or pre-emptive anti-rejection therapy.
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Affiliation(s)
- Tania Simon
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, D-69120 Heidelberg, Germany
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Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 2003; 180:885-92. [PMID: 12646425 DOI: 10.2214/ajr.180.4.1800885] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mitchell E Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213, USA
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Abstract
The emerging field of contrast ultrasound has great and untapped potential. Improved vascular enhancement may increase the number and type of diagnostic vascular examinations. Improved vessel depiction may increase examination speed and improve patient throughput. New gray-scale contrast imaging techniques may substantially increase the sonographic detection and characterization of liver, kidney, and other focal parenchymal masses. Contrast ultrasound examinations may increase diagnostic confidence, decrease nondiagnostic studies, and decrease the requirement for additional imaging studies. Further investigation is needed, however, to determine the diagnostic use and cost-effectiveness of this new approach relative to CT, MR imaging, angiography, and conventional ultrasound imaging.
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Affiliation(s)
- M L Robbin
- Department of Radiology, University of Alabama at Birmingham, USA
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38
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Izumi M, Sugiura T, Nakamura H, Nagatoya K, Imai E, Hori M. Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound. Am J Kidney Dis 2000; 35:713-9. [PMID: 10739794 DOI: 10.1016/s0272-6386(00)70020-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute renal failure (ARF) is a life-threatening disease that often causes multiple organ dysfunction. The accurate and rapid diagnosis of the cause of ARF is particularly important for selecting the appropriate therapy. Ultrasound Doppler is a noninvasive diagnostic method that has recently been introduced to clinical nephrology. We report the diagnostic value of Doppler ultrasound in differentiating acute tubular necrosis (ATN) from prerenal azotemia by comparing this study with the fractional excretion of sodium (FENa), renal failure index (RFI), and urinary/serum creatinine (Cr) ratio. Doppler ultrasound was able to differentiate prerenal azotemia from ATN, equivalent to FENa, RFI, and the urinary/serum Cr ratio. Doppler ultrasound does not require blood or urine samples and can be performed at the bedside. Of note, Doppler is unaffected by changes in Na or Cr in urine or serum after diuretics or hemodialysis. Furthermore, one can predict recovery from ATN by Doppler findings. Thus, we consider Doppler ultrasound an effective diagnostic tool in ARF.
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Affiliation(s)
- M Izumi
- Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan.
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39
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Chandraker A. Diagnostic techniques in the work-up of renal allograft dysfunction--an update. Curr Opin Nephrol Hypertens 1999; 8:723-8. [PMID: 10630820 DOI: 10.1097/00041552-199911000-00013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After renal transplantation, acute allograft dysfunction secondary to acute rejection occurs in around 30-40% of patients. Although in the majority of patients these episodes are reversible, acute rejection remains a major risk factor for the development of chronic rejection. Remarkably, prior episodes of acute allograft rejection are associated with decreased allograft survival. Histologic examination of the percutaneous core needle transplant biopsy remains the gold standard for the diagnosis of acute rejection. It does, however, have a number of shortcomings, and less invasive procedures that could diagnose incipient rejection and simultaneously provide mechanistic information on the rejection process (allowing delivery of more tailored therapy) are being sought. To address these problems a number of alternative diagnostic procedures have been suggested, including duplex Doppler ultrasound assessment, fine-needle aspiration biopsy, urine cytology, urine cytokine analysis, serum cytokine analysis, and cytokine analysis of biopsy material.
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Affiliation(s)
- A Chandraker
- Renal Division, Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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40
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Tublin ME, Tessler FN, Murphy ME. Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology 1999; 213:258-64. [PMID: 10540669 DOI: 10.1148/radiology.213.1.r99oc19258] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the effect of acute changes in renal vascular resistance (RVR) and pulse pressure on the resistive index (RI) measured by using Doppler ultrasonography (US). MATERIALS AND METHODS Rabbit kidneys were perfused by using a pulsatile perfusion system in which RVR, systolic and diastolic pulse pressures, and pulse kinetics were controlled and monitored while simultaneously measuring the RI. RESULTS When RVR was increased fivefold with phenylephrine hydrochloride, the RI increased only slightly (from 0.45 at baseline up to 0.50). There was a virtually linear relationship between the RI and the pulse pressure index ([systolic pressure-diastolic pressure]/systolic pressure) in the range of 0.30-0.80. The RI was not affected by the pulse rate or fraction of time that systolic pressure was applied during the pulse cycle. CONCLUSION Contrary to conventional teaching, which is based on theoretic considerations, the RI is not readily affected by acute changes in RVR. This indicates a need to reconsider the conventional explanations used to explain increases in RI that are frequently found in patients with renal disease or ureteral obstruction.
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Affiliation(s)
- M E Tublin
- Department of Radiology, Albany Medical College, NY 12208, USA.
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41
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Gottlieb RH, Voci SL, Cholewinski SP, Hartley DF, Rubens DJ, Orloff MS, Bronsther OL. Sonography: a useful tool to detect the mechanical causes of renal transplant dysfunction. JOURNAL OF CLINICAL ULTRASOUND : JCU 1999; 27:325-333. [PMID: 10395128 DOI: 10.1002/(sici)1097-0096(199907/08)27:6<325::aid-jcu3>3.0.co;2-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the utility of sonography in distinguishing between mechanical and nonmechanical causes for renal transplant dysfunction. METHODS We reviewed all ultrasound examination reports (n = 286) for 63 consecutive patients who received 64 renal transplants. We assessed the sensitivity and specificity of different degrees of hydronephrosis (mild, moderate, or severe) in detecting urinary tract obstruction; different volumes of new or increasing peritransplant fluid in detecting urine leaks; different total volumes of peritransplant fluid in predicting significant compression of the transplant; and Doppler vascular criteria for predicting arterial and venous occlusion. RESULTS All mechanical complications were detected (100% sensitivity) with specificities of 91.9% for ureteral obstruction (criterion, moderate hydronephrosis), 83.4% for urine leaks (criterion, any new fluid or any increase), 91.4% for fluid collections that compressed the transplant (criterion, > 100 ml), and 100% for vascular occlusion (criteria, no flow for arterial occlusion; no venous flow and reversal of arterial flow during diastole for venous occlusion). CONCLUSIONS Sonography is very useful in distinguishing between mechanical and nonmechanical causes for renal transplant dysfunction. It has high sensitivity and acceptable specificity in this setting.
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Affiliation(s)
- R H Gottlieb
- Department of Radiology, University of Rochester Medical Center, New York 14642, USA
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42
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Trillaud H, Merville P, Tran Le Linh P, Palussière J, Potaux L, Grenier N. Color Doppler sonography in early renal transplantation follow-up: resistive index measurements versus power Doppler sonography. AJR Am J Roentgenol 1998; 171:1611-5. [PMID: 9843297 DOI: 10.2214/ajr.171.6.9843297] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was designed to compare power Doppler images of perfusion with interlobar resistive index measurements obtained during the early monitoring of renal graft transplant to diagnose cortical perfusion abnormalities and assess prognosis. SUBJECTS AND METHODS Thirty-one patients underwent color Doppler sonography (4-7 MHz and 7-10 MHz) on day 6+/-2 after renal transplantation. Cortical vessel density was assessed visually and classified as either normal or decreased. Twelve months after transplantation, the results of power Doppler imaging and the levels of resistive index were reviewed in light of clinical and laboratory findings, graft biopsy results, and functional outcome. RESULTS No significant relationship was observed among power Doppler grades, levels of resistive index, and renal function. Power Doppler grades and resistive index levels failed to allow us to distinguish between tubulopathy and rejection. However, we found a statistically significant relationship between renal function at 12 months after transplantation and power Doppler grade (p = .04). CONCLUSION This study suggests that color Doppler sonography is insensitive in revealing and in allowing radiologists to differentiate the causes of graft dysfunction. However, power Doppler sonography allows a prediction of the functional recovery of the graft at 12 months after transplantation not provided by resistive index levels.
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Affiliation(s)
- H Trillaud
- Service de Radiologie, Groupe Hospitalier Pellegrin, Bordeaux, France
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43
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Licht C, Kriegesmann E, Minor T, Wingenfeld P, Isselhard W, Michalk DV. Influence of taurine supplementation on ischemic preservation of the isolated rat kidney. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1998; 442:201-6. [PMID: 9635033 DOI: 10.1007/978-1-4899-0117-0_26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- C Licht
- Department of Pediatrics, University of Cologne, Germany
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44
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Westenberg JJ, Wasser MN, van der Geest RJ, Pattynama PM, de Roos A, Vanderschoot J, Reiber JH. Variations in blood flow waveforms in stenotic renal arteries by 2D phase-contrast cine MRI. J Magn Reson Imaging 1998; 8:590-7. [PMID: 9626873 DOI: 10.1002/jmri.1880080312] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Waveform variations in blood flow measurements through stenotic renal arteries have been reported already with echo Doppler studies. We studied these variations with MRI in 14 patients (mean age, 60 years) with suspected renal arterial stenosis (24 patent arteries, four occluded). Flow measurements were successful in 15 arteries and unsuccessful in nine, due to practical limitations. Seven healthy younger volunteers (mean age, 28 years) and five healthy older volunteers (mean age, 58 years) were recruited for comparison purposes. In patients, the severity of stenoses was also assessed by digital subtraction angiography and intraarterially measured transstenotic pressure drops. We found flow patterns to be statistically significantly (P < 0.01) age-related. Younger healthy subjects showed shorter wave duration, higher diastolic flow, and total blood flow per minute. Also, with increasing stenosis severity, the systolic wave became more damped and the systolic wave duration became statistically significantly (P = .03) longer.
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Affiliation(s)
- J J Westenberg
- Division of Image Processing, Leiden University Medical Centre, The Netherlands
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45
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Radermacher J, Meiners M, Bramlage C, Kliem V, Behrend M, Schlitt HJ, Pichlmayr R, Koch KM, Brunkhorst R. Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporin A versus FK 506. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00948.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Abstract
Power Doppler is a new method of ultrasound flow imaging the utility of which is currently under investigation. This technique creates a flow map based on the integrated power of the Doppler spectrum, rather than mean Doppler frequency. Power Doppler imaging is inherently more sensitive in terms of flow detection than standard color Doppler imaging; therefore, power Doppler can display flow for situations in which color Doppler is ineffective and can even display tissue perfusion in highly vascular organs such as the kidneys. Furthermore, power Doppler is not effected by aliasing, nor is it effected by blooming in the same way as color Doppler, which has deleterious effects on color Doppler flow images. The control of blooming with power Doppler may be of great importance in the clinical application of echo-enhancing agents. This review article discusses in detail the technological advantages and disadvantages of power Doppler flow imaging. In addition, it provides a synopsis of the preliminary research studies that have been conducted to date with respect to the clinical applications of power Doppler.
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Affiliation(s)
- K J Murphy
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, USA
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47
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Nyland TG, Fisher PE, Gregory CR, Wisner ER. Ultrasonographic evaluation of renal size in dogs with acute allograft rejection. Vet Radiol Ultrasound 1997; 38:55-61. [PMID: 9238772 DOI: 10.1111/j.1740-8261.1997.tb01604.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study was to determine the best method to ultrasonographically monitor renal size changes associated with acute allograft rejection in dogs. Qualitative changes in renal cortical and medullary echogenicity were also evaluated, although this was not a major focus of the study. Four unrelated, mixed-breed dogs underwent bilateral nephrectomies and heterotopic renal allograft transplantation. Ultrasound examinations of transplanted kidneys were initiated at 3 days after surgery and continued at 2-3 day intervals until death (38 +/- 2 days). Ultrasound measurements of kidney length, width, height, cross-sectional area, and estimated volume were used to assess relative changes in renal size associated with transplantation and rejection. Transplanted kidneys had a rapid increase in volume and cross-sectional area that averaged 103% and 83% above baseline levels, respectively, by 17 days after transplantation. The increased size was attributed to a combination of hypertrophy and acute rejection, the latter of which was confirmed at postmortem. Kidney volume decreased to approximately 35% above baseline volume by day 34 as rejection became more advanced. Qualitative changes associated with rejection included medullary enlargement with decreased echogenicity early in the study, followed by increased cortical thickness and echogenicity with poor cortical medullary definition in the latter stages of the survival period. It was concluded that relative changes in renal allograft size can be easily monitored with ultrasound. In regard to linear measurements, changes in renal width were more pronounced than changes in height or length with acute rejection. Therefore measurements that incorporate the width, namely volume or cross-sectional area, appear to be the most sensitive for monitoring changes in allograft size. Renal cross-sectional area measurements are preferred because they are simple to perform using the automated calculation capability of most newer ultrasound units.
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Affiliation(s)
- T G Nyland
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, USA
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Hilborn MD, Bude RO, Murphy KJ, Platt JF, Rubin JM. Renal transplant evaluation with power Doppler sonography. Br J Radiol 1997; 70:39-42. [PMID: 9059293 DOI: 10.1259/bjr.70.829.9059293] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study was performed to determine if the marked variation we had previously noted in the power Doppler sonographic appearance of renal transplants correlated with disease, 22 renal transplants were scanned with power Doppler at 5 MHz, with biopsies being taken within 1 h in 17 kidneys and within 48 h in four other kidneys. Biopsy was not performed in one kidney with distal ureteral obstruction. Biopsy results were complex with many coexistent abnormalities; classification was based upon the predominant abnormality. Cortical vascularity was subjectively evaluated as normal, decreased or markedly decreased, and graded as 0, 1 or 2, respectively, and was compared with biopsy results, serum creatinine levels and resistive index. Cortical vascularity gradings were: 0 (12 cases); 1 (7 cases); and 2 (3 cases). The large number of disease categories (cellular rejection, 11 cases; vascular rejection, 5 cases; IgA nephropathy, 1 case; cyclosporin toxicity, 3 cases; obstruction, 1 case; and lupus nephropathy, 1 case) in relation to the number of vascular grades and number of kidneys precluded statistical analysis of cortical vascularity for rejection. However, vascularity did not appear to correlate with rejection, the three severest cases of vascular rejection having normal (grade 0) vascularity. There was no statistically significant correlation of vascular grade with creatinine levels or resistive index. In conclusion, subjective analysis of the power Doppler sonographic appearance of renal transplants does not appear to aid in their evaluation.
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Affiliation(s)
- M D Hilborn
- Department of Radiology, University of Michigan, Ann Arbor 48109-0326, USA
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Rivolta R, Mascagni B, Berruti V, Quarto Di Palo F, Elli A, Scorza R, Castagnone D. Renal vascular damage in systemic sclerosis patients without clinical evidence of nephropathy. ARTHRITIS AND RHEUMATISM 1996; 39:1030-4. [PMID: 8651967 DOI: 10.1002/art.1780390622] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the use of color-flow Doppler ultrasonography, a direct, noninvasive technique, for measurement of kidney blood flow in patients with systemic sclerosis (SSc). METHODS Twenty-five normal volunteers and 25 SSc patients (median disease duration 8 years, range 2-21 years) were studied. All were free of clinical symptoms of renal damage. The resistance index (RI) was determined on main, interlobar, and cortical vessels. RESULTS In SSc patients, the RI was significantly increased at every sampling site examined (P < 0.001). RI values were strongly correlated with disease duration (main artery r = 0.56, P < 0.04; interlobar artery r = 0.63, P < 0.02; cortical artery r = 0.75, P < 0.002). Regression analysis showed no relationship between RI and creatinine clearance values. CONCLUSION Color-flow Doppler ultrasonography is a sensitive and noninvasive technique for evaluating vascular damage of the kidney in patients with SSc.
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Affiliation(s)
- R Rivolta
- Ospedale Maggiore di Milano, Milan, Italy
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50
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Tublin ME, Dodd GD. SONOGRAPHY OF RENAL TRANSPLANTATION. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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