Renal Doppler Sonography – Update in Clinical Nephrology

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Abstract

These days renal Doppler sonography has been established as a diagnostic tool of the daily nephrological work-up. Extra- and intrarenal flow signals are obtained for different indications. The intrarenal resistive index is the best examined parameter in the literature. However, the results have to be carefully interpreted, because different hemodynamic factors, such as heart rate, stiffness of the aorta as well as observer-dependent factors may have an impact on the level of the resistive index. The value of this non-invasive technique is discussed in detail for different renal diseases, such as acute and chronic renal failure, renal artery stenosis and for patients after renal transplantation. Being aware of several pitfalls which may lead to false results, nephrologists may use renal Doppler sonography as the first screening method of choice in the diagnostic algorithm.

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Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.

J S Bleck, M Gebel, Sonal A Chavan … (2001)

Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys (indicated by resistance-index values of at least 80) can be used prospectively to select appropriate patients for treatment. We evaluated 5950 patients with hypertension for renal-artery stenosis using color Doppler ultrasonography, and we measured the resistance index ([1 - end-diastolic velocity divided by maximal systolic velocity] x 100). Among 138 patients who had unilateral or bilateral renal-artery stenosis of more than 50 percent of the luminal diameter and who underwent renal angioplasty or surgery, the procedure was technically successful in 131 (95 percent). Creatinine clearance and 24-hour ambulatory blood pressure were measured before renal-artery stenosis was corrected; 3, 6, and 12 months after the procedure; and yearly thereafter. The mean (+/-SD) duration of follow-up was 32+/-21 months. Among the 35 patients (27 percent) who had resistance-index values of at least 80 before revascularization, the mean arterial pressure did not decrease by 10 mm Hg or more after revascularization in 34 (97 percent). Renal function declined (defined by a decrease in the creatinine clearance; of at least 10 percent) in 28 (80 percent); 16 (46 percent) became dependent on dialysis and 10 (29 percent) died during follow-up. Among the 96 patients (73 percent) with a resistance-index value of less than 80, the mean arterial pressure decreased by at least 10 percent in all but 6 patients (6 percent) after revascularization; renal function worsened in only 3 (3 percent), all of whom became dependent on dialysis; and 3 (3 percent) died (P<0.001 for the comparison with patients with a resistance-index value of at least 80). A renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival.

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The renal arterial resistance index and renal allograft survival.

Janice Ellis, Michael Burg, Ute Eisenberger … (2003)

Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal arterial resistance index of less than 80 was predictive of long-term allograft survival. The renal segmental arterial resistance index (the percentage reduction of the end-diastolic flow as compared with the systolic flow) was measured by Doppler ultrasonography in 601 patients at least three months after transplantation between August 1997 and November 1998. All patients were followed for three or more years. The combined end point was a decrease of 50 percent or more in the creatinine clearance rate, allograft failure (indicated by the need for dialysis), or death. A total of 122 patients (20 percent) had a resistance index of 80 or higher. Eighty-four of these patients (69 percent) had a decrease of 50 percent or more in creatinine clearance, as compared with 56 of the 479 patients with a resistance index of less than 80 (12 percent); 57 patients with a higher resistance index (47 percent) required dialysis, as compared with 43 patients with a lower resistance index (9 percent); and 36 patients with a higher resistance index (30 percent) died, as compared with 33 patients with a lower resistance index (7 percent) (P<0.001 for all comparisons). A total of 107 patients with a higher resistance index (88 percent) reached the combined end point, as compared with 83 of those with a lower resistance index (17 percent, P<0.001). The multivariate relative risk of graft loss among patients with a higher resistance index was 9.1 (95 percent confidence interval, 6.6 to 12.7). Proteinuria (protein excretion, 1 g per day or more), symptomatic cytomegalovirus infection, and a creatinine clearance rate of less than 30 ml per minute per 1.73 m2 of body-surface area after transplantation also increased the risk. A renal arterial resistance index of 80 or higher measured at least three months after transplantation is associated with poor subsequent allograft performance and death. Copyright 2003 Massachusetts Medical Society

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Correlation of renal histopathology with sonographic findings.

Sammy Moghazi, Terence O’Neill, Virendra Arya … (2005)

Judgments about irreversible renal disease are frequently based on the sonographic appearance of the kidneys. However, the sensitivity and specificity of sonography in identifying chronic, irreversible disease have never been determined, and the specific pathologic changes that increase renal cortical echogenicity have not been defined. We retrospectively compared sonographic parameters (length, quantitative echogenicity, cortical thickness, and parenchymal thickness) to biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, and interstitial inflammation in 207 patients. Echogenicity showed the strongest correlation with all 4 histologic parameters (r= 0.28-0.35). Renal size was significantly correlated with glomerular sclerosis (r=-0.26) and tubular atrophy (r= 0.20). Parenchymal thickness, but not cortical thickness, correlated with tubular atrophy (r=-0.23). By multivariate analysis, tubular atrophy and interstitial inflammation, but not interstitial fibrosis, were significant determinants of cortical echogenicity. Severe chronic disease (>50% sclerosed glomeruli or a score of 3 out of 5 or greater for tubular atrophy or interstitial fibrosis) was present in 69% and 47% of patients with combined renal length 20 cm, respectively (P= 1.0 (>liver echogenicity) and 1.0. Cortical echogenicity is the sonographic parameter that correlates best with renal histopathology. Although size or echogenicity alone are poor predictors of chronic irreversible disease, the likelihood of treatable disease in small kidneys with increased cortical echogenicity is very low.

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Journal

Journal ID (publisher-id): NEC

Journal ID (nlm-ta): Nephron Clin Pract

Journal ID (doi): 10.1159/issn.1660-2110

Title: Nephron Clinical Practice

Publisher: S. Karger AG

ISBN: 978-3-8055-8074-8

ISBN: 978-3-318-01315-3

ISSN (Electronic): 1660-2110

Publication date Subscription-year: 2006

Publication date (Print): March 2006

Publication date (Electronic): 10 March 2006

Volume: 103

Issue: 2

Pages: c24-c28

Affiliations

Deutsche Klinik für Diagnostik, Fachbereich Nephrologie und Hypertensiologie, Wiesbaden, Germany

Article

Publisher ID: 90605 Other ID: Nephron Clin Pract 2006;103:c24–c28

DOI: 10.1159/000090605

PubMed ID: 16543752

SO-VID: b0fd0576-24ad-4a2a-b953-ca9e1bb304b1

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Karger: Nephrology

Most cited references 15

Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.

The renal arterial resistance index and renal allograft survival.

Correlation of renal histopathology with sonographic findings.

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