Accurate placement of renal-artery stents is technically feasible without major complications. The favorable early and long-term results suggest that primary stent placement is an effective treatment for renal-artery stenosis involving the ostium.

O-HDF showed a significant reduction of hypotensive episodes compared with HD. Surprisingly, o-HDF resulted in cooling of the blood via enhanced thermal energy losses within the extracorporeal system, despite use of replacement fluid prepared from pre-warmed dialysate. The incidence of symptomatic hypotension was reduced to that of o-HDF by using cooler Temp-HD. Thus, unexpected blood cooling appears to be the main blood pressure-stabilizing factor in o-HDF.

The purpose of this prospective, angiographically controlled study was to determine the diagnostic value of color Doppler sonography with two differing approaches of scanning in patients with clinical clues for renal artery stenosis (RAS). In 135 hypertensive patients peak systolic velocity in the main renal arteries and the resistive index (RI) of the intrarenal arteries were measured. The RI side-to-side-difference (delta RI) greater than 0.05 or peak systolic velocity greater than 2 m/s were used to discriminate normal from stenotic renal arteries, defined as angiographically confirmed RAS > 50%. In 88 of 135 patients 107 RAS were demonstrated by selective arteriography. Five renal artery occlusions occurred, which were all diagnosed by color Doppler sonography. Seventy-six RAS were detected by increased peak systolic velocity, and an additional 19 stenoses were identified by delta RI. The combined analysis of peak systolic velocity and delta RI resulted in a sensitivity of 89% and specificity of 92%. The positive predictive value was 92% and the negative predictive value was 88%. Our data suggest that only the combination of intra- and extrarenal scanning with color Doppler sonography represents an effective screening method for significant renal artery stenosis in hypertensive patients.

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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