Contrast-Enhanced Sonography in Early Kidney Graft Dysfunction

Purpose: Graft parenchyma perfusion disturbances (GPPD) in transplanted kidneys are common in the early postoperative period. Rapid and accurate diagnosis can guide proper treatment, preventing graft dysfunction. Methods: One hundred and eighty patients, who underwent kidney transplantation (KTx), were examined in the immediate postoperative period using real-time ultrasonography (B-mode) with color and power Doppler (US-CD/PD) and B-flow ultrasound, as well as with an additional protocol of contrast-enhanced ultrasonography (CE-US). Regions of GPPD were localized and measured. The number and size of these areas were compared between the two acquisition techniques. Follow-up examinations were carried out 6 months postoperatively. Results: CE-US revealed more GPPDs and showed them more precisely than the B+US-CD/PD/B-flow technique. Moreover, in the CE-US examination, ischemic foci had statistically significant higher echogenicity in comparison to normal parenchyma, were larger and better visualized (better circumscribed) than in B+US-CD/PD/B-flow. Conclusion: CE-US allows the visualization of GPPD caused by occlusion of small arteries. It is a noninvasive, safe, real-time method, which has many advantages over standard B+US-CD/PD/B-flow examinations, and we recommend it as a routine diagnostic procedure in the early postoperative period following KTx.

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“…Rapid and accurate diagnosis plays the crucial role in treatment that determines both the graft and patient survival [17,18,19]. …”

Section: Discussionmentioning

confidence: 99%

Perfusion Disturbances of Kidney Graft Parenchyma Evaluated with Contrast-Enhanced Ultrasonography in the Immediate Period following Kidney Transplantation

et al. 2013

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“…Th e same technique was used by Kishimoto et al to measure renal blood fl ow, demonstrating a good correlation with changes in renal blood fl ow as estimated by PAH clearance [71]. Schwenger [72] and Benozzi [73] et al demonstrated that contrast-enhanced ultrasound was able to distinguish acute rejection from acute tubular necrosis. Another study, in healthy volunteers demonstrated that contrast-enhanced ultrasound was able to detect a 20 % decrease in renal blood fl ow as induced by an angiotensin II infusion [74].…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 92%

Measurement of Kidney Perfusion in Critically Ill Patients

Schneider

Goodwin

Bellomo

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Acute kidney injury (AKI) is a major complication of critical illness [1] occurring in 30 to 40 % of all critically ill patients and in its sev ere form requires renal replacement therapy (RRT), in approximately 5 % of patients [2]. AKI has been s hown to be an independent predictor for mortality [3] and is associated with invasive therapy and substantial costs [4].Despite its impor tance, the pathoph ysiology of AKI is still poorly understood. AKI is most commonly associated with systemic diseases, such as septic shock, major surgery and cardiogenic shock [1], but a specifi c mechanism causing AKI to develop in specifi c patients can rarely be determined. Since the early description of an "acute uremia syndrome" in crush injury victims during World War II [5,6] and its association with histopathological fi ndings similar to those found in experimental renal artery ligation, ischemia or some form of alteration in renal blood fl ow has been thought to play a pivotal role in the pathogenesis of AKI. Th is paradigm that essentially all AKI in critically ill patients is the result of some form or degree of ischemia remains of continuing conceptual dominanc e to this day [7]. Despite such dominance, there are only very limited data supporting this concept. In a recent systematic review, Prowle et al. [8] highlighted the extraordinary fact that renal blood fl ow measurement, irrespective of the technique used, has only been reported in 46 critically ill patients (fi ve studies) within the last sixty years. Th us, our knowledge, understanding, and theoretical constructs regarding global renal perfu sion in critically ill patients with RRT-treated AKI (an estimated 5 % of all ICU admissions for a total of approximately a quarter of a million such patients each year in developed countries alone) is, like an inverted pyramid, based on extremely weak evidence.Furthermore, given the complex and heterogeneous nature of the renal vasculature, evaluating the fl ow in the main renal arteries (macrocirculation) might not provide suffi cient information to adequately understand perfusion alterations in complex diseases, such as septic or cardio genic shock. Indeed, some pathophysiological processes may be associated with increased global renal blood fl ow [9,10] despite loss of f un ction. In such instances, there is experimental evidence that, at least in sepsis, this phenomenon may be caused by intra-renal shunting [11]. Hence, correlation between macroscopic renal blood fl ow and function is far from linear. Th erefore, techniques allowing the study of microcircu latory parameters, such as cortico-med ullary perfusion ratio and regional tissue oxygenation measurement, and assessment of their relative change over time may be more valuable in increasing our understanding of the pathophysiology of AKI.In this state-of-the art review, we discuss the value, challenges, limitations, safety and feasibility of diff erent techniques for the measurement of kidney perfusion in critically ill patients. Th e advantages of each technique wi...

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“…Alkalmazására számos területen lenne szükség gyermekkorban, hiszen drága, sok esetben altatással járó vizsgálatok kiválthatóak általa, például májtranszplantált gyermekeknél jelentősen megkönnyíti az arteria hepatica ábrá-zolását, amely Doppler-vizsgálattal az esetek egy részé-ben nem valósítható meg. Vesetranszplantált betegeknél a perfúzió ábrázolása segítséget jelent a rejectio korai észlelésében [8,9,10,11,12].…”

Section: öSszefoglaló Közleményunclassified

Ultrasound examination in childhood: opportunities and new ways

Kis

2014

Orvosi Hetilap

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Az ultrahangvizsgálat jelentősége és fontossága a modern képalkotó vizsgálatok (CT, MR, izotóp, PET/CT) elterjedésével csökkent, nemritkán csak mint első tájékozódó vizsgálat jelenik meg. A legújabb sokszeletes spirál-CT-kkel a képalkotás másodpercek alatt elvégezhető, ami a jelentős sugárterheléssel járó vizsgálatok számának drámai növe-kedéséhez vezetett, gyermekkorban is. Ugyanakkor nem feledkezhetünk meg arról, hogy az elmúlt években jelentős fejlődés történt az ultrahang-technológiában, a képminőség egyre jobb. A gyermekek ideális alanyai a vizsgálatnak, miután az esetek nagy részében testtömegük kisebb, kevesebb zsírt tartalmaz, így könnyen vizsgálhatók magas frekvenciájú transzducerrel, aminek következtében sokkal részletgazdagabb, jobb felbontású képek nyerhetők, mint ál-talában felnőtteknél. Megfelelő készülék és gyakorlott, gyermekradiológiában tapasztalt vizsgáló esetében csaknem valamennyi testtájék vizsgálható, mindenképpen első választandó módszer, amely legtöbbször elegendő (esetleg röntgenvizsgálattal kiegészítve) a megfelelő diagnózis felállítására. A közlemény azokkal a lehetőségekkel foglalkozik, ahol a modern ultrahangkészülékek birtokában az ultrahangvizsgálat elegendő a pontos diagnózishoz. Orv. Hetil., 2014, 155(4), 132-140. Kulcsszavak: ultrahangvizsgálat, szonocisztográfi a, nekrotizáló enterocolitis Ultrasound examination in childhood: opportunities and new waysEveryday use of the modern imaging techniques such as CT, MRI, isotope, PET/CT decreased the reputation and importance of ultrasound. In some cases, ultrasound is only the fi rst exploratory imaging method. Using the latest multi-slice CT, imaging can be performed in seconds, which led to a dramatic increase in the number of CT exams. However, this also means a signifi cant radiation exposure to children, while US still harmless in this regard. In addition, signifi cant progress has been made in ultrasound technology in recent years, which led an improvement in image quality. Children are ideal subjects for US examination as they usually have smaller weight with less body fat. Thus, ultrasound examination is easy to perform with a high frequency transducer resulting in much more detailed and higher resolution than in adults. With adequate equipment and experienced examiner in pediatric radiology, almost all parts of the body can be examined, making this technique as the fi rst (sometimes together with X-ray) and, in most cases, the ultimate imaging exam for the diagnosis. This article will discuss the possibilities where ultrasound performed with a modern device is suffi cient for an accurate diagnosis. Keywords: ultrasound, urosonography, necrotising enterocolitisKis, É. [Ultrasound examination in childhood: opportunities and new ways]. Orv. Hetil., 2014, 155(4), 132-140. (Beérkezett: 2013 elfogadva: 2013. december 12.) A szerkesztőség felkérésére készült közlemény. Rövidítések CCAM = congenitalis cysticus adenomatoid malformatio; CPAM = congenitalis pulmonalis légúti malformatio; HIE = hypoxiás-ischaemiás encephalopathia; ...

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Contrast-Enhanced Sonography in Early Kidney Graft Dysfunction

Cited by 71 publications

References 4 publications

Perfusion Disturbances of Kidney Graft Parenchyma Evaluated with Contrast-Enhanced Ultrasonography in the Immediate Period following Kidney Transplantation

Perfusion Disturbances of Kidney Graft Parenchyma Evaluated with Contrast-Enhanced Ultrasonography in the Immediate Period following Kidney Transplantation

Measurement of Kidney Perfusion in Critically Ill Patients

Ultrasound examination in childhood: opportunities and new ways

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