Efficacy of echo-Doppler examination for the evaluation of renovascular disease

Handa, Nobuo; Fukunaga, Ryuzo; Etani, Hideki; Yoneda, Shotaro; Kimura, Kazufumi; Kamada, Takenobu

doi:10.1016/0301-5629(88)90157-3

Cited by 103 publications

(31 citation statements)

References 9 publications

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“…The elevated percentage of hypertensive subjects in our study is probably due, not unexpectedly, to the larger number of elderly hypertensive than elderly renal-failure patients presenting spontaneously to the nephrologic outpatient clinic. As already reported, duplex doppler sonography, even if operator-dependent, is potentially a powerful means of investigation, with a recognized elevated sensitivity and specificity [9,19]. As angiography was performed only in positive cases who consented to the procedure, we were not able to evaluate these indices, but in our hands this technique, with the possible error deriving from validation with angiography in approximately half of duplex-doppler-positive patients, had a very high positive-predictive power.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Coen¹,

Manni²,

Giannoni

et al. 1998

Am J Nephrol

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Background: Atherosclerotic renovascular disease is a frequent cause of end-stage renal failure leading to dialysis in the elderly population. Its prevalence is known from autopsy or retrospective arteriographic investigations. This prospective study was conducted in 133 subjects with the inclusion criteria of hypertension and/or chronic renal failure starting after 50 years of age. Renal failure was unrelated to other known causes of renal disease. Methods: The patients were subjected to echo-color doppler ultrasonography of renal arteries (104) and/or to renal scintigraphy (112). Thirteen of 27 patients with positivity using one or both noninvasive techniques were subjected to digital selective angiography. Results: All the patients with positivity of echo-color doppler technique were true positives, with a consequent predictive value reaching 100%. Renal scintigraphy was of markedly lower predictive value. Based on the echo-color doppler investigation, percentage positivity for hemodynamically significant stenosis (>50%) was 3.2 (16.3% had mild nonsignificant stenosis of renal arteries) in the 50- to 59-year-old group, 20% (plus 12.5% with nonsignificant stenosis) in the 60- to 69-year-old group and 25% (plus 17.8% nonsignificant stenosis) in the >70-year age group. Patients with significant stenosis also had a significantly higher degree of renal insufficiency and received a higher number of hypotensive drugs (p < 0.013). The percentage of hypertensive patients was not different in the stenotic and nonstenotic groups. Conclusions: A large percentage of the elderly population is affected by renal vascular obstructive disease and is at risk of developing end-stage renal failure. Considering the wide number of cases with foreseeable renal arterial stenosis in the vast population meeting the selection criteria, it is possible to conclude that not all cases evolve to renal failure due to different rates of progression or to untimely nonrenal death.

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Section: Discussionmentioning

confidence: 99%

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Coen¹,

Manni²,

Giannoni

et al. 1998

Am J Nephrol

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“…Recent reports with intrarenal branch arteries doppler waveform analysis with additional sampling from upper and lower pole had shown much improved resilts. 7,8 …”

Section: Discussionmentioning

confidence: 99%

“…Few studies are available in literature highlighting the hemodynamic changes distal to the stenosis causing alteration in waveform known as parvus tardus effect. [7][8][9] This effect consists of post stenotic alternation in which a wave of lower amplitude is observed with longer time to reach the peak systolic velocity. 8 We present two cases of renovascular hypertension due to accessory RAS, diagnosed on intrarenal CDUS with additional sampling from upper and lower pole, using parameters acceleration time (AT), acceleration time ratio(ATR),and acceleration index(AI).…”

Section: Introductionmentioning

confidence: 99%

Intrarenal Color Doppler Ultrasonography in the Diagnosis of Accessory Renal Artery Stenosis

et al. 2013

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Conventional color Doppler ultrasonography of main renal artery is a valuable non invasive tool in screening and diagnosing patients with renal artery stenosis. However, this technique suffer a set back from many limitations. Color Doppler ultrasonography examination of intrarenal branch arteries using the parameters like, acceleration time, acceleration time ratio, and acceleration index with additional sampling from upper and lower pole of kidney has shown good results in diagnosis of renal artery stenosis. We successfully diagnosed accessory renal artery stenosis in two patients using intrarenal Doppler technique. We conclude, intra renal Color Doppler ultrasonography with additional sampling from upper and lower pole is most accurate method for diagnosis of significant RAS including accessory RAS.

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“…As an alternative and indirect method of identifying RA stenosis, many groups use to analyze intrarenal waveforms, as pointed out by the original observations by Handa [12] and Stavros [13], looking for the tardus-parvus effect. Good results can be obtained only with some quantitative parameters [12-14], whose value in clinical practice has been reviewed elsewhere [2].…”

Section: Discussionmentioning

confidence: 99%

A comparison of Power Doppler with conventional sonographic imaging for the evaluation of renal artery stenosis

Manganaro

Andò

Salvo

et al. 2004

Cardiovasc Ultrasound

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BackgroundPower Doppler (PD) has improved diagnostic capabilities of vascular sonography, mainly because it is independent from the angle of insonation. We evaluated this technique in a prospective comparison with conventional imaging, consisting in Duplex and Color Doppler, for the evaluation of Renal Artery (RA) stenosis.MethodsSensitivity, specificity and predictive values of PD and conventional imaging were assessed in a blinded fashion on eighteen patients, 9 with angiographic evidence of unilateral RA stenosis (hypertensive patients) and 9 with angiographically normal arteries (control group). PD images were interpreted with an angiography-like criteria.ResultsIn the control group both techniques allowed correct visualization of 16 out of the 18 normal arteries (93% specificity). Only in five hypertensive patients RA stenosis was correctly identified with conventional technique (56% sensitivity and 86% negative predictive value); PD was successful in all hypertensive patients (100% sensitivity and negative predictive value), since the operators could obtain in each case of RA stenosis a sharp color signal of the whole vessel with a clear "minus" at the point of narrowing of the lumen. All results were statistically significant (p < 0.01).ConclusionsThis study demonstrates that PD is superior to conventional imaging, in terms of sensitivity and specificity, for the diagnosis of RA stenosis, because it allows a clear visualization of the whole stenotic vascular lumen. Especially if it is used in concert with the other sonographic techniques, PD can enable a more accurate imaging of renovascular disease with results that seem comparable to selective angiography.

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Efficacy of echo-Doppler examination for the evaluation of renovascular disease

Cited by 103 publications

References 9 publications

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Intrarenal Color Doppler Ultrasonography in the Diagnosis of Accessory Renal Artery Stenosis

A comparison of Power Doppler with conventional sonographic imaging for the evaluation of renal artery stenosis

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