Imaging Techniques in Acute Renal Failure

Mucelli, R Pozzi; Bertolotto, Michele; Quaia, Emilio

doi:10.1159/000060076

Cited by 33 publications

(30 citation statements)

References 27 publications

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“…In acute renal injury AKIN stage 3 or RIFLE class F, RRI usually exceed 0.7, and a threshold of 0.75 is reported as optimal in recognizing between renal and prerenal disease. In fact in prerenal ARF, RRI values lower than 0.7 are related to a good recovery after fluid rehydration, while RRI [0.7 suggest a developing ischemic ATN and worse prognosis [20].…”

Section: Rri and Akimentioning

confidence: 99%

“…In haemolytic-uremic syndrome RRI usually exceed 0.7 and renal cortex appears hyperechotic with a marked cortical-medullary differentiation as a result of platelet aggregates and fibrin thrombi in the lumen of glomerular capillaries [20]. In vasculitides such LES, Wegener Granulomatosis and PAN, RRI shows significant correlation with creatinine level and presence of interstitial disease and normal RRI value is considered a good prognostic factor [19].…”

Section: Rri and Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

See 1 more Smart Citation

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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Doppler ultrasound has been extensively used in detecting reno-vascular diseases, showing to be a noninvasive, safe, low cost and repeatable tool. The Renal Resistive Index (RRI) [(peak systolic velocity -end diastolic velocity)/peak systolic velocity] is a semi-quantitative index derived by Doppler evaluation of renal vascular bed. Normally RRI is in the range of 0.47-0.70, it increases with aging and, usually, it shows a difference between the two kidneys less than 5-8 %. RRI is an important prognostic marker in chronic kidney diseases (CKD), both in diabetic and non-diabetic kidney diseases, because, in longitudinal prospective studies, it significantly correlated with hemodynamic (ABPM, SBP, DBP, pulse pressure) and histopathological parameters (glomerular sclerosis, arteriolosclerosis, interstitial fibrosis/tubular atrophy, interstitial infiltration). In acute kidney injury (AKI) RI is a valid tool in differentiating between pre-renal and renal failure and in predicting renal response to vasoactive agents. In addition a RRI[0.74 can predict the onset of AKI in septic patients. Renal Resistive Index is a useful marker in allograft diseases because it has been widely showed a correlation with histological lesions during worsening of renal function, both in acute rejection and in chronic allograft nephropathy. Recent studies suggest its role in the risk of new onset diabetes after transplantation and it could be one of the parameters to evaluate to shift or withdrawal immunological and/or hypertensive therapy.Keywords Renal resistive index Á Diabetic nephropathy Á Acute kidney injury Á Renal transplantation Á Chronic kidney diseaseRiassunto La Metodica Color Doppler è stata diffusamente utilizzata per evidenziare patologie nefrovascolari in relazione alle caratteristiche di non invasività, sicurezza, basso costo e ripetibilità della stessa. L'indice di resistenza renale (RRI) [(Picco di velocità sistolica -Velocità telediastolica)/ Picco di velocità sistolica] è un indice semiquantitativo derivato dalla valutazione Doppler del letto vascolare renale. Normalmente il valore del RRI è nel range di 0,47-0,70, aumentando con l'età, e usualmente, è presente una differenza tra i due reni inferiore al 5-8%. RRI è un importante marker prognostico nelle patologie renali croniche (CKD), sia diabetiche che non-diabetiche, poichè, in studi prospettici longitudinali, esso correla significativamente con parametri emodinamici (ABPM, Pressione Sistolica, pressione Diastolica, Pressione di Polso) e istopatologici (glomerulosclerosi, arteriolosclerosi, fibrosi interstiziale/ atrofia tubulare e infiltrato interstiziale). Nel Danno Renale Acuto (AKI) RI è un valido strumento nel distinguere l'insufficienza acuta pre-renale da quella renale e nel predire la risposta renale agli agenti vasoattivi. Inoltre un valore di RRI [0,74 può predire la comparsa di AKI nei pazienti affetti da sepsi. RRI è un marker utile nelle patologie del rene trapiantato, perchè è stata ampiamente dimostrata una correlazione con lesioni istologiche...

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Section: Rri and Akimentioning

confidence: 99%

Section: Rri and Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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“…The loss of corticomedullary differentiation was described as a common diagnostic finding in acute renal failure in non-contrast MRI (15). However, later studies identified the loss of corticomedullary differentiation in non-contrast enhanced MRI as nonspecific as it may be present in various renal conditions such as glomerulonephritis, obstructive hydronephrosis and other etiologies of chronic renal insufficiency, and acute renal allograft rejection (16).…”

Section: Magnetic Resonance Imaging In Human Acute Renal Failurementioning

confidence: 99%

“…As in native kidneys, MRI may be valuable to distinguish urinary tract obstruction, ARF, vascular complications, and acute allograft rejection after renal transplantation (17). Respective studies have suggested that MRI may lack specificity and thus may be inappropriate to differentiate the etiology of acute allograft dysfunction (16,17,19). However, these studies did not use contrast agents or current MRI technology enabling high image resolution.…”

Section: Magnetic Resonance Imaging In Human Acute Renal Failurementioning

confidence: 99%

Newly Developed Techniques to Study and Diagnose Acute Renal Failure

Dagher¹,

Herget–Rosenthal

Ruehm

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Progress in treating human acute renal failure (ARF) is dependent on developing techniques that allow for the rapid diagnosis, quantification of injury, further understanding of the pathophysiology, and the effects of therapy. Therefore, four techniques that will facilitate this progress are described and illustrated by four different investigative teams. Techniques to measure rapid changes in GFR are available for rapid diagnosis and quantification of ARF in humans. State-of-the-art magnetic resonance imaging (MRI) presently allows for enhanced resolution of regional renal blood flow and functional evaluations in patients. Furthermore, new probes and techniques for MRI that allow for identification and quantitation of inflammation, applicable to human ARF, are being developed and tested in animal models. Finally, two-photon microscopy will allow for four-dimensional cellular and subcellular studies in animal models of ARF providing rapid insights into pathophysiology and the therapeutic effects of a variety of promising agents. Further development and utilization of these techniques, especially in concert with genetic, proteomic, and molecular approaches, will allow for needed insights into the pathophysiology and therapy in human ARF.Advances in human ARF therapy have been limited to prevention and dialytic support. Interpatient and disease process heterogeneity, as well as a limited number of patients, are barriers to successful interventional therapeutic studies over which there is limited control. However, other relative barriers such as risk factor assessment, early diagnosis and initiation of therapy, and quantitation of ARF severity are now within the reach of clinicians. Quantitation of ARF severity, and the ability to effectively evaluate the response to early therapeutic approaches, are of paramount importance if success is to be achieved. Development of rapid diagnostic tests to allow for randomization of patients on the basis of GFR and ARF severity index is necessary for accurate randomization of patients for therapeutic studies. This, in turn, will minimize interpatient variability and allow for smaller, less expensive, and more reliable studies. To this end, the following four approaches are presented in a very concise format. We have specifically progressed from more clinically applicable techniques to studies aimed at understanding pathophysiologic and therapeutic concepts. Also, many complimentary and powerful investigative techniques have not been discussed. These include the use of "knock out" and "knock in" animal models, genomic and proteomic approaches, and molecular techniques such as silencing RNA and antisense approaches. In combination, these approaches will allow for extremely rapid progress in human ARF diagnosis and therapy.

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“…It is generally accepted that the value of using sonography for the evaluation of ARF is mainly to exclude obstructive uropathy, which occurs in 5-25% of all patients. 6,7 Since the etiologies of ARF in ICU and non-ICU patients were quite different, the applications of renal sonography in the ICU may be different. In the study of Liano et al, 8 only 2 of 253 ICU patients (0.8%) had ARF and obstructive uropathy, while 14.7% of 495 non-ICU patients were given that diagnosis.…”

Section: Discussionmentioning

confidence: 99%