Improved diagnosis of early kidney allograft dysfunction by ultrasound with echo enhancer—a new method for the diagnosis of renal perfusion

Fischer, Thomas; Filimonow, S.; Dieckhöfer, Jan; Slowinski, Torsten; Mühler, Matthias; Lembcke, Alexander; Budde, Klemens; Neumayer, Hans-H; Ebeling, V; Giessing, Markus; Thomas, Anke; Morgera, Stanislao

doi:10.1093/ndt/gfl313

Cited by 50 publications

(35 citation statements)

References 20 publications

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“…Fisher, et al examined the usefulness of CEUS with another second-generation ultrasound contrast medium, SonoVue Ⓡ , in kidney transplant recipients, and found a delayed and small increase in enhancement in cortex in patients with acute tubular necrosis and vascular rejection. 10) The blood flow in CKD stage 4 seems high compared to that in CKD in other stages (Figures 8 and 9). However, the number of patients in CKD stage 4 was rather small (n = 14), the variations in the S-P slope in this stage were rather large, and there was no significant difference in the S-P slopes between CKD stage 4 and CKD in other stages.…”

Section: Discussionmentioning

confidence: 83%

“…However, there have been few reports on contrast-enhanced ultrasound (CEUS) imaging studies using second-generation echo enhancers in human kidney. 10,11) To determine the usefulness of CEUS in the visualization of peritubular capillaries and changes in enhancement with progression of renal dysfunction, we measured renal perfusion by CEUS with administration of Sonazoid TM in normal subjects and patients with chronic kidney disease, and evaluated the correlations between glomerular filtration rate and enhancement in the renal cortex and medulla.…”

Section: Evaluation Of Renal Microcirculation By Us In Ckdmentioning

confidence: 99%

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Evaluation of Renal Microcirculation by Contrast-Enhanced Ultrasound With SonazoidTM as a Contrast Agent Comparison Between Normal Subjects and Patients With Chronic Kidney Disease

et al. 2010

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SummaryChronic kidney disease (CKD) is a major and serious risk factor for cardiovascular disease (CVD). Continuous hypoxia due to hypoperfusion in peritubular capillaries is one of the factors aggravating CKD, but evaluation of perfusion in this region is difficult using clinically available imaging methods. Since the second-generation ultrasound contrast agent Sonazoid TM has a stable shell, it enables visualization of the renal vasculature for a long period of time. We therefore evaluated changes in contrast-enhanced ultrasound (CEUS) imaging with Sonazoid TM in CKD patients.Sonazoid TM was used in 85 CKD patients and 5 control subjects, and images were recorded for 10 minutes. Time-intensity curves were generated from the images of 62 time points in both cortex and medulla.In control samples, contrast enhancement spread from the hilar portion to the periphery along the direction of arterial flow, and renal cortex and medulla were then enhanced in sequence. Enhancement was maximal soon after, then gradually decreased, but was still visible at 600 seconds. In CKD patients, renal contrast enhancement was attenuated in both cortex and medulla. On time-intensity curves, the attenuation of enhancement was composed of delayed rising, reduction of peak, and acceleration of decay in both cortex and medulla with progression of renal dysfunction. No side effects of the contrast agent were observed in any subjects.The attenuation of renal contrast enhancement observed in CKD patients appears to reflect disturbance of perfusion in peritubular capillaries. CEUS with Sonazoid TM is a useful and safe means of visualizing the renal microvasculature. (Int Heart J 2010; 51: 176-182)

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Section: Discussionmentioning

confidence: 83%

Section: Evaluation Of Renal Microcirculation By Us In Ckdmentioning

confidence: 99%

Evaluation of Renal Microcirculation by Contrast-Enhanced Ultrasound With SonazoidTM as a Contrast Agent Comparison Between Normal Subjects and Patients With Chronic Kidney Disease

et al. 2010

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“…In renal tissue, CES has been used without apparent side effects. [16][17][18] However, high-intensity insonation has been reported to cause renal interstitial and glomerular microhemorrhage in anesthetized rats. 9,10 With these experiences in mind, and with the aim of regularly using CES in the evaluation of the kidney microcirculation, our study was conducted to analyze the effects of the direct interaction between contrast microbubbles and high-energy insonation in an anesthetized porcine model.…”

Section: Discussionmentioning

confidence: 99%

“…In our model, minimal attenuation of the ultrasonic energy was expected (it was applied over the kidney surface without other tissue interferences); higher doses of the contrast agent were used; and the time of insonation at a high MI was longer than normally used for CES in human studies. 13,17,18 In human studies, the quantification and analysis of these images are based on 1 pulse destruction phase. 17 The longer high-MI exposure time in our model ensured complete destruction of the microbubbles and then allowed complete reperfusion of the insonated scan plane.…”

Section: Discussionmentioning

confidence: 99%

“…Recently published experiences with CES in renal patients have not reported side effects, although in no case was the expressed intention of these studies to explore this phenomenon. 5,[16][17][18] The main limitation of our study was the number of pigs involved, which limited the investigation of various microbubble contrast agent and ultrasound doses with regard to renal damage. Therefore, the possibility existed in this limited study that the location of the damage was missed, particularly given the fact that there was no ability to exceed the level at which damage would definitely occur to show appropriate sampling.…”

Section: Discussionmentioning

confidence: 99%

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In Situ Kidney Insonation With Microbubble Contrast Agents Does Not Cause Renal Tissue Damage in a Porcine Model

Jiménez¹,

Gracia

Aguilera³

et al. 2008

Journal of Ultrasound in Medicine

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Objective. Knowledge and quantification of the microcirculation are very important for estimating the status of an organ. Real-time contrast-enhanced sonography assesses microvascular tissue perfusion. This technique has been proposed as innocuous; however, data from experimental animals (rats) have shown renal interstitial microhemorrhage after the procedure. Therefore, we developed a porcine model to explore potential renal damage that in situ exposure might cause. Methods. Kidneys from 8 anesthetized pigs were surgically exposed. An ultrasound contrast agent (sulfur hexafluoride) was infused through the femoral vein in a continuous perfusion. Destructive ultrasonic flashes were applied with a high mechanical index over only 1 kidney (the contralateral kidney was used as a control). Blinded histologic and laboratory analyses were performed to reveal any lesions. Results. Histologic analysis of the kidney samples showed no evidence of renal damage. Biochemical parameters that could represent renal tissue damage and hemoglobin levels did not change after the microbubble-ultrasound interaction. Conclusions. The ultrasound contrast agent-ultrasound interaction in anesthetized pig kidneys under the output level for the imaging visualization and microbubble destruction used did not cause tissue damage. Our results suggest that this procedure could be used in humans for regular analysis of the kidney microcirculation with minimal risk of tissue damage.

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Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast‐Enhanced Ultrasound for Patients With Renal Transplants

Kriegshauser

Smith

Zhang

et al. 2020

J of Ultrasound Medicine

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Objectives-To determine whether renal transplant diagnoses substantially change when 2 biopsy sites are chosen and whether contrast-enhanced ultrasound (CEUS) has value for targeting the second site.Methods-We prospectively enrolled 40 patients undergoing ultrasound-guided renal transplant biopsy within 2 years of transplant: 20, surveillance; and 20, for cause. A CEUS examination was performed to identify cortical regions with subjectively altered flow. One biopsy was performed at the operator-preferred (primary) site regardless of CEUS findings. Another biopsy was done at a second location, either targeted to an area in which CEUS perfusion findings differed from the primary site (targeted) or at a random location (secondary) if no other area differed. Specimens were randomly labeled A or B; pathologists were blinded to the CEUS result and biopsy location. Location-specific CEUS assessments were recorded. Pathologic results were compared, including acute and chronic Banff scores and any new findings from the targeted or secondary biopsy.Results-Forty patients were enrolled between January 2016 and December 2018. No location-specific pathologic differences correlated with differences in CEUS assessments. The second biopsy provided additional information that changed management in 4 of 40 patients (10.0% [95% confidence interval, 2.8%-23.7%]). Major bleeding complications occurred in 3 of 40 (7.5%) patients.Conclusions-Contrast-enhanced ultrasound targeting was not useful. Major bleeding complications were higher than expected, possibly due to the additional biopsy away from the operator-preferred location. Obtaining a second renal transplant biopsy from a substantially different area than the initial operatorpreferred location provided additional clinically useful information in 10% of patients.

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Improved diagnosis of early kidney allograft dysfunction by ultrasound with echo enhancer—a new method for the diagnosis of renal perfusion

Abstract: USCM might be superior in the diagnosis of early kidney allograft dysfunction compared with conventional US by means of RI determination. Perirenal haematoma, ATN and vascular rejection are associated with characteristic changes of the TIC.

Cited by 50 publications

References 20 publications

Evaluation of Renal Microcirculation by Contrast-Enhanced Ultrasound With SonazoidTM as a Contrast Agent Comparison Between Normal Subjects and Patients With Chronic Kidney Disease

Evaluation of Renal Microcirculation by Contrast-Enhanced Ultrasound With SonazoidTM as a Contrast Agent Comparison Between Normal Subjects and Patients With Chronic Kidney Disease

In Situ Kidney Insonation With Microbubble Contrast Agents Does Not Cause Renal Tissue Damage in a Porcine Model

Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast‐Enhanced Ultrasound for Patients With Renal Transplants

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