Measurement of kidney perfusion in critically ill Patients

Schneider, Antoine; Goodwin, Mark; Bellomo, Rinaldo

doi:10.1186/cc12529

Cited by 31 publications

(22 citation statements)

References 68 publications

(55 reference statements)

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“…The pathophysiology of cardiac surgery-associated AKI is still poorly understood. A decrease in renal blood flow (RBF) is believed to play a pivotal role in its pathogenesis [ 8 , 9 ]. There are, however, only very limited human data supporting this concept.…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study

et al. 2013

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IntroductionContrast-enhanced ultrasound (CEUS) is a new technique that might enable portable and non-invasive organ perfusion quantification at the bedside. However, it has not yet been tested in critically ill patients. We sought to establish CEUS's feasibility, safety, reproducibility and potential diagnostic value in the assessment of renal cortical perfusion in the peri-operative period in cardiac surgery patients.MethodsWe recruited twelve patients deemed at risk of acute kidney injury (AKI) planned for elective cardiac surgery. We performed renal CEUS with destruction-replenishment sequences before the operation, on ICU arrival and the day following the admission. Enhancement was obtained with Sonovue® (Bracco, Milano, Italy) at an infusion rate of 1 ml/min. We collected hemodynamic parameters before, during and after contrast agent infusion. At each study time, we obtained five video sequences, which were analysed using dedicated software by two independent radiologists blinded to patient and time. The main output was a perfusion index (PI), corresponding to the ratio of relative blood volume (RBV) over mean transit time (mTT).ResultsAll 36 renal CEUS studies, including 24 in the immediate post-operative period could be performed and were well tolerated. Correlation between readers for PI was excellent (R2 = 0.96, P < 0.0001). Compared with baseline, there was no overall difference in median PI's on ICU admission. However, the day after surgery, median PI's had decreased by 50% (P < 0.01) (22% decrease in RBV (P = 0.09); 48% increase in mTT (P = 0.04), both suggestive of decreased perfusion). These differences persisted after correction for haemoglobin; vasopressors use and mean arterial pressure. Four patients developed AKI in the post-operative period.ConclusionsCEUS appears feasible and well-tolerated in patients undergoing cardiac surgery even immediately after ICU admission. CEUS derived-parameters suggest a decrease in renal perfusion occurring within 24 hours of surgery.

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Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study

et al. 2013

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“…Preventative strategies, such as appropriate use of fluids including avoidance of positive fluid balance and renal venous congestion, nutritional optimisation, avoidance of nephrotoxic agents, limiting CPB exposure, and use of experimental agents (calcium channel blockers, dexmedetomidine, high-dose steroids, fenoldopam) have been described. 1,3,[13][14][15][16][17][18][19] However, the current diagnostic criteria fail to assist in providing a timely diagnosis for some of these measures to be effective. 1,3,4,6,13,[16][17][18][19]24,39 The need for a more sensitive, specific and real-time test/ biomarker of AKI is because SCr levels and urine production are not time-sensitive markers of AKI, as they may take up to 48 hours to change after an insult has occurred.…”

Section: Conventional Biomarkers Of Akimentioning

confidence: 99%

“…1,3,[13][14][15][16][17][18][19] However, the current diagnostic criteria fail to assist in providing a timely diagnosis for some of these measures to be effective. 1,3,4,6,13,[16][17][18][19]24,39 The need for a more sensitive, specific and real-time test/ biomarker of AKI is because SCr levels and urine production are not time-sensitive markers of AKI, as they may take up to 48 hours to change after an insult has occurred. 1,3,10,13,16,19,24 When trying to predict the onset of a disease, the use of a retrospective marker is not logical, especially one that can be as delayed as the rise in SCr.…”

Section: Conventional Biomarkers Of Akimentioning

confidence: 99%

“…44 RI can be influenced by parenchymal and vascular abnormalities such as: variations in vascular compliance; heart rate and rhythm; increased intra-abdominal pressure; and ureteric obstruction. 17,28,49 More studies in this area are necessary.…”

Section: Arterial Profile: the Renal Resistive Indexmentioning

confidence: 99%

“…New modalities are constantly being investigated, including conventional testing, urinary and blood biomarkers, as well as the use of ultrasound. [1][2][3]5,13,[16][17][18] Physiology of AKI AKI is a well-recognised complication post cardiac surgery, 1,3,13,14 which progresses to kidney dysfunction requiring RRT in 2-5% of patients, 15 chronic kidney disease (CKD) and mortality, if not treated timeously and judiciously. 1,3,13,16,19 Although AKI is multifactorial in origin, its aetiology post cardiac surgery is compounded by unique considerations.…”

Section: Introductionmentioning

confidence: 99%

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Novel modalities for the diagnosis of cardiac surgery associated acute kidney injury : a narrative review of the literature

Pettey

Chakane

2020

Southern African Journal of Anaesthesia and Analgesia

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Acute kidney injury (AKI) is a common complication post cardiac surgery and increases mortality during hospitalisation fivefold. If present, it is an independent risk factor for progression to chronic kidney disease. When renal replacement therapy (RRT) is required, it carries a 50% mortality rate for cardiac surgery associated (CSA) AKI. Given the dynamic nature of CSA AKI, it is imperative to implement preventative and management strategies to: prevent or limit ischaemia; reduce systemic inflammation; modify amenable pre- and perioperative risk factors; and address nutritional and fluid status at the pre- intra- and postoperative stages. Conventional modalities in the diagnosis of AKI have proven ineffectual in the timely diagnosis, and rely mostly on nonspecific biometric parameters, namely a rise in serum creatinine, and a decrease in urine output. Novel biomarkers have promoted new ideas in the search for more effective, precise and reproducible tools to aid diagnosis. In addition, ultrasonic tools for renal, hepatic and portal vascular flow patterns using Duplex Doppler for venous flow parameters, together with renal arterial resistive index, have been used as novel predictors of perioperative AKI. Although these parameters require further investigation, Duplex Doppler of the renal, hepatic, portal and cardiac systems appear to have promising results in the early detection of AKI.

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Noninvasive Renal Perfusion Measurement Using Arterial Spin Labeling (ASL) MRI: Basic Concept

Fernández‐Seara

Kober

et al. 2021

Methods in Molecular Biology

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The kidney is a complex organ involved in the excretion of metabolic products as well as the regulation of body fluids, osmolarity, and homeostatic status. These functions are influenced in large part by alterations in the regional distribution of blood flow between the renal cortex and medulla. Renal perfusion is therefore a key determinant of glomerular filtration. Therefore the quantification of regional renal perfusion could provide important insights into renal function and renal (patho)physiology. Arterial spin labeling (ASL) based perfusion MRI techniques, can offer a noninvasive and reproducible way of measuring renal perfusion in animal models. This chapter addresses the basic concept of ASL-MRI.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.

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Measurement of kidney perfusion in critically ill Patients

Cited by 31 publications

References 68 publications

Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study

Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study

Novel modalities for the diagnosis of cardiac surgery associated acute kidney injury : a narrative review of the literature

Noninvasive Renal Perfusion Measurement Using Arterial Spin Labeling (ASL) MRI: Basic Concept

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