Renal parenchymal diseases: Is characterization feasible with ultrasound?

Quaia, Emilio; Bertolotto, Michele

doi:10.1007/s00330-002-1360-z

Cited by 70 publications

(45 citation statements)

References 54 publications

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“…RRI examinations don't recognize among different renal medical pathologies, so that RI cannot be used as a diagnostic marker [19]. Ultrasound may be a useful tool to identify the degree of disease progression and secondary response to immunological and antihypertensive therapy, even if further studies are needed to have clear recommendations of follow-up.…”

Section: Rri and Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

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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 Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

“…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%

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

Spatola

Andrulli

2016

J Ultrasound

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“…16 Renal vasculitides and tubularinterstitial nephropathies are more frequently identified by conventional ultrasound than glomerular nephropathies, since glomerular component accounts only for 8% of the renal parenchyma, whereas the highest percentage is occupied by vascular and tubulo-interstitial components. 17 Since Doppler indices of renal parenchymal resistance increase with the progression of vascular (arteriosclerosis) and parenchymal (glomerular sclerosis and crescents) renal damage assessed by renal biopsy, we can assume that the Doppler indices can be used in association with biopsy and glomerular function (sCr and CKD-EPI) for the evaluation of renal damage in patients with glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: Correlation with histological findings

Gigante

Barbano

Mario

et al. 2016

Int J Immunopathol Pharmacol

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Renal Doppler ultrasound is increasingly used in nephrology for the evaluation of renovascular disease, allograft dysfunction, and chronic nephropathies. We compared intrarenal hemodynamic parameters to biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, crescents, arteriolosclerosis, and clinical variables in 100 patients. A positive correlation exists between renal function and percentage of glomerular sclerosis (P <0.01, r = 0.26), conversely a negative correlation exists between glomerular filtrate rate and percentage of glomerular sclerosis (P <0.0001, r = −0.35). The percentage of glomerular sclerosis correlate positively with pulsatile index (PI) (P <0.05, r = 0.21) and renal resistive index (RI) (P <0.05, r = 0.20). The percentage of crescents correlates positively with PI (P <0.05, r = 0.21) and RI (P <0.05, r = 0.20). Classifying arteriolosclerosis in four groups according to a severity scale, from absence to severe, PI (P <0.05) and RI (P <0.01) were significantly different. In the post hoc analysis, the median values of PI and RI are significantly different in patients with severe arteriolosclerosis than others. Ultrasound examination is a non-invasive diagnostic technique used on patients with suspected or established renal disease. Our study shows a close correlation between kidney function, ultrasound parameters, and histological findings. Measurement of renal parenchymal resistance by ultrasound could be used in association with biopsy and glomerular function for the evaluation of renal damage in patients with glomerulonephritis.

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“…RRI has shown to be related with glomerulosclerosis, arteriolosclerosis and tubulointerstitial lesions more than others morphologic parameters like renal length and cortex area (3). Although RRI examinations do not recognize among different renal medical pathologies, patients with higher RRI (< 0.7) generally show more severe arteriolosclerosis than others with normal (< 0.65) or high normal RRI (0.65 ≤ RI < 0.7) so that in mild to moderate renal dysfunction RRI predicts CKD progression and poor outcome especially when RRI ≥ 0.7 (3)(4)(5)(6). Also in the patients affected by diabetic nephropathy (where RRI is higher in comparison with those affected by others kidney diseases with an equivalent GFR) in both < 60 and > 60 years old subjects and even in subjects on RAS inhibitors therapy or not, Sugiura et al (7) proved that a RRI > 0.7 is an independent predictor of the risk of worsening renal function.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

Brardi

Cevenini

Giovannelli

et al. 2017

Arch Ital Urol Androl

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Objective: This longitudinal prospective observational type study was conceived with the aim to examine the impact on renal resistive index (RRI) of the variables that we can manipulate with therapeutic and or dietetic interventions in a chronic kidney disease population in order to known which of these variables was statistically related to changes in RRI and therefore could become the object of the greatest therapeutic effort. Material and methods: This study was undertaken between May 2016 to May 2017 in the outpatient nephrology and urology clinic of San Donato Hospital in Arezzo. The study population (84 patients: 47 males and 37 females) was randomly selected among the chronic kidney patients (with various degrees of renal impairment) affected by hypertension and or diabetes mellitus. After a comprehensive medical examination these patients were submitted to determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and finally renal Doppler ultrasonography. Then the patients were submitted to a full therapeutic and dietetic intervention to ameliorate the renal impairment by a wide range of actions and after on average a one-year interval were submitted again to a new medical examination and a second determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and a new renal Doppler ultrasonography too. Results: The comparison between basal and final data revealed a slight reduction in the mean of bilateral renal resistance indices (Delta RRI: -0.0182 ± 0.08), associated to a slight increase in the mean glomerular filtration rate (Delta GFR: 0.8738 ± 10.95 ml/min/1.73 m 2 ), a reduction in mean body weight (Delta weight: -1.9548 ± 5.26 Kg) and mean BMI (Delta BMI: -0.7643 ± 2.10 Kg/m 2 ) as well as a reduction in the mean systolic blood pressure (Delta systolic blood pressure: -8.8333 ± 25.19 mmHg). Statistical analysis showed statistically significant correlations (p < 0.05) between Delta RRI and Delta weight (p < 0.03), Delta BMI (p < 0.02) and Delta systolic blood pressure (p < 0.05). Conclusion: Despite the many limitations the our study clearly identifies the targets (yet widely known) to act on to prevent kidney alterations related to RRI and provides further evidence, if any, of the utility of RRI as a key parameter in monitoring patients with chronic renal failure and as a valuable tool to drive the clinical efforts to contrast the kidney disease.KEY WORDS: Longitudinal prospective observational type study; Renal ultrasonography; Renal resistive index; Chronic kidney patients; Conventional medical and dietetic therapy. SummaryNo conflict of interest declared.

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Renal parenchymal diseases: Is characterization feasible with ultrasound?

Cited by 70 publications

References 54 publications

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

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

Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: Correlation with histological findings

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

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