Renal perfusion evaluation with contrast-enhanced ultrasonography

Schneider, Antoine; Hofmann, Lucie; Wuerzner, Grégoire; Glatz, Nicolas; Maillard, Marc; Meuwly, Jean‐Yves; Eggimann, Philippe; Burnier, Michel; Vogt, Bruno

doi:10.1093/ndt/gfr345

Cited by 77 publications

(85 citation statements)

References 26 publications

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“…45 healthy volunteers were included as control group. All statistical analyses were performed with SPSS® v. 15.0 software package (SPSS, Chicago, IL). A difference was considered statistically significant with p , 0.05.…”

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confidence: 99%

“…12 CE ultrasound has been recently used as a new imaging technique for quantifying tissue perfusion changes in the liver, 13 heart 14 and kidney. 15 The large blood supply of the kidney was a good base for contrast studies, as .90% of kidney blood flow supplied the renal cortex by the renal arterioles and capillaries. 16 Since CE ultrasound microbubbles remain strictly inside the vessels, they can be viewed as bloodpool markers enabling functional imaging of the kidney.…”

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confidence: 99%

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Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study

Wang²,

Cao³

et al. 2014

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confidence: 99%

Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study

Wang²,

Cao³

et al. 2014

BJR

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“…CEUS has also been used to evaluate renal microvascular perfusion following the administration of vasoactive drugs. CEUS ascertained parameters decreased after the use of angiotensin II (Ang II), and increased after captopril (Ang II inhibitor) administration [32] . Noradrenaline- [33] and dopamineinduced [34] changes in renal perfusion were also correctly validated by CEUS.…”

Section: Renal Microvascular Perfusion Evaluation In Humans Using Ceusmentioning

confidence: 99%

Contrast-enhanced ultrasound: A promising method for renal microvascular perfusion evaluation

Mohan

2016

Journal of Translational Internal Medicine

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This article reviews the application of contrast-enhanced ultrasound (CEUS) in gauging renal microvascular perfusion in diverse renal diseases. The unique nature of the contrast agents used in CEUS provides real-time and quantitative imaging of the vasculature. In addition to the traditional use of CEUS for evaluation of kidney masses, it also emerges as a safe and effective imaging approach to assess microvascular perfusion in diffuse renal lesions, noninvasively. Although the precise CEUS parameters that may best predict disease still warrant systematic evaluation, animal models and limited clinical trials in humans raise hopes that CEUS could outcompete competing modalities as a first-line tool for assessing renal perfusion non-invasively, even in ailments such as acute kidney injury and chronic kidney disease.

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“…Schwenger [72] and Benozzi [73] et al demonstrated that contrast-enhanced ultrasound was able to distinguish acute rejection from acute tubular necrosis. Another study, in healthy volunteers demonstrated that contrast-enhanced ultrasound was able to detect a 20 % decrease in renal blood fl ow as induced by an angiotensin II infusion [74]. Above all, contrast-enhanced ultrasound can provide real time visualization of the renal microcirculation.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

Measurement of Kidney Perfusion in Critically Ill Patients

Schneider

Goodwin

Bellomo

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Acute kidney injury (AKI) is a major complication of critical illness [1] occurring in 30 to 40 % of all critically ill patients and in its sev ere form requires renal replacement therapy (RRT), in approximately 5 % of patients [2]. AKI has been s hown to be an independent predictor for mortality [3] and is associated with invasive therapy and substantial costs [4].Despite its impor tance, the pathoph ysiology of AKI is still poorly understood. AKI is most commonly associated with systemic diseases, such as septic shock, major surgery and cardiogenic shock [1], but a specifi c mechanism causing AKI to develop in specifi c patients can rarely be determined. Since the early description of an "acute uremia syndrome" in crush injury victims during World War II [5,6] and its association with histopathological fi ndings similar to those found in experimental renal artery ligation, ischemia or some form of alteration in renal blood fl ow has been thought to play a pivotal role in the pathogenesis of AKI. Th is paradigm that essentially all AKI in critically ill patients is the result of some form or degree of ischemia remains of continuing conceptual dominanc e to this day [7]. Despite such dominance, there are only very limited data supporting this concept. In a recent systematic review, Prowle et al. [8] highlighted the extraordinary fact that renal blood fl ow measurement, irrespective of the technique used, has only been reported in 46 critically ill patients (fi ve studies) within the last sixty years. Th us, our knowledge, understanding, and theoretical constructs regarding global renal perfu sion in critically ill patients with RRT-treated AKI (an estimated 5 % of all ICU admissions for a total of approximately a quarter of a million such patients each year in developed countries alone) is, like an inverted pyramid, based on extremely weak evidence.Furthermore, given the complex and heterogeneous nature of the renal vasculature, evaluating the fl ow in the main renal arteries (macrocirculation) might not provide suffi cient information to adequately understand perfusion alterations in complex diseases, such as septic or cardio genic shock. Indeed, some pathophysiological processes may be associated with increased global renal blood fl ow [9,10] despite loss of f un ction. In such instances, there is experimental evidence that, at least in sepsis, this phenomenon may be caused by intra-renal shunting [11]. Hence, correlation between macroscopic renal blood fl ow and function is far from linear. Th erefore, techniques allowing the study of microcircu latory parameters, such as cortico-med ullary perfusion ratio and regional tissue oxygenation measurement, and assessment of their relative change over time may be more valuable in increasing our understanding of the pathophysiology of AKI.In this state-of-the art review, we discuss the value, challenges, limitations, safety and feasibility of diff erent techniques for the measurement of kidney perfusion in critically ill patients. Th e advantages of each technique wi...

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Renal perfusion evaluation with contrast-enhanced ultrasonography

Abstract: This study demonstrates that CEUS is able to detect changes in human renal cortical microcirculation as induced by AngII infusion and/or captopril administration. The changes in perfusion indices parallel those in ERPF as obtained by PAH clearance.

Cited by 77 publications

References 26 publications

Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study

Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study

Contrast-enhanced ultrasound: A promising method for renal microvascular perfusion evaluation

Measurement of Kidney Perfusion in Critically Ill Patients

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