Renal Resistive Index and Long-term Outcome in Chronic Nephropathies

Parolini, Claudia; Noce, Annalisa; Staffolani, Emiliano; Giarrizzo, Gerlando F; Costanzi, Stefano; Splendiani, G

doi:10.1148/radiol.2523080351

Cited by 122 publications

(100 citation statements)

References 34 publications

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“…Furthermore, even when analysis was restricted to the subgroup with eGFR Ͻ60 mL/min per 1.73 m 2 , which is defined as chronic kidney disease, 24 the independent role of RI in outcomes was maintained. These findings were partially in agreement with those from previous studies on high-risk patients with chronic nephropathy, 6 transplant renal allograft, 22 or heart failure 12 and extend the predictive role of renal hemodynamic abnormalities to essential hypertensive patients. These findings corroborate the hypothesis that the impact of RI on cardiovascular and renal risk is marked and that identifying renal hemodynamic abnormalities is useful for predicting cardiovascular and renal outcomes, especially in hypertensive patients with chronic kidney disease.…”

Section: Discussionsupporting

confidence: 92%

“…6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients…”

mentioning

confidence: 99%

“…2,3 Previous studies have explored the capacity of resistive index (RI) calculated from blood flow velocity in vessels to predict the progression of renal function in patients with hypertension, 4 diabetes mellitus, 5 or chronic nephropathy. 6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients 12 ; however, the results obtained were inconsistent.…”

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confidence: 99%

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Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

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Abstract-Increased renal restive index (RI) measured using Doppler ultrasonography has been shown to correlate with the degree of renal impairment in hypertensive patients. We investigated the prognostic role of RI in cardiovascular and renal outcomes. A total of 426 essential hypertensive subjects (mean age, 63 years; 50% female) with no previous cardiovascular disease were included in this study. Renal segmental arterial RI was measured by duplex Doppler ultrasonography. During follow-up (mean, 3.1 years), 57 participants developed the primary composite end points including cardiovascular and renal outcomes. In multivariate Cox regression analysis, RI was an independent predictor of worse outcome in total subjects (hazard ratio, 1.71 for 1 SD increase), as well as in patients with estimated glomerular filtration rate (eGFR) Ͻ60 mL/min per 1.73 m 2 (hazard ratio, 2.11 for 1 SD increase; PϽ0.01, respectively). When divided into 4 groups based on the respective sex-specific median levels of RI in the eGFR Ն60 and eGFR Ͻ60 mL/min per 1.73 m 2 groups, the group with eGFR Ͻ60 and high RI (male Ն0.73, female Ն0.72) had a significantly poorer event-free survival rate ( 2 ϭ126.4; PϽ0.01), and the adjusted hazard ratio by multivariate Cox regression analysis was 9.58 (95% CI, PϽ0.01). In conclusion, impairment of renal hemodynamics evaluated by increased RI is associated with an increased risk of primary composite end points, and the combination of high RI and low eGFR is a powerful predictor of these diseases in essential hypertension. In hypertensive patients with chronic kidney disease, RI evaluation may complement predictors of cardiovascular and renal outcomes. Key Words: cardiovascular disease Ⅲ renal hemodynamics Ⅲ ultrasonography Ⅲ hypertension Ⅲ predictor I n the past few years, there has been growing attention to markers of subclinical renal damage because they provide an accurate prediction of global cardiovascular outcome.1 Renal Doppler sonography permits noninvasive assessment of intrarenal hemodynamics in addition to evaluation of anatomic information. Intrarenal arterial waveforms recorded by Doppler sonography have been widely used to evaluate renal dysfunction.2,3 Previous studies have explored the capacity of resistive index (RI) calculated from blood flow velocity in vessels to predict the progression of renal function in patients with hypertension, 4 diabetes mellitus, 5 or chronic nephropathy. 6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients 12; however, the results obtained were inconsistent. Thus, the status of RI as an independent cardiovascular risk marker remains to be elucidated. Estimated glomerular filtration rate (eGFR), which is a measure of the kidneys' ...

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

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“…In mild to moderate renal dysfunction, RRI predicts CKD progression and poor outcome especially when RRI C0.7, independently from others measures like eGFR, maybe due to advanced glomerulosclerosis [16][17][18].…”

Section: Rri and Chronic Kidney Disease (Ckd)mentioning

confidence: 96%

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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“…RI >0.7 was considered pathologic. 3 Weighted kappa was used to evaluate the intra-rater re-liability by the same observer. The kappa values for RI and S/D were 0.975 and 0.965, respectively.…”

Section: Methodsmentioning

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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Renal Resistive Index and Long-term Outcome in Chronic Nephropathies

Abstract: An RI of 0.70 or higher is predictive of an unfavorable outcome in patients with chronic nephropathies.

Cited by 122 publications

References 34 publications

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

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

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