The Renal Arterial Resistance Index and Renal Allograft Survival

Radermacher, Jörg; Mengel, Michael; Ellis, S.; Stuht, Stephan; Hiss, Markus; Schwarz, Anke; Eisenberger, Ute; Burg, M.P.M. van der; Luft, Friedrich C.; Gwinner, Wilfried; Haller, Hermann

doi:10.1056/nejmoa022602

Cited by 365 publications

(296 citation statements)

References 35 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%

“…[21][22][23] Peak systolic velocity (PSV) and minimum end-diastolic velocity (EDV) were determined using the angle correction menu of the apparatus, and RI was defined as follows: (PSVϪEDV)/PSV. All of the velocities were determined for each segmental artery and averaged to obtain the mean value for each patient.…”

Section: Renal Ultrasonography and Doppler Studiesmentioning

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%

Section: Renal Ultrasonography and Doppler Studiesmentioning

confidence: 99%

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

View full text Add to dashboard Cite

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“…However, so far these predictors have not been introduced into clinical routine. The gold standard for diagnosis of AR is still the invasive core biopsy of the allograft, which is performed if clinicians suspect AR because renal function is impaired and/or Doppler ultrasound shows deterioration of the graft (18,19). The problem is that a high incidence of subclinical rejection episodes may occur even when serum creatinine values are still inconspicuous, as clearly shown by Rush et al in several studies performed with protocol biopsy specimens (20).…”

mentioning

confidence: 99%

Prediction of Acute Renal Allograft Rejection by Urinary Monokine Induced by IFN-γ (MIG)

Hauser¹,

Spiegler²,

Kiss³

et al. 2005

Journal of the American Society of Nephrology

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Early diagnosis of acute allograft rejection (AR) is still decisive for long-term renal allograft survival. The aim of this study was to define the role of the chemokine monokine induced by IFN-␥ (MIG) (CXCL9) and IFN-␥-inducible protein 10 (IP-10) (CXCL10) as early markers of AR in renal transplantation (NTX). In a prospective study, 69 de novo renal transplant recipients were monitored and urine samples were collected after NTX for a median of 29 d. In pH-adjusted urine, MIG and IP-10 were determined by modified ELISA. AR was clinically diagnosed in 15 of 69 recipients and confirmed by biopsy in 14 of 15 AR patients (Banff classification). Corresponding to CXCR3-positive infiltrates in renal tissue, urinary MIG was elevated in 14 of 15 AR patients with a median of 2809 pg/ml (quartile 25% and 75% ‫؍‬ 870 and 13,000; n ‫؍‬ 15), being significantly (P < 0.0001) different from both nonrejecting allograft patients (NO-AR) (median, 25%, and 75%: 96, 1.0, and 161, n ‫؍‬ 54) and healthy controls (median, 25%, and 75%: 144, 19, and 208, n ‫؍‬ 13). Urinary MIG predicted AR with a sensitivity of 93% and a specificity of 89%. In AR and NO-AR groups, MIG values correlated well with IP-10 (P < 0.001). MIG values indicated both imminent rejection and response to successful antirejection therapy. MIG was not related to intercurrent infections or other causes for impairment of renal function. In a multivariate analysis, MIG correlated best (P < 0.001) with AR from all AR-associated parameters. In conclusion, urinary MIG serves as a very sensitive and specific predictor for AR, mirrors response to antirejection therapy, and thus may contribute to improved long-term renal allograft survival.

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“…Its accuracy in the diagnosis of CAN is low, compared with clinical and laboratory data [20,21]. Rademarcher et al have demonstrated that a high RI after 3-4 months since the transplantation is a negative predictive factor of long-term graft survival, more than classical risk factors such as donor and recipient age, proteinuria, hypertension and delayed graft function [22].…”

Section: Chronic Rejectionmentioning

confidence: 99%

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

et al. 2014

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Kidney transplantation is the treatment of choice in end-stage renal disease, given the better quality of life of transplanted patients when compared with patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, parts of transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function. Even though ultrasonography is considered fundamental in the diagnosis of vascular and surgical complications of the transplanted kidney, its role is not fully understood in case of parenchymal complications of the graft. The specificity of Doppler is low both in case of acute complications, such as acute tubular necrosis, drugs toxicity and acute rejection, and in case of chronic conditions, such as chronic allograft nephropathy. Single determinations of resistance indices present low diagnostic accuracy, which is higher in case of successive measurements performed during the follow-up of the graft. Modern techniques such as tissue pulsatility index, maximal fractional area and contrast-enhanced ultrasound increase ultrasonography diagnostic power in case of parenchymal complications of the transplanted kidney.Keywords Ultrasonography Á Doppler ultrasound Á Renal transplantation Á Parenchymal complications Sommario Il trapianto di rene è il trattamento di scelta nella malattia renale allo stadio terminale, data la migliore qualità di vita dei pazienti trapiantati rispetto a quelli che continuano il trattamento dialitico. Nonostante i miglioramenti chirurgici e nuovi regimi immunosoppressivi, parte dei pazienti trapiantati sviluppano ancora disfunzioni croniche. L'ecografia, sia in B-mode che Doppler, è un importante strumento diagnostico in caso di condizioni cliniche che possono alterare la funzione renale. Anche se l'ecografia è considerata fondamentale nella diagnosi di complicanze chirurgiche e vascolari del rene trapiantato, il suo ruolo non è pienamente conosciuto in caso di (2015) 18:109-116 DOI 10.1007/s40477-014-0118-1 complicanze parenchimali. La specificità del Doppler è bassa, sia in caso complicanze acute, quali la necrosi tubulare acuta, la tossicità acuta da farmaci, il rigetto, sia in caso di complicanze croniche, come la nefropatia cronica del trapianto. Singole determinazioni di indici di resistenza presentano bassa accuratezza diagnostica, che è più elevata in caso di misure effettuate successivamente durante il follow-up del trapianto. Tecniche moderne, come l'indice di pulsatilità tissutale, massima frazione di zona ed ecografia con mdc aumentano le potenzialità diagnostiche dell'ecografia in caso di complicanze parenchimali del rene trapiantato.

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The Renal Arterial Resistance Index and Renal Allograft Survival

Cited by 365 publications

References 35 publications

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Prediction of Acute Renal Allograft Rejection by Urinary Monokine Induced by IFN-γ (MIG)

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

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