The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction

Meier, Markus; Fricke, Lutz; Eikenbusch, Katrin; Smith, Evan; Kramer, Jan; Lehnert, Hendrik; Nitschke, Martin

doi:10.7863/ultra.16.07032

Cited by 7 publications

(9 citation statements)

References 31 publications

(85 reference statements)

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“…Similar to our result, Köhnke et al showed low sensitivity and low specificity of RI in the identification of acute renal allograft rejection [7]. Meier et al introduce the serial duplex index (SDI = [(RI t0 /RI t-1 ) × (PI t0 /Pi t-1 )]/(CPP t0 /CPP t-1 ), were CPP = cortex-pelvis proportion, PI = pulsatility index, t0 = values from the day of biopsy, t-1 = values from three to seven days before biopsy) and investigated how its value varies on normal kidney graft function, acute tubular necrosis, acute cellular rejection and acute vascular rejection [39]. However, age [40], pulse pressure, heart rate and cardiac rhythm [41] affect the RIs values and thus could explain the controversially RI results on kidney allograft evaluation [37,40,[42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Bolboacă

Elec

Elec³

et al. 2020

Diagnostics

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Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients' characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young's modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68-31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08-27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (−0.44, p-value < 0.0001 for allograft cortex and −0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed.

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Section: Discussionmentioning

confidence: 99%

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Bolboacă

Elec

Elec³

et al. 2020

Diagnostics

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“…In another recent study, Meier et al investigated if a newly developed serial duplex index (SDI) can be used to differentiate between AR and acute vascular rejection more effectively in comparison with the established Doppler parameters RI and pulsatility index (PI) in the first days after the transplantation [31]. The PI represents a Doppler derived index that depends on downstream renal artery resistance and stiffness [32].…”

Section: Ultrasoundmentioning

confidence: 99%

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Jehn

Schuette-Nuetgen

Kentrup

et al. 2019

Contrast Media & Molecular Imaging

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To date, allogeneic kidney transplantation remains the best available therapeutic option for patients with end-stage renal disease regarding overall survival and quality of life. Despite the advancements in immunosuppressive drugs and protocols, episodes of acute allograft rejection, a sterile inflammatory process, continue to endanger allograft survival. Since effective treatment for acute rejection episodes is available, instant diagnosis of this potentially reversible graft injury is imperative. Although histological examination by invasive core needle biopsy of the graft remains the gold standard for the diagnosis of ongoing rejection, it is always associated with the risk of causing substantial graft injury as a result of the biopsy procedure itself. At the same time, biopsies are not immediately feasible for a considerable number of patients taking anticoagulants due to the high risk of complications such as bleeding and uneven distribution of pathological changes within the graft. This can result in the wrong diagnosis due to the small size of the tissue sample taken. Therefore, there is a need for a tool that overcomes these problems by being noninvasive and capable of assessing the whole organ at the same time for specific and fast detection of acute allograft rejection. In this article, we review current state-of-the-art approaches for noninvasive diagnostics of acute renal transplant inflammation, i.e., rejection. We especially focus on nonradiation-based methods using magnetic resonance imaging (MRI) and ultrasound.

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“…Patients in the CRS and CKD groups had undergone kidney ultrasound examination performed in the nephrology outpatient center by three experienced investigators and echocardiographic examination at the cardiology department of the Hospital of Reinbek, St. Adolf Stift between 2014 and 2017. The NRF group had undergone both ultrasound and echocardiographic examination at the Medical Department of the University of Lubeck between 2007 and 2014, as described previously 9 10 . The renal ultrasound examinations of these patients had been performed by the same three experienced investigators (MM; MN, WJ) who performed the investigations of the CKD and CRS group in the same standardized protocol (described below) a few years later.…”

Section: Methodsmentioning

confidence: 99%

“…Data regarding both routine grayscale and duplex ultrasound scans were obtained for all enrolled patients. The standard ultrasound examination protocol applied for the patients included in the current study has been outlined previously 9 10 and is as follows: Ultrasound examination was performed in the supine position during the morning hours by one of the three authors using the same transducers (multifrequency probes, curved array, C4-1, C9-3 or C6-2, Zonare Medical Systems, Mountain View, Ca, USA) and devices (Z.one and ZS3, Zonare Medical Systems, Mountain View, CA, USA). The following parameters were measured and recorded during each ultrasound scan: the cortex-pelvis proportion (CPP), resistive index (RI), pulsatility index (PI), and venous velocity (VV).…”

Section: Methodsmentioning

confidence: 99%

“…The following parameters were measured and recorded during each ultrasound scan: the cortex-pelvis proportion (CPP), resistive index (RI), pulsatility index (PI), and venous velocity (VV). The definitions for these parameters have been described previously 10 . This protocol was established at the transplant center in 2006 and adopted by our outpatient clinic five years later.…”

Section: Methodsmentioning

confidence: 99%

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Sonographic Venous Velocity Index Identifies Patients with Chronic Kidney Disease and Severe Diastolic Dysfunction

Meier¹,

Jabs

Guthmann

et al. 2018

Ultrasound Int Open

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ObjectiveDiagnosing cardiorenal syndrome (CRS) in patients with chronic kidney disease (CKD) continues to remain challenging in outpatient practice. In this study, we investigate whether a newly developed venous velocity ultrasound index (VVI) can differentiate between patients with CRS and patients with CKD of other cause or normal renal function (NRF).Methods Patients with CRS (n = 30), CKD (n=30), and NRF (n=30) were included in the study. For each patient, duplex ultrasound scans of intrarenal segmental veins were retrospectively analyzed. The VVI was calculated from the renal venous doppler curve as the ratio of the maximal positive venous velocity to the maximal negative venous velocity. Patients with CRS were compared to age-matched controls with NRF and to GFR-matched controls with CKD. Results:The GFRs of patients with CRS and those with CKD were comparable (26.4±5 and 25.6±7 ml/min/m2), as was the age in patients with CRS and NRF (6 ±12 years and 68±16 years, respectively). There was no significant difference in ejection fraction between patients with CRS and those with CKD (44.2±6.2% vs. 47.4 ±7.2), but there was a significant decrease compared to those with NRF (52.6 ±5.1, p<0.01). The VVI was significantly higher in the CRS group (0.81± 0.18) compared to the CKD group (0.18± 0.17, p<0.01) or NRF group (0.22± 0.20, p<0.01). The positive predictability of CRS was 96.4% in patients with VVI values of >0.6.ConclusionThe newly developed VVI was useful in successfully predicting severe diastolic dysfunction (CRS) in patients with severe kidney injury in outpatient care.

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The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction

Cited by 7 publications

References 31 publications

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Sonographic Venous Velocity Index Identifies Patients with Chronic Kidney Disease and Severe Diastolic Dysfunction

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