Use of Doppler Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis

Radermacher, Jörg; Chavan, Ajay; Bleck, J. S.; Vitzthum, Annabel; Stoess, Birte; Gebel, M.; Galanski, Michael; Koch, K. M.; Haller, Hermann

doi:10.1056/nejm200102083440603

Cited by 685 publications

(428 citation statements)

References 25 publications

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“…15,16 A recent study declared duplex ultrasound to be most valuable not only in the screening for renal artery disease but also to estimate its functional significance by means of determination of the resistive index. 17 The duplex ultrasound performance in this study, however (ie, sensitivity 97%; specificity 98%), was derived from a previous report by the same authors in a selected group of patients with a high prevalence of renovascular disease (58%). 18 Therefore, implicit adoption of these test performance parameters to a non-selected population with a relatively low prevalence for renovascular disease (2.3%) seems somewhat premature and raises doubts about whether the resistive index has the same prognostic significance for the remaining patients with stenosis not detected by duplex ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Renovascular disease in patients with hypertension: detection with duplex ultrasound

et al. 2002

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The aim of this study was to evaluate the accuracy of duplex ultrasound for the diagnosis of renovascular disease in a cohort of hypertensive patients. In 78 patients suspected of renovascular hypertension on clinical grounds duplex ultrasound examination of the renal arteries was performed. Renal angiography was used as the standard of reference. Duplex ultrasound was inconclusive in 11 kidneys (7%). None of the supernumerary renal arteries was detected with duplex ultrasound. The overall prevalence of significant renovascular disease (у50% stenosis) was 20%. Based on the combination of parameters at thresholds commonly applied in current literature: ie PSV max Ͼ180 cm/sec and RAR Ͼ3.5 the overall sensitivity of duplex ultrasound for detection of haemodynamically significant renovascular disease was 50.0% with a specificity of 91.3% (PPV: 87.9%; NPV:

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Section: Discussionmentioning

confidence: 99%

Renovascular disease in patients with hypertension: detection with duplex ultrasound

et al. 2002

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Section: Distal Criteria (Indirect Evaluation Of the Stenosis)mentioning

confidence: 99%

“…Radermacher et al [43] showed in a large prospective study that symptoms and urinary values do not improve after stenting in patients with elevated RI > 0.80. The authors [43] therefore suggested that repair of the stenosis is not warranted in these patients. However, a subsequent study showed that 29% of patients with renal insufficiency and RI > 0.80 showed improved renal function after revascularization, and 50% had improvement of hypertension [28].…”

Section: Distal Criteria (Indirect Evaluation Of the Stenosis)mentioning

confidence: 99%

Doppler ultrasound and renal artery stenosis: An overview

Granata

Fiorini²,

Andrulli

et al. 2009

Journal of Ultrasound

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KEYWORDSDoppler ultrasound; Ischemic nephropathy; Renal artery stenosis; Renovascular disease.Abstract Renovascular disease is a complex disorder, most commonly caused by fibromuscular dysplasia and atherosclerotic diseases. It can be found in one of three forms: asymptomatic renal artery stenosis (RAS), renovascular hypertension, and ischemic nephropathy. Particularly, the atherosclerotic form is a progressive disease that may lead to gradual and silent loss of renal function. Thus, early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Screening for RAS is indicated in suspected renovascular hypertension or ischemic nephropathy, in order to identify patients in whom an endoluminal or surgical revascularization is advisable. Screening tests for RAS have improved considerably over the last decade. While captopril renography was widely used in the past, Doppler ultrasound (US) of the renal arteries (RAs), angio-CT, or magnetic resonance angiography (MRA) have replaced other modalities and they are now considered the screening tests of choice. An arteriogram is rarely needed for diagnostic purposes only. Color-Doppler US (CDUS) is a noninvasive, repeatable, relatively inexpensive diagnostic procedure which can accurately screen for renovascular diseases if performed by an expert. Moreover, the evaluation of the resistive index (RI) at Doppler US may be very useful in RAS affected patients for predicting the response to revascularization. However, when a discrepancy exists between clinical data and the results of Doppler US, additional tests are mandatory.Sommario La malattia nefrovascolare è un disordine complesso e le cause più comuni sono la malattia aterosclerotica e la displasia fibromuscolare. Classicamente si presenta in una delle seguenti tre forme: stenosi dell'arteria renale (SAR) asintomatica, associata a ipertensione nefrovascolare e/o con nefropatia ischemica. La SAR su base aterosclerotica è una malattia progressiva che può determinare in maniera asintomatica o paucisintomatica perdita graduale della funzione renale. Per tale motivo, la diagnosi precoce di SAR è un obiettivo clinico importante poiché la terapia interventistica può migliorare o curare l'ipertensione e preservare la funzione renale. Lo screening per SAR è indicato nel sospetto di ipertensione nefrovascolare o di nefropatia ischemica al fine di identificare i pazienti in cui è indicato un intervento di rivascolarizzazione. I test di screening per SAR sono migliorati considerevolmente durante l'ultimo decennio. Mentre la scintigrafia con test al captopril è stata utilizzata quasi esclusivamente nel passato, l'ecocolorDoppler delle arterie renali, l'angioTC e/o l'angioRM hanno sostituito le altre modalità di screening in molti centri. Per tale motivo l'arteriografia riveste sempre più un ruolo interventistico e solo di rado diagnostico. L'ecocolorDoppler è una procedura diagnostica non invasiva, ripetibile e relativamente economica che negli ultim...

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“…For example, the study by Radermacher et al evaluating Doppler ultrasonography for prediction of response to renal artery stenosis therapy found that ''a renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival'' (2). Importantly, this renal resistive index was measured in the interlobar arteries in the parenchyma of the kidney contralateral to that undergoing intervention, that is, it is the global parenchymal changes (particularly glomerulosclerosis) in the kidneys themselves that are important in predicting response to revascularization.…”

Section: Atheroscelroticmentioning

confidence: 99%

Renovascular imaging in the NSF Era

Roditi

Maki

Oliveira

et al. 2009

Magnetic Resonance Imaging

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The detection of the association between nephrogenic systemic fibrosis (NSF), a rare but potentially life‐threatening disease only encountered in patients with severely impaired renal function, and the previous administration of some Gd‐chelates has cast a shadow on the administration of Gd‐chelates in patients with chronic renal failure. So far, contrast‐enhanced MR‐angiography (MRA) was considered the best diagnostic modality in patients with suspected renal disease. This review explores the most appropriate use of renal MRA with a focus on newly developed nonenhanced MRA techniques. Nonenhanced MRA techniques mainly based on SSFP with ECG‐gating allow for acceptable spatial resolution to visualize at least the proximal parts of the renal arteries. In addition functional renal imaging techniques and their current clinical role are critically appreciated. J. Magn. Reson. Imaging 2009;30:1323–1334. © 2009 Wiley‐Liss, Inc.

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Use of Doppler Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis

Abstract: A renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival.

Cited by 685 publications

References 25 publications

Renovascular disease in patients with hypertension: detection with duplex ultrasound

Renovascular disease in patients with hypertension: detection with duplex ultrasound

Doppler ultrasound and renal artery stenosis: An overview

Renovascular imaging in the NSF Era

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