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Renal Circulation

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Doppler Sonography in Infancy and Childhood

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Abstract

Color and spectral Doppler allow flow measurement in renal arteries and veins. Normal values for the flow velocities and resistance indices are necessary for the quantification of kidney perfusion. Flow velocities decrease from the hilus to the periphery of the kidney: They are highest in the renal arteries and veins and lowest in the interlobar arteries and veins. Additionally the flow velocities increase with age and weight of the patient. If pathologic flow parameters are estimated the location of the sample volume and the age and weight of the patient have to be considered. Renal flow parameters may be influenced by hemodynamic, cardiovascular and renal or urinary tract diseases. Cardiovascular malformations which influence renal perfusion are leakages of the aortic ‘Windkessel’ such as an open duct, common arterial trunk and left heart obstructions such as hypoplastic left heart syndrome and coarctation of the aorta. Leakages of the aortic ‘Windkessel’ are characterized by a decrease of the diastolic amplitude whereas left heart obstruction reduce the systolic amplitude. Acute renal failure can be caused pre-renal, renal and post-renal. These conditions may be associated with low diastolic flow, sometimes retrograde diastolic flow, which causes low volume flow and renal failure. Examples for pre-renal failure are cardiovascular anomalies and shock. Examples of renal failure are reno-parenchymal diseases such as glomerulonephritis, pyelonephritis and cystic kidney disease. Post-renal abnormalities are obstructive uropathies.

Renal venous thrombosis is characterized by an increase of kidney volume and an absent or retrograde diastolic flow in the renal arteries. Renal arterial stenosis is characterized by a marked increase of the flow velocities in the affected artery often over 2 m/s.

Other indications for Doppler sonography are nephrolithiasis (twinkling sign), traumatic injury of the kidney and space occupying lesions of the kidney such as renal cysts and tumors. Renal cysts show no perfusion, whereas Wilm’s tumors are characterized by venous leaks and displacement or infiltration of adjacent arteries and veins. After kidney transplantation Doppler sonography can differentiate between various post-transplant complications such as arterial or venous occlusion, stenosis, arterio-venous fistulas, lymphoceles etc. Spectral Doppler is an important tool for early diagnosis of acute vascular rejection. It is characterized by decrease of the diastolic amplitude velocity and an increase of the resistive index. Color Doppler can display ureteral jets within the bladder. The frequency of the jets, the area of the jet and the inflow velocity can be measured. If the various jet characteristics are helpful for the differential diagnosis of various urological diseases has to be evaluated.

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  1. Clinic for Children and Adolescents, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    Karl-Heinz Deeg

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Deeg, KH. (2015). Renal Circulation. In: Doppler Sonography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-03506-2_10

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