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Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

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Abstract

Doppler ultrasound has been extensively used in detecting reno-vascular diseases, showing to be a non-invasive, 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 vaso-active 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.

Riassunto

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 nel contesto di un peggioramento della funzione renale, sia nel rigetto acuto che nella nefropatia cronica del trapianto. Studi recenti suggeriscono un suo ruolo nel predire la comparsa del diabete di nuova insorgenza dopo il trapianto (NODAT) e potrebbe essere uno dei parametri da valutare nella sostituzione o nella sospensione della terapia immunologica e/o ipertensiva.

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References

  1. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(Suppl 1):266

    Google Scholar 

  2. Tuttle KR, Bakris GL, Bilous RW (2014) Diabetic kidney disease: a report from an ADA consensus conference. Am J Kidney Dis 64(4):510–533

    Article  PubMed  Google Scholar 

  3. Darmon M, Schnell D, Zeni F (2010) Doppler-based renal resistive index: a comprehensive review. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Heidelberg, pp 331–338

    Google Scholar 

  4. Mancini M, Masulli M, Liuzzi R et al (2013) Renal duplex sonographic evaluation of type 2 diabetic patients. J Ultrasound Med 32(6):1033–1040

    Article  PubMed  Google Scholar 

  5. Pape L, Offner G, Ehrich JH (2003) Renal arterial resistance index. N Engl J Med 349(16):1573–1574

    Article  PubMed  Google Scholar 

  6. Bruno RM, Daghini E, Landini L (2011) Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes. Diabetologia 54:2430–2439

    Article  CAS  PubMed  Google Scholar 

  7. Ohta Y, Fujii K, Arima H et al (2005) Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography. J Hypertens 23(10):1905–1911

    Article  CAS  PubMed  Google Scholar 

  8. Hamano K, Nitta A, Ohtake T, Kobayashi S (2008) Association of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients. Diabetes Care 31(9):1853–1857

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kawai T, Kamide K, Onishi M et al (2011) Usefulness of the resistive index in renal Doppler ultrasonography as an indicator of vascular damage in patients with risks of atherosclerosis. Nephrol Dial Transplant 26(10):3256–3262

    Article  PubMed  Google Scholar 

  10. Heine GH, Reichart B, Ulrich C et al (2007) Do Ultrasound renal resistance indices reflect systemic rather than renal vascular damage in chronic kidney disease? Nephrol Dial Transplant 22:163–170

    Article  PubMed  Google Scholar 

  11. Sugiura T, Wada A (2009) A Resistive index predicts renal prognosis in chronic kidney disease. Nephrol Dial Transplant 24(9):2780–2785

    Article  PubMed  Google Scholar 

  12. Leoncini G, Martinoli C, Viazzi F (2002) Change in renal resistive index and urinary albumin excretion in Hypertensive patients under long-term treatment with lisinopril and Nifedipine GITS. Nephron 90(2):169–173

    Article  CAS  PubMed  Google Scholar 

  13. Radermacher J (2006) Resistive Index: an ideal test frorenovascular disease or ischemic nephropathy? Nat Clin Pract Nephrol 2(5):232–233

    Article  PubMed  Google Scholar 

  14. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  15. de Zeeuw D, Hillege HL, de Jong PE (2005) The kidney, a cardiovascular risk marker, and a new target for therapy. Kidney Int Suppl 98:S25–S29

    Article  Google Scholar 

  16. Hanamura K, Tojo A, Knugasa S, Asaba K, Fujita TT (2012) The resistive index is a marker of renal function, pathology, prognosis, and responsiveness to steroid therapy in chronic kidney disease patients. Int J Nephrol 2012:139565

    PubMed  PubMed Central  Google Scholar 

  17. Ikee R, kobayashi S, Hemmi N et al (2005) Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J kidney dis 46(4):603–609

    Article  PubMed  Google Scholar 

  18. Parolini C, Noce A, Staffolani E, Giarrizzo GF, Costanzi S, Splendiani G (2009) Renal resistive index and long-term outcome in chronic nephropathies. Radiology 252(3):888–896

    Article  PubMed  Google Scholar 

  19. Quaia E, Bertolotto M (2002) Renal parenchymal diseases: is characterization feasible with ultrasound? Eur Radiol 12(8):2006–2020

    Article  PubMed  Google Scholar 

  20. Pozzi Mucelli R, Bertolotto M, Quaia E (2001) Imaging techniques in acute renal failure. Contrib Nephrol 132:76–91

    Article  Google Scholar 

  21. Mehta RL, Kellum JA, Shah SV (2007) Acute kidney injury network report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31

    Article  PubMed  PubMed Central  Google Scholar 

  22. KDIGO (Kidney Disease Improving Global Outcomes) (2012) Clinical practical guidelines for acute kidney injury. Kidney Int Suppl 2:19–36

    Article  Google Scholar 

  23. Zeng X, McMahon G, Brunelli SM (2014) Incidence outcomes, and comparisons across definitions of AKI in Hospitalized individuals. Clin J Am Soc Nephrol 9:12–20

    Article  CAS  PubMed  Google Scholar 

  24. Singbartl K et al (2012) AKI in ICU: definition, epidemiology, risk stratification and outcomes. Kidney Int 81(9):819–825

    Article  CAS  PubMed  Google Scholar 

  25. Li P et al (2013) Acute kidney injury: global health alert. Transplantation 95(5):653–657

    Article  CAS  PubMed  Google Scholar 

  26. Legrand MM, Darmon M (2015) Renal imaging in acute kidney injury. Acute Nephrol Crit Care Phys. doi:10.1007/978-3-319-17389-4_10 Springer International Publishing

    Google Scholar 

  27. Lauschke A, Teichgraber UKM, Frei U et al (2006) “Low-Dose” dopamine worsens renal perfusion in patients withacute renal failure. Kidney Int 69:1669–1674

    Article  CAS  PubMed  Google Scholar 

  28. Deruddre S, Cheisson G, Mazoit JX et al (2007) Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med 33(9):1557–1562

    Article  PubMed  Google Scholar 

  29. Lerolle N, Guerot E, Faisy C et al (2006) Renal failure in septic shock: predictive value of Doppler based renal arterial resistive index. Intensive Care Med 32(10):1553–1559

    Article  PubMed  Google Scholar 

  30. Granata A, Andrulli S, Bigi MQ et al (2009) Predictive role of duplex Doppler ultrasonography in the diagnosis of acute renal obstruction in patients with unilateral renal colic. Clin Nephrol 71(6):680–686

    Article  CAS  PubMed  Google Scholar 

  31. Solez K, Vincenti F, Filo R (1998) Histopathologic findings from 2-year protocol biopsies from a U:S: multicenter kidney transplant trial comparing tacrolimus versus cyclosporine: a report of the FK506. Kidney Transplant Study Group. Transplantation 66:1736–1740

    Article  CAS  PubMed  Google Scholar 

  32. Paul LC (1999) Chronic allograft nephropathy: an update. Kidney Int 56:783–793

    Article  CAS  PubMed  Google Scholar 

  33. Nankivell BJ, Borrows RJ, Fung CL et al (2003) The natural history of chronic allograft nephropathy. N Engl J Med 349:2326–2333

    Article  CAS  PubMed  Google Scholar 

  34. Solez K, Colvin RB, Racusen LC et al (2007) Banff’05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy (‘CAN’). Am J Transplant 7:518–526

    Article  CAS  PubMed  Google Scholar 

  35. Radermacher J, Mengel M, Ellis S et al (2003) The renal resistance index and renal allograft survival. N Engl J Med 349(2):115–124

    Article  PubMed  Google Scholar 

  36. Vallejos A, Alperovich G, Moreso F et al (2005) Resistive Index and chronic allograft nephropathy evaluated in protocol biopsies as predictor of graft outcome. Nephrol Dial Transplant 20(11):2511–2516

    Article  PubMed  Google Scholar 

  37. Kramann R, Frank D, Brandeburg VM et al (2012) Prognostic impact of renal arterial resistance index upon renal allograft survival: the time point matters. Nephrol Dial Transplant 27(10):3958–3963

    Article  PubMed  Google Scholar 

  38. Naesens M, Heylen L, Lerut H et al (2013) Intrarenal resistive index after renal transplantation. N Engl J Med 369(19):1797–1806

    Article  CAS  PubMed  Google Scholar 

  39. Mutinelli-Szymanski P, Caille A, Tranquart F et al (2012) Renal resistive index as a new independent risk factor for new onset diabetes mellitus after kidney transplantation. Transpl Int 25(4):464–470

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Internal Medicine Unit, Hospital San Pellegrino srl, Castiglione delle Stiviere, Mantua, MN, Italy

    Leonardo Spatola

  2. Renal Unit, Hospital “A. Manzoni”, via Dell’Eremo, Lecco, LC, Italy

    Simeone Andrulli

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  1. Leonardo Spatola
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  2. Simeone Andrulli
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Correspondence to Leonardo Spatola.

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Spatola, L., Andrulli, S. Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up. J Ultrasound 19, 243–250 (2016). https://doi.org/10.1007/s40477-016-0201-x

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