Skip to main content
SpringerLink
Log in

Intraparenchymal Renal Resistive Index: The Basic of Interpretation and Common Misconceptions

  • Chapter
  • First Online:
Imaging in Nephrology

Abstract

Renal resistive indices (RRIs) express the percentage reduction of the end diastolic blood flow in renal vessels in relation to the maximum systolic blood flow and can be obtained through the Doppler spectrum analysis from segmental and/or interlobar arteries. RRIs have had a great diffusion in clinical practice as markers of purely renal organ damage, providing a useful noninvasive evaluation of renal microcirculation. However, studies in the past that have tried to correlate RRIs with the type of renal histological damage (glomerular, mesangial, or tubular-interstitial) have given conflicting results. Growing data from the literature demonstrate that RRIs are not only derived from specific renal components (such as the renal capillary wedge pressure), but are also the result of complex interactions between the vascular tree and systemic hemodynamic factors, including the pulse pressure, systemic vascular compliance, and cardiac function. The purpose of this chapter is to explain the emerging pathophysiological aspects of the relationship between renal microcirculation and cardiovascular system and to answer some of the most frequent questions about RRI applicability and utility in renal and non-primarily renal clinical scenarios.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stefan G, Capusa C, Stancu S, Petrescu L, Nedelcu ED, Andreiana I, Mircescu G. Abdominal aortic calcification and renal resistive index in patients with chronic kidney disease: is there a connection? J Nephrol. 2014;27(2):173–9.

    Article  CAS  PubMed  Google Scholar 

  2. Granata A, Zanoli L, Clementi S, Fatuzzo P, Di Nicolò P, Fiorini F. Resistive intrarenal index: myth or reality? Br J Radiol. 2014;87:1038.

    Article  Google Scholar 

  3. Andriani G, Persico A, Tursini S, Ballone E, Cirotti D, Lelli Chiesa P. The renal-resistive index from the last 3 months of pregnancy to 6 months old. BJU Int. 2001;87:562–4.

    Article  CAS  PubMed  Google Scholar 

  4. Gigante A, Barbano B, Di Mario F, Rosato E, Simonelli M, Rocca AR, Conti F, Ceccarelli F, Giannakakis K, Valesini G, Cianci R. Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: correlation with histological findings. Int J Immunopathol Pharmacol. 2016;29(3):469–74.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fiorini F, Granata A, Noce A, Durante O, Insalaco M, Di Daniele N. Index resistance in renal ultrasound: what is the clinical significance? G Ital Nefrol. 2013;30(2):gin/30.2.4.

    PubMed  Google Scholar 

  6. Tublin ME, Bude RO, Platt JF. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol. 2003;180(4):885–92.

    Article  PubMed  Google Scholar 

  7. Chirinos JA, Townsend RR. Systemic arterial hemodynamics and the “renal resistive index”: what is in a name? J Clin Hypertens (Greenwich). 2014;16(3):170–1.

    Article  Google Scholar 

  8. Bude RO, Rubin JM. Relationship between the resistive index and vascular compliance and resistance. Radiology. 1999;211:411–7.

    Article  CAS  PubMed  Google Scholar 

  9. Tublin ME, Tessler FN, Murphy ME. Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology. 1999;213:258–64.

    Article  CAS  PubMed  Google Scholar 

  10. O’Neill WC. Renal resistive index: a case of mistaken identity. Hypertension. 2014;64(5):915–7.

    Article  PubMed  CAS  Google Scholar 

  11. Calabia J, Torguet P, Garcia I, Martin N, Mate G, Marin A, Molina C, Valles M. The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation. J Clin Hypertens (Greenwich). 2014;16(3):186–91.

    Article  Google Scholar 

  12. Kuznetsova T, Cauwenberghs N, Knez J, Thijs L, Liu YP, Gu YM, Staessen JA. Doppler indexes of left ventricular systolic and diastolic flow and central pulse pressure in relation to renal resistive index. Am J Hypertens. 2015;28(4):535–45.

    Article  CAS  PubMed  Google Scholar 

  13. Ciccone MM, Iacoviello M, Gesualdo L, Puzzovivo A, Antoncecchi V, Doronzo A, Monitillo F, Citarelli G, Paradies V, Favale S. The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression. Eur J Heart Fail. 2014;16(2):210–6.

    Article  CAS  PubMed  Google Scholar 

  14. Hashomoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics: pathophysiological implication for microalbuminuria in hypertension. Hypertension. 2011;58(5):839–46.

    Article  CAS  Google Scholar 

  15. Kirkpatrick AW, Colistro R, Laupland KB, et al. Renal arterial resistive index response to intraabdominal hypertension in a porcine model. Crit Care Med. 2007;35:207–13.

    Article  PubMed  Google Scholar 

  16. Pozniak MA, Kelcz F, Stratta RJ, Oberley TD. Extraneous factors affecting resistive index. Investig Radiol. 1988;23:899–904.

    Article  CAS  Google Scholar 

  17. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WH. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53:589–96.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ohuchi H, Ikado H, Noritake K, Miyazaki A, Yasuda K, Yamada O. Impact of central venous pressure on cardiorenal interactions in adult patients with congenital heart disease after biventricular repair. Congenit Heart Dis. 2013;8(2):103–10.

    Article  PubMed  Google Scholar 

  19. Ennezat PV, Maréchaux S, Six-Carpentier M, Pinçon C, Sediri I, Delsart P, Gras M, Mounier-Véhier C, Gautier C, Montaigne D, Jude B, Asseman P, Le Jemtel TH. Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction. Nephrol Dial Transplant. 2011;26(12):3908–13.

    Article  PubMed  Google Scholar 

  20. Mostbeck GH, Gössinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D. Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology. 1990;175:511–3.

    Article  CAS  PubMed  Google Scholar 

  21. Rozemeijer S, Haitsma Mulier JLG, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM. Renal resistive index: response to shock and its determinants in critically ill patients. Shock. 2019;52(1):43–51.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Boddi M, Natucci F, Ciani E. The internist and the renal resistive index: truths and doubts. Intern Emerg Med. 2015;10(8):893–905.

    Article  PubMed  Google Scholar 

  23. O’Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007;50(1):1–13.

    Article  PubMed  Google Scholar 

  24. Boddi M, Sacchi S, Lammel RM, et al. Age-related and vasomotor stimuli-induced changes in renal vascular resistance detected by Doppler ultrasound. Am J Hypertens. 1996;9:461–6.

    Article  CAS  PubMed  Google Scholar 

  25. O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46(1):200–4.

    Article  PubMed  CAS  Google Scholar 

  26. Pontremoli R, Viazzi F, Martinoli C, Ravera M, Nicolella C, Berruti V, Leoncini G, Ruello N, Zagami P, Bezante GP, Derchi LE, Deferrari G. Increased renal resistive index in patients with essential hypertension: a marker of target organ damage. Nephrol Dial Transplant. 1999;14(2):360–5.

    Article  CAS  PubMed  Google Scholar 

  27. Doi Y, Iwashima Y, Yoshihara F, Kamide K, Takata H, Fujii T, Kubota Y, Nakamura S, Horio T, Kawano Y. Association of renal resistive index with target organ damage in essential hypertension. Am J Hypertens. 2012;25(12):1292–8.

    CAS  PubMed  Google Scholar 

  28. Platt JF, Rubin JM, Ellis JH. Acute renal failure: possible role of duplex Doppler US in distinction between acute prerenal failure and acute tubular necrosis. Radiology. 1991;179(2):419–23.

    Article  CAS  PubMed  Google Scholar 

  29. Vives M, Wijeysundera D, Marczin N, et al. Cardiac surgery-associated acute kidney injury. Interact Cardiovasc Thorac Surg. 2014;18:637–45.

    Article  PubMed  Google Scholar 

  30. Bossard G, Bourgoin P, Corbeau JJ, et al. Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass. Br J Anaesth. 2011;107:891–8.

    Article  CAS  PubMed  Google Scholar 

  31. Hertzberg D, Ceder SL, Sartipy U, et al. Preoperative renal resistive index predicts risk of acute kidney injury in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:847–52.

    Article  PubMed  Google Scholar 

  32. Bellos I, Pergialiotis V, Kontzoglou K. Renal resistive index as predictor of acute kidney injury after major surgery: a systematic review and meta-analysis. J Crit Care. 2019;50:36–43.

    Article  PubMed  Google Scholar 

  33. Nori G, Granata A, Leonardi G, Sicurezza E, Spata C. The US color Doppler in acute renal failure. Minerva Urol Nefrol. 2004;56(4):343–52.

    CAS  PubMed  Google Scholar 

  34. Parolini C, Noce A, Staffolani E, Giarrizzo GF, Costanzi S, Splendiani G. Renal resistive index and long-term outcome in chronic nephropathies. Radiology. 2009;252(3):888–96.

    Article  PubMed  Google Scholar 

  35. Sugiura T, Wada A. Resistive index predicts renal prognosis in chronic kidney disease. Nephrol Dial Transplant. 2009;24(9):2780–5.

    Article  PubMed  Google Scholar 

  36. Sugiura T, Wada A. Resistive index predicts renal prognosis in chronic kidney disease: results of a 4-year follow-up. Clin Exp Nephrol. 2011;15(1):114–20.

    Article  PubMed  Google Scholar 

  37. Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, Galanski M, Koch KM, Haller H. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344(6):410–7.

    Article  CAS  PubMed  Google Scholar 

  38. Bruno RM, Daghini E, Versari D, Sgrò M, Sanna M, Venturini L, Romanini C, Di Paco I, Sudano I, Cioni R, Lerman LO, Ghiadoni L, Taddei S, Pinto S. Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis: a monocentric observational study. Cardiovasc Ultrasound. 2014;12:9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Heine GH, Gerhart MK, Ulrich C, Köhler H, Girndt M. Renal Doppler resistance indices are associated with systemic atherosclerosis in kidney transplant recipients. Kidney Int. 2005;68:878–85.

    Article  PubMed  Google Scholar 

  40. Toledo C, Thomas G, Schold JD, Arrigain S, Gornik HL, Nally JV, Navaneethan SD. Renal resistive index and mortality in chronic kidney disease. Hypertension. 2015;66(2):382–8.

    Article  CAS  PubMed  Google Scholar 

  41. Kim JH, Lee SM, Son YK, Kim SE, An WS. Resistive index as a predictor of renal progression in patients with moderate renal dysfunction regardless of angiotensin converting enzyme inhibitor or angiotensin receptor antagonist medication. Kidney Res Clin Pract. 2017;36(1):58–67.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Naesens M, Heylen L, Lerut E, Claes K, De Wever L, Claus F, et al. Intrarenal resistive index after renal transplantation. N Engl J Med. 2013;369:1797–806.

    Article  CAS  PubMed  Google Scholar 

  43. Bellos I, Perrea DN, Kontzoglou K. Renal resistive index as a predictive factor of delayed graft function: a meta-analysis. Transplant Rev (Orlando). 2019;33(3):145–53.

    Article  Google Scholar 

  44. Grün OS, Herath E, Weihrauch A, Flügge F, Rogacev KS, Fliser D, Heine GH. Does the measurement of the difference of resistive indexes in spleen and kidney allow a selective assessment of chronic kidney injury? Radiology. 2012;264:894–902.

    Article  PubMed  Google Scholar 

  45. Lennartz CS, Pickering JW, Seiler-Mußler S, Bauer L, Untersteller K, Emrich IE, Zawada AM, Radermacher J, Tangri N, Fliser D, Heine GH. External validation of the kidney failure risk equation and re-calibration with addition of ultrasound parameters. Clin J Am Soc Nephrol. 2016;11(4):609–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, Rousson V, Mohaupt MG, Alwan H, Ehret G, Pechere-Bertschi A, Paccaud F, Staessen JA, Vogt B, Burnier M, Martin PY, Bochud M. Reference values and factors associated with renal resistive index in a family-based population study. Hypertension. 2014;63(1):136–42.

    Article  CAS  PubMed  Google Scholar 

  47. Di Nicolò P, Granata A. Renal resistive index: not only kidney. Clin Exp Nephrol. 2017;21(3):359–66.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology and Dialysis Unit, S. Maria della Scaletta Hospital, Imola (Bo), Italy

    Pierpaolo Di Nicolò

  2. Nephrology and Dialysis Unit, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy

    Michele Prencipe

  3. Nephrology and Dialysis Unit, Ospedale “San Bassiano”, Bassano del Grappa, VI, Italy

    Paolo Lentini

  4. Department of Nephrology and Dialysis, “Cannizzaro” Emergency Hospital, Catania, Italy

    Antonio Granata

Authors
  1. Pierpaolo Di Nicolò
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Prencipe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Lentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Granata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierpaolo Di Nicolò .

Editor information

Editors and Affiliations

  1. Department of Nephrology and Dialysis, “Cannizzaro” Emergency Hospital, Catania, Italy

    Antonio Granata

  2. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Michele Bertolotto

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Di Nicolò, P., Prencipe, M., Lentini, P., Granata, A. (2021). Intraparenchymal Renal Resistive Index: The Basic of Interpretation and Common Misconceptions. In: Granata, A., Bertolotto, M. (eds) Imaging in Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-60794-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-60794-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-60792-0

  • Online ISBN: 978-3-030-60794-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation