Intensive Care Medicine

, Volume 16, Issue 3, pp 153–158 | Cite as

Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man

  • P. E. Stevens
  • S. J. Gwyther
  • M. E. Hanson
  • J. E. Boultbee
  • W. J. Kox
  • M. E. Phillips
Originals

Abstract

Duplex Doppler ultrasound (DDU) was used to study the blood flow characteristics of the renal interlobar artery in 20 subjects with acute renal failure (ARF), 14 subjects with transient impairment of renal function and 23 control subjects with normal function. Renovascular resistance was assessed by pulsatility index (PI) and change in flow velocity by change in mean frequency shift (Δf). The 99% confidence intervals for PI in the three groups were 3.32–5.46, 1.58–2.34 and 0.99–1.33 respectively. Values for Δf were 0.2–0.38, 0.5–0.62 and 0.7–1.02 kHz respectively. Ten ARF patients recovered function, 99% confidence intervals for PI just prior to recovery were 0.9–1.48 and for Δf 0.52–1.02 kHz. There was increased renovascular resistance and reduced intrarenal blood flow velocity at the onset of ARF. These changes persisted during ARF; recovery of function occurred after they returned to normal. Similar, but less marked, changes were found in patients with a transient impairment of function.

Key Words

Acute renal failure Renal blood flow Renovascular resistance Duplex Doppler ultrasound 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Tanner GA, Sloan KL, Sophasan S (1973) Effects of renal artery occlusion on kidney function in the rat. Kidney Int 4:377–389Google Scholar
  2. 2.
    Eisenbach GM, Steinhausen M (1973) Micropuncture studies after temporary ischaemia of rat kidneys. Pflugers Arch 343:11–25Google Scholar
  3. 3.
    Arendshorst WJ, Finn WF, Gottschalk CW (1975) Pathogenesis of acute renal failure following temporary renal ischaemia in the rat. Circ Res 37:558–568Google Scholar
  4. 4.
    Tanner GA, Sophasan S (1976) Kidney pressures after temporary renal artery occlusion in the rat. Am J Physiol 230:1173–1181Google Scholar
  5. 5.
    Olbricht C, Mason J, Takabatake T, Hohlbrugger G, Thurau K (1977) The early phase of experimental acute renal failure: II. Tubular leakage and the reliability of glomerular markers. Pflugers Arch 372:251–258Google Scholar
  6. 6.
    Donohoe JF, Venkatachalam MA, Bernard DB, Levinsky NG (1978) Tubular leakage and obstruction after renal ischaemia: structural-functional correlations. Kidney Int 13:208–222Google Scholar
  7. 7.
    Venkatachalam MA, Bernard DB, Donohoe JF, Levinsky NG (1978) Ischaemic damage and repair in the rat proximal tubule. Difference among the S1, S2 and S3 segments. Kidney Int 14:31–49Google Scholar
  8. 8.
    Moran SM, Myers BD (1985) Pathophysiology of protracted acute renal failure in man. J Clin Invest 76:1440–1448Google Scholar
  9. 9.
    Ayer G, Grandchamp A, Wyler T, Truniger B (1971) Intrarenal haemodynamics in glycerol-induced myohaemoglobinuric acute renal failure in the rat. Circ Res 29:128–135Google Scholar
  10. 10.
    Cronin RE, DeTorrente A, Miller PD, Bulger RE, Burke M, Schrier RW (1978) Pathogenetic mechanisms in early norepinephrine-induced acute renal failure. Functional and histological correlates of protection. Kidney Int 14:115–125Google Scholar
  11. 11.
    Trueta J, Barclay AE, Daniel PM, Franklin KJ, Prichard MML (1947) Studies of the renal circulation. Blackwell Scientific, OxfordGoogle Scholar
  12. 12.
    Shaldon S, Sheville E, Rae AI (1964) Angiography in acute renal failure. Clin Radiol 15:123–129Google Scholar
  13. 13.
    Hollenberg NK, Adams DF, Oken DE, Abrams HL, Merrill JP (1970) Acute renal failure due to nephrotoxins. Renal haemodynamic and angiographic studies in man. N Engl J Med 282:1329–1334Google Scholar
  14. 14.
    Epstein M, Berk DP, Hollenberg NK, Adams DF, Chalmers TC, Abrams HL, Merrill JP (1970) Renal failure in the patient with cirrhosis. The role of active vasoconstriction. Am J Med 49:175–185Google Scholar
  15. 15.
    Stevens PE, Davies SP, Brown EA, Riley B, Gower PE, Kox W (1988) Continuous arteriovenous haemodialysis in critically ill patients. Lancet II:150–152Google Scholar
  16. 16.
    Stevens PE, Gwyther SJ, Bolsin S, Hanson ME, Boultbee JE,Kox W (1989) Practical use of duplex Doppler analysis of the renal vasculature in critically ill patients. Lancet I:240–242Google Scholar
  17. 17.
    Gosling RG, King DH (1974) Continuous wave ultrasound as an alternative and complement to X-rays in vascular examination. In: Reneman RS (ed) Cardiovascular applications of ultrasound. North Holland, Amsterdam, pp 266–282Google Scholar
  18. 18.
    Bull GM, Joekes AM, Lowe KG (1950) Renal function studies in acute tubular necrosis. Clin Sci 9:379–404Google Scholar
  19. 19.
    Munck O (1955) Renal circulation in acute renal failure. Blackwell Scientific, OxfordGoogle Scholar
  20. 20.
    Walker JG, Silva H, Lawson TR, Ryder JA, Shaldon S (1963) Renal blood flow in acute renal failure measured by renal arterial infusion of indocyanine green. Proc Soc Exp Biol Med (New York) 112:932–935Google Scholar
  21. 21.
    Hollenberg NK, Epstein M, Rosen SM, Basch RI, Oken DE, Merrill JP (1968) Acute oliguric renal failure in man. Evidence for preferential renal cortical ischaemia. Medicine (Baltimore) 47:455–474Google Scholar
  22. 22.
    Hollenberg NK, Sandor T, Controy M et al (1973) Xenon transport through the oliguric human kidney: analysis by maximum likelihood. Kidney Int 3:177–185Google Scholar
  23. 23.
    Rigsby CM, Taylor KJ, Weltin G et al (1986) Renal allografts in acute rejection: evaluation using duplex sonography. Radiology 158:375–378Google Scholar
  24. 24.
    Epstein FH, Brown RS (1988) Acute renal failure: a collection of paradoxes. Hospital Practice, January, 171–194Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • P. E. Stevens
    • 1
  • S. J. Gwyther
    • 2
  • M. E. Hanson
    • 3
  • J. E. Boultbee
    • 2
  • W. J. Kox
    • 4
  • M. E. Phillips
    • 5
  1. 1.Department of Renal MedicinePrincess Mary's Royal Air Force HospitalAylesburyUK
  2. 2.Department of RadiologyCharing Cross Hospital (Fulham)LondonUK
  3. 3.Department of Radiation PhysicsCharing Cross Hospital (Fulham)LondonUK
  4. 4.Department of AnaesthesiaCharing Cross Hospital (Fulham)LondonUK
  5. 5.Department of MedicineCharing Cross Hospital (Fulham)LondonUK

Personalised recommendations