Intensive Care Medicine

, 34:1360 | Cite as

Doppler monitoring of renal hemodynamics: why the best is yet to come

  • Jacques Duranteau
  • Stéphane Deruddre
  • Bernard Vigue
  • Denis Chemla

Sir: In this issue of “Intensive Care Medicine,” Wan et al. [1] report that Doppler ultrasound-derived estimates of renal blood flow (RBF) are weakly correlated with implanted flow probe measurements of RBF and RBF changes in merino ewes. It is widely admitted that it is impossible to accurately estimate RBF and RBF changes by using Doppler ultrasound for two main reasons: firstly, as mentioned by the authors, there are limits to the accuracy of measurement of vessel diameter and the subsequent estimation of cross-sectional area with Doppler ultrasound. Unfortunately, the authors did not report the diameter values (mean and confidence intervals), and reproducibility of their measurements. Secondly, small changes in the angle of insonation may induce major changes in Doppler shift and blood flow velocity. The study by Wan et al. [1] recalls this evidence by presenting a comprehensible evaluation of the limits of the Doppler ultrasound technology.

The other limitations of the study are...


  1. 1.
    Wan L, Yang N, Hiew C, Schelleman A, Johnson L, May C, Bellomo R (2008) An assessment of the accuracy of renal blood flow estimation by doppler ultrasound. Intensive Care Med DOI 10.1007/s00134-008-1106-8
  2. 2.
    Tublin ME, Bude RO, Platt JF (2003) The resistive index in renal Doppler sonography: Where do we stand? Am J Roentgenol 4:885–892Google Scholar
  3. 3.
    Mostbeck GH, Zontsich T, Turetschek K (2001) Ultrasound of the kidney: obstruction and medical diseases. Eur Radiol 10:1878–1889CrossRefGoogle Scholar
  4. 4.
    Shokeir AA, Abubieh EA, Dawaba M, el-Azab M (2003) Resistive index of the solitary kidney: a clinical study of normal values. J Urol 2(1):377–379CrossRefGoogle Scholar
  5. 5.
    Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A, Eisenberger U, Burg M, Luft FC, Gwinner W, Haller H (2003) The renal arterial resistance index and renal allograft survival. N Engl J Med 2:115–124CrossRefGoogle Scholar
  6. 6.
    Ohta Y, Fujii K, Arima H, Matsumura K, Tsuchihashi T, Tokumoto M, Tsuruya K, Kanai H, Iwase M, Hirakata H, Iida M (2005) Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography. J Hypertens 10:1905–1911CrossRefGoogle Scholar
  7. 7.
    Petersen LJ, Petersen JR, Ladefoged SD, Mehlsen J, Jensen HA (1995) The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure. Nephrol Dial Transplant 11:2060–2064Google Scholar
  8. 8.
    Radermacher J, Ellis S, Haller H (2002) Renal resistance index and progression of renal disease. Hypertension 2(2):699–703CrossRefGoogle Scholar
  9. 9.
    Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY (2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 10:1553–1559CrossRefGoogle Scholar
  10. 10.
    Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J (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 9:1557–1562CrossRefGoogle Scholar
  11. 11.
    Mostbeck GH, Kain R, Mallek R, Derfler K, Walter R, Havelec L, Tscholakoff D (1991) Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation. J Ultrasound Med 4:189–194Google Scholar
  12. 12.
    Sugiura T, Nakamori A, Wada A, Fukuhara Y (2004) Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol 2:119–126Google Scholar
  13. 13.
    Derchi LE, Leoncini G, Parodi D, Viazzi F, Martinoli C, Ratto E, Vettoretti S, Vaccaro V, Falqui V, Tomolillo C, Deferrari G, Pontremoli R (2005) Mild renal dysfunction and renal vascular resistance in primary hypertension. Am J Hypertens 7:966–971CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jacques Duranteau
    • 1
  • Stéphane Deruddre
    • 1
  • Bernard Vigue
    • 1
  • Denis Chemla
    • 2
  1. 1.Département d’Anesthésie-Réanimation, AP-HP, Hôpital BicêtreUniversité Paris Sud XILe Kremlin-BicêtreFrance
  2. 2.Department of Physiology, AP-HP, Hôpital BicêtreUniversité Paris Sud-EA4046Le Kremlin-BicêtreFrance

Personalised recommendations