Pediatric Radiology

, Volume 23, Issue 5, pp 365–368 | Cite as

Duplex Doppler examination of renal allografts in children: correlation between renal blood flow and clinical findings

  • D. M. Briscoe
  • F. A. Hoffer
  • N. Tu
  • W. E. Harmon


We reviewed the diastolic blood flow (DBF), pulsatility index (PI), and resistive index (RI) in 211 duplex Doppler ultrasound examinations of 63 pediatric renal transplant recipients. We correlated our findings with the clinical diagnosis, independently determined at the time of ultrasound examination. DBF, evaluated in 202 examinations, was found to be decreased, absent, or reversed in acute rejection (kappa=0.4,p<0.01) and acute tubular necrosis (ATN) (kappa=0.3,p<0.01). The PI and RI were evaluated in 87 and 78 ultrasound examinations respectively. The range of normal PI and RI values in recipients between six and 18 years of age were similar to those reported in adults. However, normal PI and RI values were somewhat higher in recipients less than six years of age who had received adult donor allografts. Overall, the PI was greater than 1.5 in acute rejection (kappa=0.3,p<0.05) and ATN (kappa=0.3,p<0.01), but not in chronic rejection (kappa <0,p=NS). The RI was greater than 0.7 in chronic rejection (kappa=0.3,p<0.05) and ATN (kappa=0.3,p<0.05), but not in acute rejection (kappa=0.03,p=NS). We conclude that the PI and RI vary in pediatric recipients of renal allografts and are not associated with a specific clinical diagnosis.


Acute Rejection Ultrasound Examination Resistive Index Renal Blood Flow Renal Transplant Recipient 
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  1. 1.
    Rigsby CM, Taylor KJ, Weltin GG, Burns PN, Bia M, Princenthal RA, Kashgarian M, Flye MW (1986) Renal allografts in rejection: evaluation using duplex sonography. Radiology 158: 375PubMedGoogle Scholar
  2. 2.
    Rifkin MD, Needleman L, Pasto ME, Kurtz AB, Foy PM, McGlynn E, Canino C, Baltarowich OH, Pennell RG, Goldberg BB (1986) Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index. AJR 148: 759Google Scholar
  3. 3.
    Rigsby CM, Burns PN, Weltin GG, Chen B, Bia M, Taylor KJ (1987) Doppler signal quantitation in renal allografts: comparison in normal and rejecting transplants, with pathologic correlation. Radiology 162: 39PubMedGoogle Scholar
  4. 4.
    Taylor KJ, Burns PN (1985) Duplex Doppler scanning in the pelvis and abdomen. Ultrasound Med Biol 11: 643CrossRefPubMedGoogle Scholar
  5. 5.
    Wan SK, Ferguson CJ, Cochlin DL, Evans C, Griffiths DF (1989) Duplex Doppler ultrasound in the diagnosis of acute renal allograft rejection. Clin Radiol 40: 573CrossRefPubMedGoogle Scholar
  6. 7.
    Leimenstoll G, Engelmann R, Grigat KP, Bartholdy A, Niedermayer W (1990) Duplex ultrasound: monitoring of rejection episodes of renal allografts. Transplant Proc 22: 1392PubMedGoogle Scholar
  7. 7.
    Surratt JT, Siegel MJ, Middleton WD (1990) Sonography of complications in pediatric renal allografts. Radiographics 10: 687PubMedGoogle Scholar
  8. 8.
    Taylor KJ, Marks WH (1990) Use of doppler imaging for evaluation of dysfunction in renal allografts. AJR 155: 536PubMedGoogle Scholar
  9. 9.
    Kelcz F, Pozniak MA, Pirsch JD, Oberly TD (1990) Pyramidal appearance and resistive index: insensitive and nonspecific sonographic indicators of renal transplant rejection. AJR 155: 531PubMedGoogle Scholar
  10. 10.
    Allen KS, Jorkasky DK, Arger PH, Velchick MG, Grumbach K, Coleman BG, Mintz MC, Betsch SE, Perloff LJ (1988) Renal allografts: prospective analysis of Doppler sonography. Radiology 169: 371PubMedGoogle Scholar
  11. 11.
    Genkins SM, Sanfilippo FP, Carroll BA (1989) Duplex Doppler sonography of renal transplants: lack of sensitivity and specificity in establishing pathologic diagnosis. AJR 152: 535PubMedGoogle Scholar
  12. 12.
    Perrella RR; Duerinckx AJ, Tessler FN, Danovitch GM, Wilkinson A, Gonzalez S, Cohen AH, Grant E (1990) Evaluation of renal transplant dysfunction by duplex sonography: a prospective study and review of the literature. Am J Kidney Dis 15: 544PubMedGoogle Scholar
  13. 13.
    Fitzpatrick MM, Gleeson FV, de Bruyn R, Trompeter RS, Gordon L (1992) The evaluation of pediatric renal transplants using resistive index and renal blood flow. Pediatr Nephrol 6: 172CrossRefPubMedGoogle Scholar
  14. 14.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: 159PubMedGoogle Scholar
  15. 15.
    Saarinen O, Ahonen J, Eklund B, Hockerstedt K, Isoniemi H, Salmela K, Tierala E, von Willibrand E, Edgren J (1990) Duplex ultrasound and acute allograft rejection. Transplant Proc 22: 167PubMedGoogle Scholar
  16. 16.
    Pozniak MA, Kelcz F, Stratta RJ, Oberly TD (1988) Extraneous factors affecting resistive index. Invest Radiol 23: 899PubMedGoogle Scholar
  17. 17.
    Kaveggia LP, Perrella RR, Grant EG, Tessler FN, Rosenthal JT, Wilkinson A, Danovitch GM (1990) Duplex Doppler sonography in renal allografts: the significance of reversed flow in diastole. AJR 155: 295PubMedGoogle Scholar
  18. 18.
    Berland LL, Lawson TL, Adams MB, Melrose BL, Foley WD (1982) Evaluation of renal transplants with pulsed Doppler duplex sonography. J Ultrasound Med 1: 215PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • D. M. Briscoe
    • 1
  • F. A. Hoffer
    • 2
  • N. Tu
    • 3
  • W. E. Harmon
    • 1
  1. 1.Division of Nephrology, Department of MedicineChildren's Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of RadiologyChildren's Hospital and harvard Medical SchoolBostonUSA
  3. 3.Department of BiostatisticsDana Farber Cancer Institute and Harvard Medical SchoolBostonUSA

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