Abstract
After the age of 30 years, GFR progressively declines at an average rate of 8 mL/min/1.73 m/decade. A problem of advanced age is that the evaluation of renal function on the basis of indicators valid in young adults, such as creatininemia, is unreliable. In fact, many patients with chronic renal failure may have serum creatinine levels within the normal range even if they have a significant reduction in renal function. Ultrasound has become a routine method of investigation in renal disease: kidney size and parenchymal echogenicity are considered markers of renal function, so US is useful in assessing the presence and degree of renal failure. CEUS is useful in the evaluation of kidney disease in the elderly: the increased hemodynamic resistance of renal microvessels reduces perfusion in the renal cortex, so fewer microbubbles enter the renal cortex. EcoColor and EcoDoppler are also useful in the evaluation of senile alterations: here, the distribution of color-signals, as compared to that in the young adult population, appears more attenuated, limited to intersegmental and interlobar districts. Among the ecoDoppler parameters, the resistance index can be considered a marker of renal damage progression, with attention needing to paid to possible concomitant confounding factors. Ultrasonography, color-Doppler and CEUS are a non-invasive and convenient modality for managing kidney disease; their integration with anamnestic, objective and laboratory data permits fast and reliable clinical, diagnostic, and therapeutic classification. It also allows early therapeutic intervention and, ultimately, improvements in patient management.
Similar content being viewed by others
References
McClure M, Jorna T, Wilkinson L, Dorset JT (2017) Elderly patients with chronic kidney disease: do they really need referral to the nephrology clinic? UK Clin Kidney J 10(5):698–702
Mallappallil M, Friedman EA, Delano BG, McFarlane SI, Salifu MO (2014) Chronic kidney disease in the elderly: evaluation and management. Clin Pract 11(5):525–535
Granata A, Fiorini F, D’Amelio AL’(2010) ecocolorDoppler nella pratica clinica nefrologica. Aggiornamenti in tema di nefrologia. ill, Brossura, p192
Cammarota T, Piccoli G, Sarno A, Rabbia C, Bonenti G, Olivieri G (2006) Rene senile: Insufficienza renale nell’anziano. Radiologia geriatrica. Springer, Milan, pp 445–459
Macunluoğlu B, Gökçe I, Atakan A, Demirci M, Arı E, Topuzoğlu A, Borazan A (2011) A comparison of different methods for the determination of glomerular filtration rate in elderly patients with chronic renal failure. Int Urol Nephrol 43(1):257–263
Roubenoff R (2003) Sarcopenia: effects on body composition and function. J Gerontol Ser A Biol Sci Med Sci 58:1012–1017
Fehrman-Ekholm I, Skeppholm L (2004) Renal function in the elderly (> 70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol 38(1):73–77
Dowling TC, Wang ES, Ferrucci L, Sorkin JD (2013) Glomerularltration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore longitudinal study on aging: impact on renal drug dosing. Pharmacotherapy 33(9):912–921
Nankivell BJ (2001) Creatinine clearance and the assessment of renal function. Australian Prescriber 24:15–71
Quaia E (2014) Radiological imaging of the kidney. Springer, Heidelberg. ISBN 978-3-642-54046-2
Hoi S, Takata T, Sugihara T, Ida A, Ogawa M, Mae Y, Fukuda S, Munemura C, Isomoto H (2018) Predictive value of cortical thickness measured by ultrasonography for renal impairment: a longitudinal study in chronic kidney disease. J Clin Med 7(12). https://doi.org/10.3390/jcm7120527
Mancuso D, Comi N, Andreucci M, Donato C, Presta P. Fuiano (2007) Parametri ecografici renali predittivi di outcome nei pazienti con insufficienza renale cronica. Giornale Italiano di Nefrologia/Anno 24 S-39, pp. S85–S93
Platt JF, Rubin JM, Bowerman RA, Marn CS (1988) The inability to detect kidney disease on the basis of echogenicity. Am J Roentgenol 165:317–319
Parenti GC, Basteri V, Bucchi E, Sturani A, Degli EE (2006) Colour-Doppler US evaluation of patients with hypertension and nephropathy. Radiol Med 111(8):1115–1123 (Epub 2006 Dec 20)
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 (Epub 2009 Jun 15)
Tublin ME, Bude RO, Platt JF et al (2003) Review. The resistive index in renal Doppler sonography: where do we stand? Am J Roentgenol 180(4):885–892
Fiorini F, Granata A, Noce A, Durante O, Insalaco M, Di Daniele N (2013) Gli indici di resistenza ecografici in nefrologia: quale significato clinico? G Ital Nefrol 30(2):1724–5590
Yang WQ, Mou S, Xu Y, Xu L, Li FH, Li HL (2018) Quantitative parameters of contrast-enhanced ultrasonography for assessment of renal pathology: a preliminary study in chronic kidney disease. Clin Hemorheol Microcirc 68(1):71–82. https://doi.org/10.3233/CH-170303
Singh H, Panta OB, Khanal U, Ghimire RK (2017) Renal cortical elastography: normal values and variations. J Med Ultrasound 25(4):215–220
Ferrari FS, Scorzelli A, Megliola A, Drudi FM, Trovarelli S, Ponchietti R (2009) Real-time elastography in the diagnosis of prostate tumor. J Ultrasound 12(1):22–31
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK (2017) Ultrasound elastography: review of techniques and clinical applications. Theranostics 7(5):1303–1329
Rogowicz-Frontczak A, Araszkiewicz A, Pilacinski S, Zozulinska-Ziolkiewicz D, Wykretowicz A, Wierusz-Wysocka B (2011) Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients are dependent on age and mean blood pressure. Exp Clin Endocrinol Diabetes 119(5):281–285 (Epub 2010 Oct 28)
O’Neill WC (2014) Renal relevant radiology: use of ultrasound in kidney disease and nephrology procedures. Clin J Am Soc Nephrol 9(2):373–381
Dong Y, Wang WP, Cao WP, Fan P, Lin X (2014) Early assessment of chronic kidney dysfunction using contrast-enhanced ultrasound: a pilot study. Br J Radiol 87(1042):20140350
Tsuruoka K, Yasuda T, Koitabashi K, Yazawa M, Shimazaki M, Sakurada T, Shirai S, Shibagaki Y, Kimura K, Tsujimoto F (2010) Evaluation of renal microcirculation by contrast-enhanced ultrasound with Sonazoid as a contrast agent. Int Heart J 51(3):176–182
Eckerbom P, Hansell P, Cox EF, Buchanan C, Weis J, Palm F, Francis ST, Liss P (2019) Multiparametric assessment of renal physiology in healthy volunteers using non-invasive magnetic resonance imaging. Am J Physiol Renal Physiol 316(4):F693–F702
Caroli A, Schneider M, Friedli I, Ljimani A, De Seigneux S, Boor P, Gullapudi L, Kazmi I, Mendichovszky IA, Notohamiprodjo M, Selby NM, Thoeny HC, Grenier N, Vallée JP (2018) Diffusion-weighted magnetic resonance imaging to assess diffuse renal pathology: a systematic review and statement paper. Nephrol Dial Transpl 33(2):ii29–ii40
Lin HY-H, Lee Y-L, Lin K-D, Chiu Y-W, Shin S-J, Hwang S-J, Chen H-C, Hung C-C (2017) Association of renal elasticity and renal function progression in patients with chronic kidney disease evaluated by real-time ultrasound elastography. Sci Rep 7:43303
Petrucci I, Clementi A, Sessa C, Torrisi I, Meola M (2018) Ultrasound and color Doppler applications in chronic kidney disease. J Nephrol 31(6):863–879
Dong Y, Wang W-P, Lin P, Fan P, Mao F (2016) Assessment of renal perfusion with contrast-enhanced ultrasound: preliminary results in early diabetic nephropathies. Clin Hemorheol Microcirc 62:229–238
Fuiano G, Caglioti A, Marino F, Mancuso D, Comi N, Natale G, Mangiacapra S, Iodice C (2001) L’insufficienza renale acuta nell’anziano. Giorn It Nefrol 18:469–481
Cartabellotta A, Di Iorio B (2014) Diagnosi e valutazione dell’insufficienza renale acuta. Evidence (www.evidence.it) vol 6(2):e1000068
Girometti R, Stocca T, Serena E, Granata A, Bertolotto M (2017) Impact of contrast-enhanced ultrasound in patients with renal function impairment. World J Radiol 9(1):10–16
Zhou HY, Chen TW, Zhang XM (2016) Functional magnetic resonance imaging in acute kidney injury: present status. Biomed Res Int 2016:2027370
Nestola M, De Matthaeis N, Ferraro PM, Fuso P, Costanzi S, Zannoni GF, Pizzolante F, Vasquez Quadra S, Gambaro G, Rapaccini GL (2018) Contrast-enhanced ultrasonography in chronic glomerulonephritides: correlation with histological parameters of disease activity. J Ultrasound 21(2):81–87
Apoku IN, Ayoola OO, Salako AA, Idowu BM (2015) Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest. Intern Braz J Urol 41(3):556–561
Tseng TY, Stoller ML (2009) Obstructive uropathy. Clin Geriatr Med 25(3):437
Huang E, Segev DL, Rabb H (2009) Kidney transplantation in the elderly. Semin Nephrol 29(6):621–635
Tekin S, Yavuz HA, Yuksel Y, Yucetin L, Ateş I, Tuncer M, Demirbas A (2015) Kidney transplantation from elderly donor. Transpl Proc 47(5):1309–1311
Galgano SJ, Lockhart ME, Fananapazir G, Sanyal R (2018) Optimizing renal transplant Doppler ultrasound. Abdom Radiol 43(10):2564–2573
Schwenger V, Korosoglou G, Hinkel UP et al (2006) Real-time contrast-enhanced sonography of renal transplant recipients predicts chronic allograft nephropathy. Am J Transpl 6(3):609–615
Drudi FM, Pretagostini R, Padula S, Donnetti M, Giovagnorio F, Mendicino P, Marchetti F, Ricci P, Passariello R (2004) Color Doppler ultrasound in renal transplant: role of resistive index versus renal cortical ratio in the evaluation of renal transplant diseases. Nephron Clin Pract 98:c67–c72
Drudi FM, Liberatore M, Cantisani V, Malpassini F, Maghella F, Di Leo N, Fasciolo D, D’Ambrosio F (2014) Role of color Doppler ultrasound in the evaluation of renal transplantation from living donors. J Ultrasound 17(3):207–213
Bertolotto M, Quaia E, Rimondini A, Lubin E, Pozzi Mucelli R (2001) Current role of color Doppler ultrasound in acute renal failure. Radiol Med 102(5–6):340–347
Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, Calliada F, Clevert D-A, Cosgrove D, Deganello A, D’Onofrio M, Drudi FM, Freeman S, Harvey C, Jenssen C, Jung E-M, Klauser AS, Lassau N, Meloni MF, Leen E, Nicolau C, Nolsoe C, Piscaglia F, Prada F, Prosch H, Radzina M, Savelli L, Weskott H-P, Wijkstra H (2018) The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017. Ultraschall Med 39:154–180
Wang X, Yu Z, Guo R, Yin H, Hu X (2015) Assessment of postoperative perfusion with contrast-enhanced ultrasonography in kidney transplantation. Int J Clin Exp Med 8:18399–18405
Tatar IG, Teber MA, Ogur T, Kurt A, Hekimoglu B (2014) Real time sonoelastographic evaluation of renal allogra s in correlation with clinical prognostic parameters: comparison of linear and convex transducers according to segmental anatomy. Med Ultrason 16:229–235
Tukhbatullin MG, Galeev ShR, Garifullina LI, Galeev RH (2017) Shear wave ultrasound elastography to evaluate the state of renal transplant. Clin Med
Onniboni M, De Filippo M, Averna R, Coco L, Zompatori M, Sverzellati N, Rossi C (2013) Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med 118:837–850
Preston RA, Epstein M (1997) Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens 15(12 Pt 1):1365–1377
Coen G, Calabria S, Lai S, Moscaritolo E, Nofroni I, Ronga G, Rossi M, Ventroni G, Sardella D, Ferrannini M, Zaccaria A, Cianci R (2003) Diagnosis and prevalence in a hypertensive and/or uremic elderly population. BMC Nephrol 6(4):2
Barozzi L, Capannelli D, Imbriani M (2014) Contrast enhanced ultrasound in the assessment of urogenital pathology. Archivio Italiano di Urologia e Andrologia 86:4
Goyal S, Dixit VK, Jain AK, Shukla RC, Ghosh J, Kumar V (2013) Intrarenal resistance index (RI) as a predictor of early renal impairment in patients with liver cirrhosis. Trop Gastroenterol 34(4):235–239
Wang Y, Liu LP, Bai WY, Wen SB, Dan HJ, Luan YY, Zeng MX, Hu B (2011) Renal haemodynamics in patients with liver cirrhosis assessed by colour ultrasonography. J Int Med Res 39(1):249–255
Schneider AG, Schelleman A, Goodwin MD, Bailey M, Eastwood GM, Bellomo R (2015) Contrast-enhanced ultrasound evaluation of the renal microcirculation response to terlipressin in hepato-renal syndrome: a preliminary report. Ren Fail 37(1):175–179
George SM, Kalantarinia K (2011) The role of imaging in the management of cardiorenal syndrome. Intern J Nephrol 2011:245241
de la Espriella-Juan R, Núñez E, Miñana G, Sanchis J, Bayés-Genís A, González J, Chorro J, Núñez J (2018) Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness. ESC Heart Fail 5:1173–1175
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Drudi, F.M., Cantisani, V., Granata, A. et al. Multiparametric ultrasound in the evaluation of kidney disease in elderly. J Ultrasound 23, 115–126 (2020). https://doi.org/10.1007/s40477-019-00390-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40477-019-00390-5