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Ultrasound and color Doppler applications in chronic kidney disease

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Abstract

Chronic kidney disease (CKD) includes all clinical features and complications during the progression of various kidney conditions towards end-stage renal disease (ESRD). These conditions include immune and inflammatory disease such as: primary and hepatitis C virus (HCV)-related glomerulonephritis; infectious disease such as pyelonephritis with or without reflux and tuberculosis; vascular disease such as chronic ischemic nephropathy; hereditary and congenital disease such as polycystic disease and congenital cystic dysplasia; metabolic disease including diabetes and hyperuricemia; and systemic disease (collagen disease, vasculitis, myeloma). During the progression of CKD, ultrasound imaging and color Doppler imaging (US–CDI) can differentiate the etiology of the renal damage in only 50–70% of cases. Indeed, the end-stage kidney appears shrunken, reduced in volume (Ø < 9 cm), unstructured, amorphous, and with acquired cystic degeneration (small and multiple cysts involving the cortex and medulla) or nephrocalcinosis, but there are rare exceptions, such as polycystic kidney disease, diabetic nephropathy, and secondary inflammatory nephropathies. The main difficulties in the differential diagnosis are encountered in multifactorial CKD, which is commonly presented to the nephrologist at stage 4–5, when the kidney is shrunken, unstructured and amorphous. As in acute renal injury and despite the lack of sensitivity, US–CDI is essential for assessing the progression of renal damage and related complications, and for evaluating all conditions that increase the risk of CKD, such as lithiasis, recurrent urinary tract infections, vesicoureteral reflux, polycystic kidney disease and obstructive nephropathy. The timing and frequency of ultrasound scans in CKD patients should be evaluated case by case. In this review, we will consider the morpho-functional features of the kidney in all nephropathies that may lead to progressive CKD.

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Fig. 1

American Journal of Kidney Diseases, Vol. 39/2, National Kidney Foundation, KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification/Part 2. Background, pages No., S32–S36, Copyright (2002), with permission from Elsevier

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Authors and Affiliations

  1. Sant’Anna School of Advanced Studies, Department of Internal Medicine, University of Pisa, Pisa, Italy

    Ilaria Petrucci & Mario Meola

  2. Nephrology and Dialysis Department, Santa Marta and Santa Venera Hospital, Via Caronia, Acireale, Catania, Italy

    Anna Clementi

  3. Nephrology and Dialysis Department, “Maggiore” Hospital, Modica, Ragusa, Italy

    Concetto Sessa

  4. Nephrology and Dialysis Department, “San Vincenzo” Hospital, Taormina, Messina, Italy

    Irene Torrisi

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  1. Ilaria Petrucci
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Correspondence to Anna Clementi.

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Petrucci, I., Clementi, A., Sessa, C. et al. Ultrasound and color Doppler applications in chronic kidney disease. J Nephrol 31, 863–879 (2018). https://doi.org/10.1007/s40620-018-0531-1

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