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Abstract
Intrarenal Doppler ultrasonography is a non-invasive method to evaluate the renal blood flow in patients with renal arterial stenosis as well as chronic kidney diseases (CKD). Until recently, the relationship between ultrasonography findings and CKD stage has not been fully understood. Overall, 162 patients with CKD without apparent renal arterial stenosis were included in this study, and the pulsed-wave Doppler ultrasonography findings were evaluated in terms of the following parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) at the renal arterial trunk, hilum, segmental, and interlobar regions. Age showed a significant negative correlation with the estimated glomerular filtration rate (eGFR), kidney size, and aortic PSV. Additionally, age showed a significant positive correlation with RI in all 4 regions. The eGFR showed a positive correlation with the aortic PSV and kidney size, but a negative correlation with RI. Both age and eGFR were found to be independently associated with aortic blood flow. On the intrarenal ultrasound, EDV and RI showed stronger correlations with eGFR than PSV, suggesting that the former indices would be better markers of renal function. In particular, the interlobar EDV was found to be the best index that reflects renal function. Although the RI is also a good marker of renal function, it is confounded by age; thus, its utility would be weaker than that of the EDV. In conclusion, intrarenal pulsed-wave Doppler ultrasonography is a useful tool to estimate and evaluate the renal function; the interlobar EDV may be the best index to estimate the effective perfusion and filtration of the kidneys.
Highlights
It is a useful marker of renal function, serum creatinine is not a highly sensitive biomarker of renal hemodynamic parameters such as intrarenal blood flow
The globally recognized criterion to judge the presence of renal arterial stenosis were peak systolic velocity (PSV) >180 cm/sec and PSV renal/aortic ratio (RAR) >3.5 [13,14]
Advanced technical skills are required to perform a renal ultrasonography in obese subjects; the results of this study show that renal ultrasonography is a useful method for the assessment of renal function even in obese subjects
Summary
In patients with chronic kidney disease (CKD) and renal arterial diseases, renal arterial stenosis, evaluations of blood flow with pulsed-wave Doppler ultrasonography in the aorta, renal artery, and intrarenal small-to-middle sized arteries have been attempted previously. The most commonly used marker of renal function is the serum creatinine level; but it is affected by age, sex, muscle mass, exercise, nutritional status, and hydration status. It is a useful marker of renal function, serum creatinine is not a highly sensitive biomarker of renal hemodynamic parameters such as intrarenal blood flow. If clinicians and ultrasonographers can correctly perform and interpret a renal Doppler ultra-sonogram, it would be a more sensitive test for renal hemodynamics than the assessment of the serum creatinine level and can be quickly performed at every hospital visit
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