Abstract
Introduction. Chronic kidney disease (CKD) represents a global public health problem. Its progression to the end stage is based on the existence and severity of histological lesions, especially interstitial fibrosis and vascular lesions, and exposes a high risk of mortality and cardiovascular events. Renal biopsy remains the reference examination allowing an accurate evaluation of the importance of fibrosis and remains an invasive and risky examination. The assessment of the risk of progression of CKD by a non-invasive examination would be of capital interest to the nephrologist in order to reinforce nephroprotection measures to delay the progression of renal disease and reduce the risk of cardiovascular events, which represents the first cause of mortality in this population. The value of the resistive index (RI), measured by an echo-doppler, seems to be important. The primary objective of this work was to evaluate the correlation between the value of the RI and the severity of the histological lesions. Secondary objectives were to evaluate the correlation of RI with CKD progression, cardiovascular mortality, and to define a prognostic threshold for progression. Material and method. This is a prospective monocentric study including 104 patients hospitalized in the nephrology department of the regional military university hospital of Constantine during the period April 2014-January 2019, presenting with CKD and scheduled for a renal biopsy for diagnostic purposes. RI measurement was performed 24-48 hours before this procedure. Results. We showed that there is a positive and statistically significant correlation of RI with age (r=0.38, p < 103), the number of cardiovascular risk factors (r=0.39, p < 103),systolic blood pressure (r=0.39 , p < 103) and pulse pressure ( r=0.51 , p < 103), percentage of glomerulosclerosis (r=0.51, p < 103), percentage of interstitial fibrosis ( r=0.43 , p < 103) and vascular damage (p < 103). While there is a negative correlation with initial eGFR (r= -0.52 , p < 103) and to a lesser degree with the combined size of the two kidneys (r= -0.26 , p < 103), no correlation was observed with diastolic blood pressure, proteinuria (proteinuria / creatinuria ratio) and the use of antiproteinuric treatment. Switching to renal replacement therapy (RRT) and cardiovascular mortality were associated with the highest RI. Beyond a threshold value of 0.65, histological lesions are more pronounced with a worse evolution of CKD. Conclusion. This study underlines that RI is a non invasive marker of progression and the interest to propose it as a prognostic criterion in the management of chronic kidney disease.
Published Version
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