Renal Artery Resistance Index Research Articles

Renal arterial resistive index, monocyte chemotactic protein 1 and neutrophil gelatinase-associated lipocalin, for predicting acute kidney injury in critically ill cancer patients.

We evaluated the renal arterial resistive index (RRI), urine monocyte chemotactic protein 1 (uMCP-1), and urine neutrophil gelatinase-associated lipocalin (uNGAL) to predict acute kidney injury (AKI) in critically ill cancer patients. In this prospective study, we included patients without AKI. We compared the area under the curve (AUC) of RRI, uMCP-1, and uNGAL to predict any stage of AKI and stage-3 AKI with the DeLong method, and we established cutoff points with the Youden index. We included 64 patients, and 43 (67.2%) developed AKI. The AUC to predict AKI were: 0.714 (95% CI 0.587-0.820) for the RRI, 0.656 (95% CI 0.526-0.770) for uMCP-1, and 0.677 (95% CI 0.549-0.789) for uNGAL. The AUC to predict stage-3 AKI were: 0.740 (95% CI 0.615-0.842) for the RRI, 0.757 (95% CI 0.633-0.855) for uMCP-1, and 0.817 (95% CI 0.701-0.903) for uNGAL, without statistical differences among them. For stage 3 AKI prediction, the sensitivity and specificity were: 56.3% and 87.5% for a RRI > 0.705; 70% and 79.2% for an uMCP-1 > 2169ng/mL; and 87.5% and 70.8% for a uNGAL > 200ng/mL. The RRI was significantly correlated to age (r = 0.280), estimated glomerular filtration rate (r = -0.259), mean arterial pressure (r = -0.357), and serum lactate (r = 0.276). The RRI, uMCP-1, and uNGAL have a similar ability to predict AKI. The RRI is more specific, while urine biomarkers are more sensitive to predict stage 3 AKI. The RRI correlates with hemodynamic variables. The novel uMCP-1 could be a useful biomarker that needs to be extensively studied.

Assessment of the Utility of Point-of-Care Testing Incorporating Ultrasound and Arterial Blood Gas in Patients with Acute Febrile Illness in the Emergency Department to Determine Disease Severity, Disposition, Need for Ventilation and Renal Replacement Therapy.

Acute febrile illness (AFI) patients present to the emergency department (ED), with fever to multi-organ dysfunction. There is a lack of early point-of-care-based disposition criteria in AFI patients regarding the need for intensive care unit (ICU) or high dependency unit (HDU) care. We enrolled 100 patients with AFI presenting to the ED and evaluated using point-of-care ultrasound with two-dimensional echocardiography (ECHO), lung ultrasound score (LUS), renal arterial resistive index (RRI), and arterial blood gas. The need for ICU/HDU admission, ventilation (either noninvasive or invasive), and renal-replacement therapy (RRT) within 48 h of hospitalization was noted. Ninety-five patients were included in the analysis. 72 (75.8%) patients required either ICU or HDU admission, 45 (47.4%) required ventilatory support (either noninvasive or invasive), and 32 (33.7%) required RRT. After logistic regression, LUS ≥16, and arterial lactate ≥12 mg/dL were independent predictors of the need for ICU or HDU admission. The respiratory rate (RR) ≥28/minute, LUS ≥16 and RRI ≥61 were the independent predictors of the need for ventilation. The MAP ≤73 mmHg, LUS (≥16), and RRI (≥67) were the predictors of the need for RRT. In AFI patients presenting to the ED, the MAP, LUS, and lactate are predictors of the need for ICU/HDU admission. The LUS and RRI were predictors of the need for RRT whereas the RR, LUS, and RRI were the predictors of the need for ventilation.

Clinical value of renal artery resistance index and urinary angiotensinogen in early diagnosis of acute kidney injury in patients with sepsis

To investigate the value of renal artery resistance index (RRI) and urinary angiotensinogen (UAGT) in the early diagnosis of acute kidney injury (AKI) in patients with sepsis. A prospective study was conducted. Seventy-eight patients with sepsis admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from January to September 2021 were enrolled. Patients were observed for the development of AKI within 1 week. General data [gender, age, body mass index (BMI), major infection sites and critical illness related scores], laboratory indicators [mean arterial pressure (MAP), central venous pressure (CVP), procalcitonin (PCT), arterial blood lactic acid (Lac), etc.], duration of mechanical ventilation and length of intensive care unit (ICU) stay were recorded. After hemodynamic stabilization of the patients, renal ultrasound was performed to measure the RRI within 24 hours after ICU admission. Urine samples were taken immediately after diagnosis, and the level of UAGT was detected by enzyme-linked immunosorbent assay (ELISA). The above parameters were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of AKI in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of related indicators for AKI in sepsis. A total of 78 patients were finally enrolled, of which 45 developed AKI and 33 did not. Compared with the non-AKI group, the rates of vasoactive drugs use, 28-day mortality, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, PCT, Lac, RRI and UAGT were significantly higher in the AKI group [rates of vasoactive drugs use: 68.9% vs. 39.4%, 28-day mortality: 48.9% vs. 24.2%, SOFA score: 12.0 (10.5, 14.0) vs. 8.0 (7.0, 10.0), APACHE II score: 22.0 (18.0, 27.5) vs. 16.0 (15.0, 18.5), PCT (μg/L): 12.5±2.6 vs. 10.9±2.8, Lac (mmol/L): 2.6 (1.9, 3.4) vs. 1.9 (1.3, 2.6), RRI: 0.74±0.03 vs. 0.72±0.02, UAGT (μg/L): 75.16±19.99 vs. 46.28±20.75, all P < 0.05], the duration of mechanical ventilation and the length of ICU stay were significantly prolonged [duration of mechanical ventilation (days): 8.0 (7.0, 12.0) vs. 5.0 (4.0, 6.0), length of ICU stay (days): 14.0 (10.0, 16.0) vs. 9.0 (8.0, 11.5), both P < 0.01], and MAP was significantly lowered [mmHg (1 mmHg ≈ 0.133 kPa): 68.5±11.2 vs. 74.2±12.8, P < 0.05]. There was no significant difference in other parameters between the two groups. Multivariate Logistic regression analysis showed that SOFA score [odds ratio (OR) = 2.088, 95% confidence interval (95%CI) was 1.322-3.299], APACHE II score (OR = 1.447, 95%CI was 1.134-1.845), RRI (OR = 1.432, 95%CI was 1.103-1.859), and UAGT (OR = 1.077, 95%CI was 1.035-1.121) were independent risk factors for sepsis complicated with AKI (all P < 0.01). ROC curve analysis showed that SOFA score, APACHE II score, RRI and UAGT had certain predictive value for AKI in septic patients, the area under the ROC curve (AUC) were 0.814 (95%CI was 0.716-0.912), 0.804 (95%CI was 0.708-0.901), 0.789 (95%CI was 0.690-0.888), and 0.840 (95%CI was 0.747-0.934), respectively, and the AUC of RRI combined with UAGT was 0.912 (95%CI was 0.849-0.974), which was better than the above single index (all P < 0.05). RRI combined with UAGT has a high early predictive value for septic AKI.

Renal Artery Resistive Index and Estimated Glomerular Filtration Rate in Patients with Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) may affect many organs and systems, especially the kidney as well as the liver. While NAFLD's renal impacts can be evaluated via the estimated glomerular filtration rate (eGFR), its effects on renal hemodynamic changes can be monitored with the renal resistive index (RRI). Our aim in this study is to evaluate RRI and eGFR in NAFLD patients. In this study, a total of 69 patients with NAFLD and 50 age- and gendermatched healthy controls were included. The basic clinical and laboratory parameters of patient and control groups were assessed and recorded. In the patient group, the RRI was observed as 0.64±0.06 and eGFR value as 86±52 (mL/min/1.73m2), while in the control group, the RRI was 0.61±0.05 and eGFR was 95.40±20.21 (mL/min/1.73m2). Compared to the control group, the RRI and eGFR values were significantly different in the patient group (PRRI=0.003 and PeGFR=0.025). There was a negative correlation observed between the RRI and eGFR (r=-0.347, P=0.003). Receiver-operating characteristic curve analysis suggested that the optimum RRI cut-off value for patients with NAFLD is 0.62, with 65% sensitivity and 60% specificity (p=0.002). There was an independent relationship found between the RRI and eGFR according to the linear regression analysis (β=-0.301, P=0.015). This study shows that RRI may be an indicator of renal functions, such as eGFR in patients with NAFLD.

S1396 Response-Guided Ascites Mobilization in Patients of Acute on Chronic Liver Failure (ACLF) With Acute Kidney Injury Treated With Slow Albumin, Furosemide and Vasoconstrictor Therapy (SAFI+T) versus Standard Treatment

Introduction: Acute-on-chronic liver failure (ACLF) with increasing organ failure is associated with poor outcome. Severely deranged systemic hemodynamic and decreased effective arterial blood volume contributes to tissue damage and organ failure. Response guided therapy with albumin, vasoconstrictors and furosemide may help overcome effective hypovolemia improve diuresis and impact survival. Methods: In observation cohort, 56 patients with ACLF (CANONIC criteria) complicated with AKI ( S.Cr ³ 1.5, >50% increased S.cr from baseline), ascites (≥ Grade II) were enrolled. 30 patients (GROUP I) received response guided(Urine sodium >80mmol/day) slow albumin-furosemide infusion ± terlipressin (SAFI±T), while 26 patients (GROUP II) received standard medical therapy. 28-day survival, ascites mobilization (nil or grade 1), reversal of AKI and adverse events were noted. Laboratory evidences for improvement in various pathophysiological alterations; endotoxemia, cytokine storm, neutrophil dysfunction and secondary infections, following SAFI±T were evaluated. Results: Alcohol and sepsis were the commonest etiologies for chronic and acute insult respectively. Ascites was completely mobilized in 18/30 (60%) patients in Group I (SAFI±T) and 7/26 (26.9%) in Group II (p< 0.05). At 28 days the survival analysis showed, Group I 23/30 (76.4%) and Group II 14/26 (53.8%) (P=< 0.05). There was a lower incidence of hospital acquired infection in Group I of 6.7% vs 38.4% in Group II (p=0.05) and the same was reflected in serum endotoxin and pro-inflammatory cytokine levels; IL-6 and IL-1b showed significant reduction in Group I. Serum endotoxin and TNF-a level increased in Group II despite SMT while it showed significant fall in SAFI+T arm post treatment. Renal artery resistive index was significantly lower after SAFI(T) therapy (0.84 to 0.72) (p< 0.05) as similar trend emulated in UNa level. Conclusion: Patients with ACLF treated with SAFI+T protocol had higher natriuresis, enhanced urine output, complete ascites removal, and improved renal function with a faster mean duration of treatment and better 28-day survival. An in-hospital infection rate was lower. Ascites mobilization was associated with improvement in gut permeability, endotoxemia, pro-inflammatory cytokines, and NETosis in the SAFI+T cohort, showing an association between ascites mobilization and improved pathophysiologic dysfunctions.

Risk factors for delayed kidney graft function from a deseased donor

Aim. To determine statistically significant risk factors for delayed renal graft function. To assess the impact of delayed kidney graft function on the development of other complications, graft and recipient survival.Material and methods. In 237 consecutive kidney transplant recipients (from June 2018 to December 2021), we assessed its function in the early postoperative period. Delayed function was considered to be the need for hemodialysis in the first week after surgery. Among the donor factors, the type of donor, age, body mass index, the presence of vasopressor support, the time the donor was in intensive care, and the maximum level of creatinine during the follow-up were evaluated. Recipient risk factors include age, gender, body mass index, presence/absence and amount of urine, presence of preformed anti-HLA antibodies and/or repeated kidney transplantation, number of mismatches for six HLA antigens, number of mismatches for HLA-DR, presence and type of renal replacement therapy, etiology of end stage kidney disease. Among the perioperative risk factors are the duration of cold preservation, the time of second warm ischemia, the volume of intraoperative blood loss, the intraoperatively determined renal arterial resistive index of the renal graft, and the maximum concentration of tacrolimus in the first 4 days after kidney transplantation. After that the relationship between the presence of delayed kidney graft function and the development of early postoperative complications was assessed and its effect on the long-term survival of grafts and recipients was analyzed.Results. Out of 237 cases, 9 showed no function of the transplanted kidney, and therefore the grafts were removed. The incidence of delayed renal graft function was 24.5% (58/237). According to the results of a univariate analysis, a statistically significant relationship with the development of delayed kidney graft function had donor body mass index (p=0.019), male gender of the recipient (p=0.048), recipient body mass index (p=0.038), amount of urine (p=0.003), anuria (p=0.002), presence of preformed antibodies (p=0.025), repeated transplantation (p=0.002), time of second warm ischemia (p=0.036), intraoperative renal arterial resistive index (p=0.004) and maximum tacrolimus concentration in the first 4 days (p=0.022). In the multivariate model, donor body mass index &gt;30 kg/m2 and peak tacrolimus concentration &gt;23 ng/mL in the first 4 days were statistically significant (p=0.018 and p=0.025, respectively). A trend towards statistical significance was noted in the presence of oligoanuria before kidney transplantation (p=0.066) and resistance index &gt;0.75 after surgery (p=0.056). One-year renal transplant survival in the absence and presence of delayed kidney graft function was 92.4% and 87.7%, two-year survival was 89.4% and 76.1%, respectively. The effect of delayed kidney graft function on graft survival was statistically significant (p=0.01), while overall recipient survival did not differ between the groups.Conclusion. During the univariate analysis, we identified 9 statistically significant factors, of which at least 3 are potentially modifiable. In the multivariate model, the most significant modifiable risk factor was an increased concentration of tacrolimus, which prompted the authors to reconsider the existing immunosuppressive protocol at the City Clinical Hospital n.a. S.P. Botkin. We consider the search for modifiable statistically significant risk factors for patients, their analysis and implementation of preventive measures to be an important task for each kidney transplant center.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

The Effect of TCM Syndrome Type and Western Medicine Detection on Patients with Hypertension and Diabetes Mellitus.

Objective To investigate the clinical changes of TCM syndrome type and microalbuminuria in patients with hypertension and diabetes mellitus. Methods A total of 442 patients with hypertension and diabetes who were admitted to our hospital from June 2016 to June 2021 were selected. All patients were divided into medication group and control group according to the random number method. Patients in the medication group were treated with conventional Western medicine-assisted traditional Chinese medicine, while patients in the control group were not treated with adjuvant medicine. The blood pressure and blood glucose of patients in the two groups were controlled within the normal range, and the clinical effects of the two groups were observed. Results The treatment of hypertension and diabetes in the two groups was diagnosed by the TCM syndrome type, and the cure rate was higher in the medication group. After 3 months, the glomerular filtration rate in the medication group increased steadily and the renal artery resistance index decreased, while the indexes in the control group had no significant change, with statistical significance (P < 0.05). After 6 months, the urinary albumin excretion rate and the ratio of urinary albumin to creatinine in the medication group were significantly decreased compared with those before medication, while there were no significant changes in the control group, with statistical significance (P < 0.05). The urine excretion rate of albumin in hypertensive patients with diabetes is higher, leading to the increased probability of microalbuminuria in patients, which is not only related to the course of hypertension and diabetes but also positively related to the course of hypertension and diabetes, smoking, drinking, and diet. Conclusion The combination of the TCM syndrome type and Western medicine detection method is more conducive to the two diagnosis and treatment methods that complement each other, improve each other, improve the effect of diagnosis and treatment, and are worthy of further research by researchers, so as to promote clinical application. Some other bad habits should also be corrected, such as smoking, drinking, and irregular diet, through adjusting the diet; control of high protein intake is also an important intervention measure for disease.

Sex-specific effects of daily tadalafil on diabetic heart kinetics in RECOGITO, a randomized, double-blind, placebo-controlled trial.

Cyclic GMP-phosphodiesterase type 5 (PDE5) inhibition has been shown to counteract maladaptive cardiac changes triggered by diabetes in some but not all studies. We performed a single-center, 20-week, double-blind, randomized, placebo-controlled trial (NCT01803828) to assess sex differences in cardiac remodeling after PDE5 inhibition in patients with diabetic cardiomyopathy. A total of 122 men and women (45 to 80 years) with long-duration (>3 years) and well-controlled type 2 diabetes mellitus (T2DM; HbA1c < 86 mmol/mol) were selected according to echocardiographic signs of cardiac remodeling. Patients were randomly assigned (1:1) to placebo or oral tadalafil (20 mg, once daily). The primary outcome was to evaluate sex differences in cardiac torsion change. Secondary outcomes were changes in cardiovascular, metabolic, immune, and renal function. At 20 weeks, the treatment-by-sex interaction documented an improvement in cardiac torsion (-3.40°, -5.96; -0.84, P = 0.011) and fiber shortening (-1.19%, -2.24; -0.14, P = 0.027) in men but not women. The primary outcome could not be explained by differences in cGMP concentrations or tadalafil pharmacodynamics. In both sexes, tadalafil improved hsa-miR-199-5p expression, biomarkers of cardiovascular remodeling, albuminuria, renal artery resistive index, and circulating Klotho concentrations. Immune cell profiling revealed an improvement in low-grade chronic inflammation: Classic CD14++CD16- monocytes reduced, and Tie2+ monocytes increased. Nine patients (14.5%) had minor adverse reactions after tadalafil administration. Continuous PDE5 inhibition could offer a strategy to target cardiorenal complications of T2DM, with sex- and tissue-specific responses. Further studies are needed to confirm Klotho and hsa-miR-199-5p as markers for T2DM complications.

A STUDY OF RENAL ARTERIAL RESISTIVE INDEX IN HEPATIC CIRRHOSIS AND ITS ROLE IN ASSESSING THE RISK FOR HEPATORENAL SYNDROME

Aim: The study was undertaken with the aim to evaluate the relationship of Renal arterial resistive with renal impairment/hepatorenal syndrome in cirrhosis. The present cross-sectional study was conducted among 50 cirrhotic patients (≥ 18 years old). Duplex dopplerMethodology: evaluation of the renal arteries was done with calculation of mean renal arterial resistive index. The relationship between RI and Child-Turcotte- Pugh score, MELD score, severity of ascites and HRS was ascertained. RI increases as the degree of ascites increases with maximumResults: being in severe ascites and had signicant comparability with CTP and MELD scoring systems. 36 patients were having RI ≥ 0.7 and 14 patients were having RI &lt; 0.7. RI increases with degree of hepatic decompensation. Higher values of RI help in early detection of subsequentConclusion: kidney dysfunction and hepatorenal syndrome which can be translated into the early initiation of treatment for impending HRS.

Renal Segmental Artery Resistive Index as a Non-Invasive Indicator of Functional Deterioration in Patients with Chronic Kidney Disease

Background: Chronic kidney disease refers to the gradual loss of renal function over time and is a significant public health problem worldwide. Doppler ultrasonography can be used as a non-invasive modality to detect renal macroabnormalities and renal vascular status in these patients. The objective of our study was to assess the role of renal segmental artery resistive index in the evaluation of the renal functional status in patients with different grades of chronic kidney disease. Methods: A hospital-based study using a non-interventional study design was employed in the study. The inclusion criteria were adult patients between 20 to 60 years of age with chronic renal disease but not undergoing renal replacement therapy. Renal Doppler was performed by a single operator on these patients with a curvilinear probe of 3.2 megahertz. Data were entered in a predesigned proforma, and analysis was done using IBM SPSS version 20. Results: The mean renal segmental artery resistive index in our study was 0.74 (SD=0.08) for the right kidney and 0.75 (SD=0.07) for the left kidney. A positive correlation was observed between the grade of chronic kidney disease and segmental artery resistive index with an r-value of 0.76 and 0.72 for the right kidney and left kidney, respectively. Conclusion: The renal segmental artery resistive index can be used as a non-invasive indicator for evaluating patients with chronic kidney disease. It correlates with the renal functional status as estimated by the glomerular filtration rate. It can be used as a marker for deterioration of renal function and can also prognosticate the outcome in patients with chronic kidney diseases.

Correlation of resistive index of main renal artery and inter-lobar artery with degree of hydronephrosis.

Objective: To study the correlation of resistive index of main renal artery and inter-lobar artery with degree of hydronephrosis. For the purpose of this study data collection was carried through different research works conducted previously regarding hydronephrosis and its effects on the resistivity index of renal arteries. Study Design: Systemic Review. Setting: Radiology Research Section, University of Lahore. Period: September 2018 to May 2020. Material &amp; Methods: Research was conducted with the help of keywords. One hundred and three articles were found at initial stage. A table was designed for data collection purpose including the information such as author of article, year of research, type of hydronephrosis, number of patients, and the resistive index of renal arteries. The data included both male and female patients of any age suffering from hydronephrosis of any origin and no area or time limitation was applied. Results: Pooling results of this systematic review depicts that the researchers conducted various researches addressing the cause of hydronephrosis, the effect of type of hydronephrosis on the resistive index, difference between resistivity index of obstructive and non-obstructive hydronephrosis, level of obstruction and its effect on RI of the renal artery, factors that influence RI other than renal in origin but not a single research conducted on human subject represents the correlation of different grades or degrees of hydronephrosis with either main renal artery or inter-lobar arteries. Out of 17 articles, 8 (47%) articles discuss the resistive index for both obstructive and non-obstructive hydronephrosis while remaining 9 (53%) articles discuss only the mean resistive index for the obstructed kidney. Conclusion: Although renal resistive index is the parameter which is influenced by a variety of other factors such as age of patient, plasma renin level, and the simultaneous presence of certain diseases like hypertension, cardiac diseases, diabetes mellitus, and renal disorders. The presence of any of these factors may rise the RI values even if there is no renal obstruction. Yet different research mainly shows that the values of RI are high i.e. &gt;0.70 in case of obstructed kidney while generally the values of RI are &lt;0.70 in case of none obstructed kidney.

Renal arterial resistive index as a noninvasive biomarker of disease activity in lupus nephritis patients

Aim of the workTo evaluate the renal resistive index (RI) in lupus nephritis (LN) patients and to study its association with clinical features, laboratory investigations and LN pathological classes in systemic lupus erythematosus (SLE) patients. Patients and methodsThe study included 45 SLE patients and 25 matched controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into LN (renal SLEDAI ≥ 4) and no-renal activity (NRA) (renal SLEDAI = 0). Ultrasound Doppler renal examination was done to measure RI. Renal biopsies were performed in 30 LN patients. ResultsThe mean age of patients was 29.8 ± 10.1 years and disease duration 4.3 ± 3.9 years. They were 40 females and 5 males (F:M 8:1). Their SLEDAI was 10.9 ± 8.2 and renal SLEDAI was 5.2 ± 5.1. They were 30 with LN and 15 NRA SLE patients. Renal RI was significantly higher in LN patients compared to NRA SLE patients and controls (0.61 ± 0.04 vs. 0.55 ± 0.01 vs. 0.55 ± 0.02; p < 0.0001). RI significantly correlated with anti-double stranded deoxyribonucleic acid (anti-dsDNA) positivity (r = 0.33, p = 0.03), 24-hour proteins in urine (r = 0.38, p = 0.01) and negatively with creatinine clearance (r = -0.33, p = 0.03). Renal RI significantly correlated with pathological classes of renal biopsy (r = 0.65, p < 0.0001). At renal RI cut-off value 0.57 renal RI can detect renal activity with sensitivity of 83.3%, specificity of 82.5%, p < 0.0001. Renal RI ≥ 0.57 had higher activity index score compared to those with normal RI (5.7 ± 0.6 vs. 9 ± 3.3, p = 0.04). Conclusion: Renal RI was significantly increased in LN compared to NRA patients and was associated with laboratory parameters and pathological classes.

Potential Role of the Renal Arterial Resistance Index in the Differential Diagnosis of Diabetic Kidney Disease.

AimsTo investigate the potential role of renal arterial resistance index (RI) in the differential diagnosis between diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) and establish a better-quantified differential diagnostic model.Materials and MethodsWe consecutively reviewed 469 type 2 diabetes patients who underwent renal biopsy in our center. According to the renal biopsy results, eligible patients were classified into the DKD group and the NDKD group. The diagnostic significance of RI was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to search for independent risk factors associated with DKD. Then a novel diagnostic model was established using multivariate logistic regression analysis.ResultsA total of 332 DKD and 137 NDKD patients were enrolled for analysis. RI was significantly higher in the DKD group compared with those in the NDKD group (0.70 vs. 0.63, p< 0.001). The optimum cutoff value of RI for predicting DKD was 0.66 with sensitivity (69.2%) and specificity (80.9%). Diabetic retinopathy, diabetes duration ≥ 60 months, HbA1c ≥ 7.0(%), RI ≥ 0.66, and body mass index showed statistical significance in the multivariate logistic regression analysis. Then, we constructed a new diagnostic model based on these results. And the validation tests indicated that the new model had good sensitivity (81.5%) and specificity (78.6%).ConclusionsRI has a potential role in discriminating DKD from NDKD. The RI-based predicting model can be helpful for differential diagnosis of DKD and NDKD.

Estimating Renal Insufficiency in Breast Cancer Patients Using Ultrasound Determined Resistive Index

Purpose: The purpose of this study was to investigate if the renal arterial resistive index (RRI) is impaired in women with breast cancer and correlate these values with estimated glomerular filtration rate (eGFR) as determined by the Chronic Kidney Disease Epidemiology Collaboration equation. Materials and Methods: This was an observational study of fifty chemotherapy-naïve women with histologically confirmed breast carcinoma recruited consecutively over a 1-year period. All women had a Doppler ultrasonography done to determine their RRI and eGFR. Results: Fifty women with breast cancer were evaluated. Their ages ranged from 28 to 85 years, with a mean age of 48.6 ± 13.8 years. The mean RRI in the study was 0.7 ± 0.07. There were thirty subjects (60%) with abnormal resistive index (RI) (&gt;0.7), whereas twenty subjects (40%) had normal RRI. The mean eGFR in the study cohort was 62.6 ± 17. eGFR was abnormal in 96% of the women. About half (n = 24, 48%) had severe renal insufficiency (stages 3 and 4). The majority had advanced breast disease (stages 3 and 4), with 23 patients (46%) presenting with stage 3 disease and 17 (34%) stage 4 disease. Pearson's correlation done between RRI and eGFR showed a mild but statistically significant correlation between RI and eGFR (r = −0.28, P = 0.04). Conclusions: Renal artery RI is raised in most subjects with breast cancer and correlates significantly with the eGFR as determined by cystatin C alone.

Therapeutic effect and mechanism of 4-phenyl butyric acid on renal ischemia-reperfusion injury in mice.

The aim of the present study was to explore the effects and possible mechanism of 4-phenylbutyric acid (4-PBA) on renal ischemia-reperfusion injury (RIRI) in mice. A RIRI model of HK-2 cells was constructed using hypoxia/reoxygenation (H/R) treatment. Dexmedetomidine and 4-PBA were used to treat the cells before and after modeling. Apoptosis and expression levels of cyclophilin D (CypD), cytochrome c, eukaryotic translation initiation factor 2α (eIF2α), glucose-regulated protein 78 (GRP78), intercellular adhesion molecule (ICAM)-1 and vascular adhesion molecule (VCAM)-1 were measured using flow cytometry, western blotting and immunohistochemistry. The renal volume, weight and renal arterial resistance index (RRI) were determined using the renal ischemia model. Compared with untreated model cells, 4-PBA treatment significantly decreased apoptosis and the expression levels of CypD, Cytochrome c, eIF2α and GRP78 in HK-2 cells. There was no significant change in renal volume and weight after modeling, but RRI was significantly decreased after 4-PBA treatments in the model. Western blotting and immunohistochemistry analysis demonstrated that 4-PBA treatment also significantly decreased the expression of ICAM-1 and VCAM-1. Overall, 4-PBA had a therapeutic effect on RIRI in mice. This protection may be mediated by decreasing the expression levels of CypD, Cytochrome c, eIF2α and GRP78, and subsequent reduction of cellular oxygen free radicals and apoptosis, leading to an alleviated endoplasmic reticulum stress response and RIRI.

The value of renal color Doppler ultrasound in evaluating the severity and prognosis of patients with acute organophosphorus pesticide poisoning complicated by acute kidney injury

Objective: To analyze the value of renal color Doppler ultrasound examination and clinical indicators in evaluating the severity and prognosis of acute organophosphorus pesticide poisoning (AOPP) complicated by acute kidney injury (AKI) . Methods: In November 2019, 86 AOPP patients complicated by AKI who were admitted from May 2018 to May 2019 were selected as the observation group, and they were divided into AKI stage 1 group (n=37) , AKI stage 2 group (n=32) and AKI stage 3 group (n=17) . 40 healthy people were selected as the control group. The differences in power Doppler ultrasound (PDU) score, renal interlobular artery resistance index (RI) value and related clinical indicators of each group were measured and analyzed, and the correlations between the indicators were analyzed. At the same time, binary logistic regression was used to analyze the risk factors of death in AOPP patients complicated by AKI. Results: There were statistically significant differences in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱscore, mean arterial pressure (MAP) , serum creatinine (SCr) and the length of continuous renal replacement therapy (CRRT) between different groups (P<0.05) . Compared with the control group, the APACHE Ⅱscores and SCr of patients in the AKI stage 2 and resistance index AKI stage 3 groups increased, while the MAP decreased (P<0.05) . Compared with the control group, AKI stage 1 group and AKI stage 2 group, the PDU score of patients in the AKI stage 3 group was significantly decreased, and the renal interlobular artery RI value was significantly increased (P<0.05) . SCr was positively correlated with the RI value of renal interlobular arteries and CRRT days (r=0.435, 0.713, P<0.05) , and was negatively correlated with renal PDU score (r=-0.643, P<0.05) . The renal PDU score was negatively correlated with the RI value of renal interlobular arteries and CRRT days (r=-0.350, -0.556, P<0.01) . Binary logistic regression analysis showed that SCr (OR=1.017, 95%CI: 1.004-1.041) and APACHE Ⅱ score (OR=1.289, 95%CI: 1.019-1.827) were risk factors for death in patients with AOPP complicated by AKI (P<0.05) . Conclusion: Both PDU score and the RI value of renal interlobular artery can reflect the severity and stage of patients with AOPP complicated by AKI to a certain extent, but neither of them is a key factor affecting the death of patients.

Evaluation of Fetal Renal Artery Doppler Indices in Pregnancies Complicated with Preeclampsia

Objective: Preeclampsia, characterized by endothelial dysfunction, is associated with maternal and fetal Doppler alterations. This study aimed to evaluate fetal renal artery Doppler indices in pregnancies complicated with preeclampsia and compare them with normotensive pregnancies. Design: This cross-sectional study enrolled 46 pregnancies complicated with preeclampsia between weeks 24 and 37 of gestation as the study group and 48 normotensive pregnancies as the control group. Materials and Methods: The abdominal aorta, its bifurcation, and the renal arteries were visualized in the coronal view of the fetal abdomen using color Doppler. Renal artery Doppler indices were measured after arising from the abdominal aorta. The angle of insonation was ≤30° from the direction of blood flow, and the sample volume was 2 mm. Fetal renal artery pulsatility index, resistance index, systolic/diastolic ratio, and peak systolic velocity (PSV) were measured. All Doppler measurements were performed in the absence of fetal movements. Moreover, demographic characteristics and the perinatal outcome data of patients were recorded. Results: The values of fetal renal artery pulsatility and resistance indices were found to be significantly lower in the study group than those in the control group (p < 0.001 and p = 0.013, respectively). The fetal renal artery systolic/diastolic ratio and PSV values were also significantly lower in the study group compared with those in the control group (p = 0.007 and p < 0.001, respectively). Renal artery pulsatility and resistance indices were negatively correlated with mean arterial pressure (r = −0.381, p < 0.001 and r = −0.267, p = 0.009, respectively). The renal artery systolic/diastolic ratio was also significantly negatively correlated with the mean arterial pressure (r = −0.257, p = 0.013). Limitations: The main limitations of this study are its cross-sectional design and the small number of participants. Another limitation of the study is that preeclamptic pregnancies complicated with fetal growth restriction were not included. Conclusion: The observed decrease in fetal renal artery Doppler impedance may be caused by the unique response of the fetal renal artery to the factors involved in the etiopathogenesis of preeclampsia than other fetal peripheral vessels. These changes in fetal renal artery indices in pregnancies complicated with preeclampsia could be taken into account in the assessment of fetal health.

Impact of Different Modalities of Treatment of Hepatorenal Syndrome as Midodrine, Somatostatin analogue, Albumin infusion and Tapping of Ascites on Renal Artery Resistive Index by Doppler ultrasound

Abstract Background Liver cirrhosis is a major cause of morbidity and mortality worldwide, mainly due to complications of portal hypertension. Ascites formation in patients with Kristeen E. cirrhosis, portal hypertension, or both usually results from hyperdynamic circulatory Zaki dysfunction. Aim of the Work to investigate the effect and prognostic value of treatment of hepatorenal syndrome in patients with liver cirrhosis and massive ascites by LVP, somatostatin analogue and midodrine intake and its effect on renal resistive index. Patients and Methods This study was carried on 40 patients divided into 4 groups where 10 patients (G1) received midodrine therapy and albumin infusion, 10 patients (G2) had tapping of ascites with albumin infusion, 10 patients (G3) received octreotide therapy and albumin infusion and the last 10 patients (G4) received octreotide, midodrine and albumin infusion. All patients were subjected to careful history taking and thorough clinical examination. Before and after intervention, patients had laboratory investigation including complete blood picture, liver function tests, renal function test and ascitic fluid analysis in addition to renal artery Doppler imaging. Results The study revealed considerable decline in RI in G1 (midodrine group), the change fell short of statistical significance. However, our study showed significant effect of midodrine administration on renal functions as expressed by serum creatinine, blood urea and creatinine clearance. In G3 (octreotide group), the effect of treatment on renal artery RI was minimal. The other group that perceived significant decline in renal artery resistive index was G4 (midodrine and octreotide group). Conclusions LVP and midodrine combination administration resulted in significant decrease in creatinine clearance. Renal artery resistive index has significant correlation with creatinine clearance in studied group and can be used as non-invasive tool.

Backpropagation Neural Network Algorithm-Based Color Doppler Ultrasound Detection of Gestational Diabetes Mellitus and Perinatal Outcomes

In this work, the related risk factors and perinatal outcomes of pregnant women with gestational diabetes mellitus (GDM) were analyzed based on color Doppler ultrasound (CDU) diagnosis. Backpropagation (BP) algorithm-based CDU imaging algorithm (BPC) was constructed in this study and applied in CDU images of 80 pregnant women with GDM. Besides, amplitude and phase estimation (APES) and low-complexity adaptive beam (LCA) algorithms were introduced for comparison with BPC in turn. It was found that Dice similarity coefficient (96.44%), sensitivity (95.45%), and specificity (91.56%) of BPC were greater than those of APES (83.97%, 85.84%, 78.45%) and LCA (84.74%, 86.29%, 82.35%), while its running time (6.44 ± 1.39 s) was shorter than that of APES (11.87 ± 2.41 s) and LCA (13.76 ± 1.54 s) ( P &lt; 0.05 ). Pregnant women in the experimental group (group B) were older than those in the control group (group A) ( P &lt; 0.05 ). The pulsatility index (PI) and renal artery resistance index (RI) of fetuses in group B (0.95 ± 0.15) were higher than those of group A (0.57 ± 0.24) ( P &lt; 0.05 ). In addition, pregnancy age, family history of hypertension, and abortion history were positively correlated with GDM ( P &lt; 0.05 ). In conclusion, BPC could not only improve diagnosis accuracy in fetuses’ CDU images but also shorten calculation time. Pregnancy age, family history of hypertension, and abortion history were the related risk factors for GDM in pregnant women.