Renal Doppler Ultrasonography Research Articles

Value of Renal Artery Resistive Index in Nonazotaemic Cirrhotic Patients with Ascites

Background: Renal dysfunction is a common complication in patients with liver cirrhosis, with hepatorenal syndrome (HRS) being the most severe form. HRS is characterized by disturbances in both circulatory and kidney functions and is diagnosed by excluding other causes of renal failure. Objective: This study aimed to measure the renal artery resistive index (RI) in non-azotaemic cirrhotic patients with ascites to predict early renal haemodynamic dysfunction. Methodology: A prospective study was conducted involving 30 cirrhotic patients with ascites and 15 healthy controls. Renal artery RI was measured using Duplex Doppler ultrasonography. Inclusion criteria for patients included normal renal function, as indicated by serum creatinine ≤ 1.2 mg/dl and creatinine clearance rate ≥ 50 ml/min. Results: The mean renal artery RI was significantly higher in cirrhotic patients with ascites (70% had RI ≥ 0.70) compared to controls (all had RI < 0.70). Significant differences were observed in serum bilirubin, SGPT, SGOT, and prothrombin time between cases and controls (p < 0.05). Conclusion: Renal Doppler ultrasonography is a valuable noninvasive method for detecting early renal haemodynamic dysfunction in cirrhotic patients with ascites. Elevated renal artery RI can serve as an indicator of renal dysfunction, aiding in early diagnosis and management.

The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial

Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2–17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn’t show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

The pattern of renal artery Doppler indices in patients with sickle cell disease

Aim: To evaluate the pattern of renal artery Doppler indices in patients with sickle cell disease who do not have laboratory evidence of renal impairment. Material and methods: A case-control study was carried out after enrolling 50 patients with sickle cell disease (HbSS phenotype) (sickle cell disease group) and 50 con- trol subjects (control group). All the participants underwent ultrasound and color Doppler examination, and the pulsatility index and resistive index values of the main renal artery, segmental artery, and interlobar artery in both kidneys were recorded and compared. Results: The Doppler measurements of the main renal artery, segmental artery, and interlobar artery were compared between the control and sickle cell disease groups. It was found that both pulsatility index and resistive index were significantly higher in the sickle cell disease group, as compared to the control group, for the main renal artery, segmental artery, and interlobar artery (p <0.0001, p <0.0001, and p <0.0001, respectively). The optimal cut-off points for mean pulsatility index and resistive index, as measured by the Youden index, were found to be >1.08 (72% sensitivity and 88% specificity) and >0.635 (66% sensitivity and 98% specificity), respectively. Conclusions: Resistive index and pulsatility index values in renal Doppler sonography can serve as early radiologic predictors of renal vascular changes in sickle cell disease patients who do not have laboratory evidence of renal impairment.

Renal Doppler Velocimetric Indices among Adult Seropositive Viral Hepatitis Patients Attending Tertiary Care Facility in Kano State, Nigeria

Context: Viral hepatitis is associated with an increased risk of renal disease leading to hepato-renal syndrome. Currently, urine and blood tests are the primary tools used to detect and monitor kidney disease among seropositive viral hepatitis patients. However, these biomarkers are affected by co-existing liver disease, age, and BMI, making their use unreliable in some patients with renal impairments. Renal Doppler sonography has been explored as a viable non-invasive alternative for the diagnosis of subclinical renal changes among asymptomatic patients with viral hepatitis. Aim: This study aimed to evaluate renal Doppler velocimetric indices of asymptomatic adult patients with viral hepatitis and compared Doppler values between carrier serotypes with correlations with prothrombin time (PT) at Aminu Kano Teaching Hospital, Kano. Settings and Design: This was a hospital-based cross-sectional observational study conducted at the Radiology Department of AKTH. Materials and Method: This study was conducted between March 2022 and January 2023, among seropositive viral hepatitis patients grouped into acute hepatitis B (AHB), chronic hepatitis B (CHB), and chronic hepatitis C (CHC). The resistive index (RI) and pulsatility index (PI) for the different serotypes were obtained following renal Doppler sonography among study subjects. Also, PT was recorded for each serotype. Statistical Analysis Used: Relevant data obtained were entered and analyzed using SPSS version 23. The significance level was considered at P < 0.05. Results: The study had 153 patients. The resistive index (RI) was significantly higher among AHB than CHB serotypes, and PI was also higher among CHB than CHC serotypes − likewise, the PT. Positive correlations (r = 0.75, P = 0.01) and (r = 0.78, P = 0.01) were seen between RI and PT in both male and female patients, respectively. Conclusion: The RI, PI, and PT values were higher among acute and chronic hepatitis B serotypes than in chronic hepatitis C serotypes.

Evaluation of Kidneys with Renal Doppler Ultrasonography and Ultrasound Elastography in Patients with Type 2 Diabetes Mellitus

Introduction: The aim of this study early recognize diabetic nephropathy by ultrasound elastography.This study was to predict the possibility of developing diabetic nephropathy without the need for renal biopsy. Methods:This study included 100 patients and 100 healthy volunteers. Shear wave elastography examination were taken of the renal parenchyma and the Resistive Index values were taken renal artery. Results:.In the patient group, the elastography values were measured as 7.02±2.15 kPa in the right kidney parenchyma and 6.90±2.09 kPa in the left. In the control group, the elasticity values were measured as 4.14±0.98 kPa in the right kidney parenchyma and 4.11±0.85 kPa in the left. The RI mean values were determined as 0.59±0.05 in the right kidney and 0.59±0.04 in the left kidney in the patient group and 0.52±0.05 in the right kidney and 0.52±0.05 in the left kidney in the control group. Conclusion: The elastography values and the RI values were significantly higher in the patients with Type 2 DM than in the control group. Thus, it can be concluded that it is possible to determine renal fibrosis and predict the possibility of diabetic nephropathy development with the non-invasive methods of SWE and colour Doppler US, without the need for biopsy.

Retracted: Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis

Retracted: Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis

Hemodynamic evaluation of right-sided congestion with doppler ultrasonography in pulmonary hypertension: portal vs intra-renal venous flow patterns

Abstract Introduction Renal congestion is a key pathophysiological mechanism mediating adverse outcomes in patients with heart failure. Novel approaches to evaluate renal congestion like renal Doppler ultrasonography show promise as a noninvasive hemodynamic monitoring tool. Portal Doppler ultrasound is a less challenging exam and could potentially provide similar information than intra-renal Doppler. Methods and Results We enrolled 95 patients with suspected or diagnosed pulmonary hypertension (PH) presenting to the emergency department or to a scheduled ambulatory clinic. Patients underwent renal and portal Doppler ultrasonography. Renal congestion was graded using the validated renal venous stasis index (RVSI) or renal venous patterns. The portal vein pulsatility fraction (PVPF) was used to quantify portal congestion. We found high degree of correlation (R = 0.93) between portal and renal congestion, with excellent agreement (κ = 0.92 [0.86-0.98]). Both RVSI and PVPF showed excellent interclass correlation and agreement amongst operators (ICC 0.93). 90-day mortality or need for renal replacement therapy was significantly more frequent in patients with high PVPF (p=0.001) HR: 5.3 (1.9-17.0). Conclusions Altered portal venous flow accurately predicts the presence of renal congestion and is technically easier to obtain. Portal vein Doppler may identify patients with pulmonary hypertension at risk for renal deterioration secondary to venous congestion.Portal-renal patterns and their outcomes

Renal artery stenosis: a single center experience

Objectives: Renal artery stenosis (RAS) is among the most common causes of secondary hypertension. Prevalence of RAS are seen in end-stage renal disease (ESRD) patients with hypertension between 1-10%. In our study, we evaluated the data of patients with RAS who were followed up with medical treatment and stenting. Methods: In our study, patients who were thought to have renal artery stenosis (RAS) with renal artery doppler ultrasonography were scanned with contrast-enhanced Magnetic Resonance Angiography (MRA). Fifty-three patients (10 received medical therapy, 43 applied invasive procedure) who diagnosed with RAS evaluated. Results: Follow-up times were 15 (12-84) months in patients who received medical therapy, and 12 (10-96) months in patients who treated with invasive therapy (p = 0.583). Median ages were 56 (19-74) years in medical treatment group, and 60 (15-77) years in invasive therapy group (p = 0.955). Compared with the beginning of treatment, diastolic hypertension was decreased of 12.5% in invasive treatment group opposite medical therapy group (p = 0.040), so eGFR was increased of 5.94% in invasive treatment group. Conclusions: In recent years, several studies about survival in patients with RAS was observed that there was no significant difference between the medical and invasive treatment. Clinical, laboratory, and individual characteristics should be considered in treatment choice.

Renal Doppler ultrasonography for predicting non-diabetic kidney disease in patients with diabetes.

This study was conducted to assess the role of renal Doppler ultrasonography (US) in predicting non-diabetic kidney disease (NDKD) in patients with diabetes, using histologic findings as the reference standard. Fifty-nine consecutive patients with diabetes who underwent renal Doppler US and native kidney biopsy were included in this retrospective, single-institutional study. Based on histologic findings, patients were classified as having diabetic nephropathy (DN) or NDKD. Renal Doppler US findings, including cortical echogenicity, corticomedullary differentiation, and the resistive index (RI), were compared between DN and NDKD. A subgroup analysis according to chronic kidney disease (CKD) status was also performed. Cortical echogenicity and corticomedullary differentiation showed no significant differences between DN and NDKD (P=0.887 and P>0.99, respectively), whereas the RI was significantly higher in patients with DN than in those with NDKD (P=0.032). The subgroup analysis revealed a significant difference in the RI between DN and NDKD in patients with diabetes and CKD (P=0.010), but a significant difference was not found in those without CKD (P=0.713). When limited to patients with diabetes and CKD, the RI had an area under the curve value of 0.759, sensitivity of 57.1%, specificity of 81.0%, positive likelihood ratio of 3.0, and negative LR of 0.5 for predicting NDKD, using a cutoff value of ≤0.69. Renal Doppler US may be useful in predicting NDKD in patients with diabetes and CKD.

Influence of hyperthermic intraperitoneal chemotherapy on renal blood perfusion

PurposeHyperthermic intraperitoneal chemotherapy (HIPEC) is accompanied with an increased risk of acute kidney injury (AKI). Whether AKI is induced by chemotoxicity or hyperthermia-related changes in renal perfusion remains controversial. The influence of HIPEC on renal perfusion has not been evaluated in patients yet.MethodsRenal blood perfusion was assessed in ten patients treated with HIPEC by intraoperative renal Doppler pulse-wave ultrasound. Ultrasound (US) examinations were performed pre-, intra-, and postoperative with analyses of time-velocity curves. Patient demographics, surgical details, and data regarding renal function were recorded perioperatively. For evaluation of renal Doppler US to predict AKI, patients were divided in two groups with (AKI +) and without (AKI −) kidney injury.ResultsThroughout HIPEC perfusion, neither significant nor consistent changes in renal perfusion could be observed. Postoperative AKI occurred in 6 of 10 participating patients. Intraoperative renal resistive index (RRI) values > 0.8 were observed in one patient developing stage 3 AKI according KDIGO criteria. At 30 min in perfusion, RRI values were significantly higher in AKI + patients.ConclusionAKI is a common and frequent complication after HIPEC, but underlying pathophysiology remains elusive. High intraoperative RRI values may indicate an increased risk of postoperative AKI. Present data challenges the relevance of hyperthermia-derived hypothesis of renal hypoperfusion with prerenal injury during HIPEC. More attention should be drawn towards chemotoxic-induced hypothesis of HIPEC-induced AKI and caution applying regimens containing nephrotoxic agents in patients. Further confirmatory and complementary studies on renal perfusion as well as pharmacokinetic HIPEC studies are required.

Diagnostic Value of Renal Duplex Doppler Ultrasonography in the Evaluation of Renal Amiloidosis Associated with Familial Mediterranean Fever

Diagnostic Value of Renal Duplex Doppler Ultrasonography in the Evaluation of Renal Amiloidosis Associated with Familial Mediterranean Fever

Predictability performance of urinary C–C motif chemokine ligand 14 and renal resistive index for persistent sepsis-associated acute kidney injury in ICU patients

ObjectivesThe performance of renal resistance index (RRI) in predicting persistent sepsis-associated acute kidney injury (S-AKI) remains debatable, and the value of urinary C–C motif chemokine ligand 14 (CCL14) in predicting persistent S-AKI has not been validated yet. Therefore, we aimed to determine the applicability of a urinary biomarker CCL14 for the early detection of persistent S-AKI. Furthermore, the use of RRI obtained from renal Doppler ultrasonography was applied to differentiate transient from persistent S-AKI. Finally, we aimed to evaluate the use of these techniques in predicting different subtypes of S-AKI.MethodsThis prospective observational study was conducted at the internal medicine intensive care unit (ICU) of a university hospital. The RRI was determined within 12 h of ICU admission and the urinary CCL14 was evaluated at T0, T6, T12, and T24. The reversibility of renal dysfunction was assessed within 48 h. The receiver operating characteristic curves were then plotted to assess the diagnostic efficacy of the RRI and urinary CCL14 in predicting persistent S-AKI.ResultsOut of 48 patients, 23 developed persistent S-AKI upon admission. The RRI was higher in the persistent S-AKI group (P = 0.02) and the RRI ≥ 0.679 could predict persistent S-AKI with an area under the receiver operating characteristic curve of 0.79 (95% CI 0.65–0.93), a sensitivity of 91.30% (95% CI 70–98%), and a specificity of 65.20% (95% CI 43–83%). Urinary CCL14 was not significantly different between the two groups at the tested period, showing poor diagnostic performance at T0, T6, T12, and T24, with areas under the receiver operating characteristic curves of 0.56 (95% CI 0.38–0.73), 0.62 (95% CI 0.46–0.79), 0.52 (95% CI 0.35–0.68), and 0.60 (95% CI 0.43–0.77), respectively.ConclusionsThe RRI obtained from renal Doppler ultrasound is extremely effective in predicting persistent S-AKI in critically ill patients, and urinary CCL14 could not distinguish between transient and persistent S-AKIs.

The relationship between renal renal resistive index and hypertensive end-organ damage

Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients. Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria). Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.

Evaluation of Diuretic Renal Doppler Ultrasonography Findings in Chronic Unilateral Partial Ureteral Obstruction in Rabbits

Evaluation of Diuretic Renal Doppler Ultrasonography Findings in Chronic Unilateral Partial Ureteral Obstruction in Rabbits

PS-R07-6: RENOVASCULAR HYPERTENSION SECONDARY TO MASSIVE ILIOPSOAS HEMATOMA

An 81-year-old female with stage G3 chronic kidney disease and post left nephrectomy for upper tract urothelial carcinoma 20 years ago, was admitted to our hospital for heart failure. She acutely developed right thigh pain, and contrast-enhanced computed tomography (CT) revealed an idiopathic iliopsoas hematoma for which transcatheter arterial embolization (TAE) was performed. Subsequently, her hypertension worsened despite multiple antihypertensive medications (Nifedipine, Carvedilol, Doxazosin, Spironolactone), remained uncontrolled over one month. At this point, plasma renin activity and plasma aldosterone concentration were both elevated on taking carvedilol and spironolactone. An angiotensin II receptor blocker (ARB, Olmesartan) was additionally started for refractory hypertension. Oliguric acute kidney injury (AKI) developed on the day following ARB administration, and her serum creatinine increased from 0.98 to 2.0 mg/dL. After stopping the ARB, the kidney function immediately recovered to the previous level. On review of the previously performed contrast CT, the remnant (right) kidney was ventrally displaced, and the right renal artery was kinked by the massive iliopsoas hematoma (Figure 1a and 1b). Three months after TAE, the hematoma completely disappeared, and the right kidney and renal artery returned to their original positions. Renal Doppler ultrasonography before the appearance, and after the disappearance of hematoma, demonstrated no abnormalities indicative of renal artery stenosis. Furthermore, hypertension also improved over the three months after TAE. Renal artery stenosis is primarily caused by atherosclerosis, fibromuscular dysplasia, and rarely external compression. We report a rare case of renovascular hypertension which would be induced by renal artery kinking due to massive iliopsoas hematoma. JOURNAL/jhype/04.03/00004872-202301001-01329/figure1/v/2023-10-24T163949Z/r/image-jpeg

PS-BPR02-4: RENOVASCULAR HYPERTENSION FROM FIBROMUSCULAR DYSPLASIA WITHOUT ABNORMALITIES IN RENAL DOPPLER ULTRASOUND: A CASE REPORT.

Background: Renovascular hypertension (RVH) is one of the most common forms of secondary hypertension, and accounts for nearly 1% of all hypertension cases. It is characterized by compromised renal perfusion pressure, resultant renin secretion, and hypokalemia due to secondary hyperaldosteronism. Arteriosclerosis is a common underlying pathogenesis in middle-aged and older adults, whilst fibromuscular dysplasia is occasionally seen in younger patients with RVH. Since cardiovascular complications are of grave concern in RVH, early detection and appropriate therapeutic intervention are particularly important. Here, we report a case of renovascular hypertension from fibromuscular dysplasia which was incidentally unveiled during close examination of an adrenal tumor. Case report: A 55-year-old woman was being treated for hypertension by her primary care physician. She was referred to our hospital for a thorough examination of her right ureteral stone, which necessitated a CT scan incidentally revealing an left adrenal nodule measuring 8 mm in size. Primary aldosteronism was unlikely based on the lack of renin suppression (active renin concentration, 36.5 pg/mL; plasma aldosterone levels, 263 pg/mL and aldosterone-renin ratio < 40 under treatment with nifedipine 40 mg/day. Ultrasound of the kidney demonstrated a notable difference in size between the right and left kidneys of 87 mm and 106 mm, respectively, albeit Renal Artery Doppler failed to suggest the renal artery stenosis. CT scan with contrast material revealed the remarkable irregularity and “string on beads” sign on the distal main trunk of the right renal artery. Renovascular hypertension from fibromyalgia dysplasia was suspected, and percutaneous renal artery angioplasty was performed. After the pressure gradient across the stenotic lesion (105/99 mmHg on the distal side and 125/67 mmHg on the proximal side of the renal artery) was verified, balloon dilation was applied. The procedure was successful as the pressure gradient virtually resolved (105/95 mmHg on the distal side and 109/101 mmHg on the proximal side of the renal artery). Digital subtraction angiography indeed reaffirmed improvement in blood flow. Conclusion: Renovascular hypertension can go unnoticed solely based on renal Doppler Ultrasound. This was a case in which renovascular hypertension from fibromuscular dysplasia was incidentally identified in CT scan designated as a work-up for an adrenal tumor.

PS-C37-3: MULTIPLE VISITS TO THE EMERGENCY SERVICE - A CASE OF NUTCRACKER SYNDROME

Background: Nutcracker Syndrome (NS) is a rare clinical entity consisting of compression of the left renal vein by the superior mesenteric artery as it travels between it and the abdominal aorta. The compressive process leads to different levels of extrinsic renal artery stenosis, from asymptomatic episodes to episodes of macroscopic hematuria, proteinuria, renovascular hypertension, left flank pain, dyspareunia, dysmenorrhea and pelvic varicose veins. It is more prevalent in females and it can be diagnosed at any age, but particularly during the 2nd and 3rd decades of life. Renal veins Doppler ultrasonography is the exam of choice in the initial evaluation, being confirmed by imaging exams such as CT and MRI. The treatment is controversial, ranging from conservative treatment to nephrectomy. Case Description: Between 2015 and 2022, a 24-year-old Caucasian woman, without noteworthy personal and family clinical background, resorted several times to the Emergency Department with vomiting, diarrhea and abdominal distension and pain. Numerous alternative diagnoses have been made, such as Acute Gastroenteritis, Urinary Tract Infection, among other. Due to the large number of emergency episodes, the patient was examined by gastroenterologist who requested an abdominal CT, and diagnosed NS. The patient underwent an unsuccessful left renal vein stenting, which subsequently forced a renal auto transplantation, which was performed without complications. Take Home Message: In the GP daily practice, establishing NS diagnosis is difficult and usually made after the exclusion of other problematics. A great level of suspicion is therefore crucial in patients with diversified clinical findings.

An Unusual Etiology of Proteinuria and Hematuria in a Case with IgA Vasculitis Nephropathy: Nutcracker Syndrome

IgA vasculitis is the most frequent type of vasculitis in children and progresses with the involvement of skin, gastrointestinal system, joints and glomerulonephritis. The most frequent findings of IgAV nephritis are microscopic hematuria and proteinuria ranging from trace amounts to nephrotic levels. The nutcracker syndrome (NCS) is a phenomenon that refers to compression of the left renal vein between the abdominal aorta and superior mesenteric artery. The presenting manifestations are hematuria, orthostatic proteinuria, abdominal pain or left flank pain. Herein we reported a case diagnosed with NCS with regard to persistent microscopic hematuria, intermittent macroscopic hematuria and a fluctuating proteinuria in non-nephrotic levels during the follow up of IgA vasculitis nephritis. A 4,5 year-old boy with rashes extending from the dorsal foot to the sacral regions, arthritis of the ankles and abdominal pain had been admitted to hospital and diagnosed with IgA vasculitis. The total urine analysis revealed +3 proteinuria, and +2 erythrocyte. Nephrotic range of proteinuria was detected in 24-hour urine analysis. The renal biopsy was in accordance with grade II IgA vasculitis nephritis according to the ISKDC classification. The patient was started on an ACE inhibitor and fish oil. In further follow-up, intermittent microscopic hematuria and non-nephrotic range of proteinuria reappeared. The amount of proteinuria was measured in the urine collected during the daytime and the nighttime urine and it was observed that the proteinuria was orthostatic. The patient was re-evaluated regarding etiologies for proteinuria and hematuria. Renal Doppler ultrasonography revealed that the angle between the abdominal aorta and SMA was 14 degrees. Abdominal computed tomography angiography demonstrated that the left renal vein was trapped between aorta and SMA, so the case was diagnosed with NCS. In conclusion, non-glomerular etiologies should be kept in mind in the differential diagnosis of patients with hematuria and/or proteinuria although they are being followed for glomerular pathologies.

Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: a retrospective cohort study

Renal resistive index (RRI), which reflects intrarenal arterial impedance, is routinely measured when undertaking renal Doppler ultrasonography (RDU). Increased RRI has been suggested to reflect renal parenchymal disease and imply risk of kidney disease progression. But this has been disputed and extra-renal haemodynamic factors rather than intra-renal factors have been proposed to determine RRI. To investigate the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examine whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow up. This retrospective observational study examined the association of elevated RRI (>0.7) with the presence of CKD (eGFR < 60 mL/min for >3 months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow up using mixed models. Of the 346 patients undergoing RDU (median age 69.7 years; 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = -0.53, -0.51, -0.53, all P < 001). Elevated RRI was independently predicted by older age (odds ratio 3.29; 95% confidence interval 2.25-4.8; P < 0.001) and diabetes (odds ratio 2.65; 95% confidence interval 1.21-5.80; P = 0.015), but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow up. Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline.

Role of Renal Doppler Ultrasound in Early Detection of Acute Kidney Injury in Critically Ill Patients

Role of Renal Doppler Ultrasound in Early Detection of Acute Kidney Injury in Critically Ill Patients