Renal Doppler Ultrasonography Research Articles

Doppler-Based Renal Venous Stasis Index as a New Prognostic Marker in Right Heart Failure

Background: Persistent congestion with deteriorating renal function is an important cause of adverse outcomes in heart failure. Renal Doppler ultrasonography has been proposed to assess renal congestion but is not fully characterized, and current approaches do not reflect the full continuum of renal congestion. We aimed to characterize new approaches to evaluate renal congestion using Doppler ultrasonography. Methods: We enrolled 205 patients with suspected or pre-diagnosed pulmonary hypertension (PH) undergoing right heart catheterization. PH is the most common precursor to right ventricular failure, and thus represents an ideal scenario to study congestion. Patients underwent renal Doppler ultrasonography and assessment of invasive cardiopulmonary haemodynamics, echocardiography, renal function, intra-abdominal pressure, and hormonal and hydration status. Four renal venous flow patterns (RVFPs) and a novel renal venous stasis index (RVSI) were defined. The rate of PH-related morbidity and all-cause mortality (composite endpoint) was evaluated for 1 year post-discharge. Associations with outcome were assessed using Cox proportional hazard models. Prognostic utility of RVSI and RVFP was compared using receiver operating characteristic (ROC) curves. Findings: RVSI increased across the RVFPs (p<0*0001), and was significantly associated with right heart and renal function, intra-abdominal pressure, and hormonal and hydration status. During follow-up, the morbidity/mortality endpoint occurred in 91 patients and was independently predicted by RVSI (RVSI in 3rd tertile vs RVSI=0: hazard ratio 4*72 [95% confidence interval 2*10-10*59; p<0*0001]). ROC curves suggested superiority of RVSI to RVFPs in predicting outcome (area under curve: 0*789 and 0*761, respectively). Interpretation: We describe four RVFPs, and we propose RVSI as a conceptually new, non-invasive, objective, and reproducible Doppler index of renal congestion. RVSI might provide additional information to stratify vulnerable patients with right heart failure. Clinical Trial Number: The study is registered at www.ClinicalTrials.gov (NCT03039959). Funding: This study was funded by the German Research Foundation (DFG) SFB1213, projects B08 and B07. Declaration of Interests: Dr. Seeger disclosed personal fees for consulting from Bayer Pharma AG, from Liquidia Technologies, Inc, and from United Therapeutics Corporation outside the submitted work. Dr. Gall discloses personal fees and non-financial support from Actelion, AstraZeneca, Bayer, BMS, GlaxoSmithKline, Janssen Cilag, Lilly, MSD, Novartis, Pfizer, and United Therapeutics/OMT outside the submitted work. Dr. Gofrani discloses grants from German Research Foundation (DFG) during the conduct of the study, and personal fees from Actelion, Bayer, GSK, Novartis, Pfizer, Bellerophon Pulse Technologies, and MSD Merck Sharpe & Dohme outside the submitted work. None of the other authors declare any competing interests. Ethical Approval Statement: The study was approved by the local Human Research Ethics Committee (AZ 237/16) and complied with the Declaration of Helsinki. All participants gave signed informed consent and were included in the Giessen PH registry.

Nutcracker Syndrome in Children: Role of Doppler Ultrasonographic Indices in Detecting the Pattern of Symptoms.

The purpose of this study was to evaluate the clinical characteristics of 44 pediatric patients who were diagnosed as having nutcracker syndrome (NCS). We also investigated the left renal vein Doppler ultrasonography (DUS) results, to determine whether or not there was an association between clinical symptoms and DUS findings among these patients. The clinical data from 44 pediatric patients who were diagnosed as having NCS from January 2008 to December 2015 were retrospectively reviewed. We grouped the patients according to the presenting symptoms as symptomatic (loin pain; macroscopic hematuria or both) and non-symptomatic (microscopic hematuria and proteinuria were detected incidentally) and evaluated the left renal vein DUS indices in these two groups separately. Asymptomatic NCS was found in 27 (61.4%) patients; 21 (47.7%) of whom were admitted for the evaluation of proteinuria. The most frequent presenting symptoms were left flank pain (20.5%) and macroscopic hematuria (13.6%); and 2 (4.5%) patients presented with a combination of left flank pain and macroscopic hematuria. The mean ratio of the diameter of the hilar portion of the left renal vein (LRV) to that of the aortomesenteric portion was 4.36 ± 1.55. The mean ratio of the peak velocity (PV) between the two sites of the LRV was 7.32 ± 2.68 (3.1–15.6). The differences in the ratio of the diameters were statistically significant between the two groups and significantly higher in children with asymptomatic NCS (p = 0.025). The PV ratios of the LRV (p = 0.035) were significantly higher in asymptomatic children with NCS than in the symptomatic group. Our study identifies that increased compression ratio of the LRV entrapment is most observed in orthostatic proteinuria and microscopic hematuria.

Generalized arterial calcification of infancy with a novel ENPP1 mutation: a case report

BackgroundGeneralized Arterial Calcification of Infancy (GACI) is a heritable ectopic mineralization disorder resulting in diffuse arterial calcifications and/or stenosis, mostly caused by mutations in the ENPP1 gene. Here we present a case report of GACI in a male infant with a new familial mutation of the ENPP1 gene and the clinical outcome after biphosphonates therapy.Case presentationThe clinical presentation was characterized by a severe early-onset of hypertension refractory to multiple therapy. To investigate this atypical hypertension, a renal Doppler ultra-sonography was performed and diffuse echo-bright arteries were detected; then a low-dose whole-body computed tomography demonstrated extensive arterial calcifications, suggesting GACI. A novel homozygous mutation c.784A > G (p.Ser262Gly) was detected in the ENPP1 gene. The infant was administered four courses of bisphosphonates: arterial calcifications were found to decrease but severe refractory hypertension was persistent. Although GACI can be a rapidly fatal illness and frequently results in death in infancy, the patient was 24 months of age at the time of writing this report.ConclusionsThree points of interest: the first one is to remind clinicians of this rare and atypical etiology in neonates with severe hypertension and in fetuses with cardiomyopathy and non-immune hydrops fetalis. The second point is the identification of a novel mutation in the ENPP1 gene associated with a clinical presentation of GACI. The third point is the fairly favourable outcome of our patient after bisphosphonates therapy, with calcifications regression but not hypertension.

Predictor Role of Pretreatment Resistive and Pulsatile Indexes in the Success of Medical Expulsive Therapy of Ureteral Stones

To investigate the role of renal resistive index (RI) and pulsatile index levels measured with renal Doppler ultrasonography in predicting the success of medical expulsive treatment in patients with ureteral stones. Patients admitted to our clinic between January and December 2017 with a ureteral stone of less than 1 cm in diameter were evaluated in terms of their RI and pulsatile index values obtained using Doppler ultrasonography, and the localization and diameter of their stone and grade of hydronephrosis using computed tomography at the time of admission. After 4 weeks of medical expulsive treatment with tamsulosin, spontaneous stone passage was assessed to investigate the relationship between the data obtained before treatment and the success of medical expulsive treatment. Forty-eight of 71 patients passed the stone spontaneously after treatment (67.6%). Among the related variables, the largest diameter of stone and ipsilateral RI levels were independently associated with the success of medical expulsive treatment (P <.001). In the receiver operating characteristic curve analysis, a RI value of less than 0.72 was associated with spontaneous stone expulsion with a sensitivity of 89.6%, a specificity of 69.6%, and a positive predictive value of 97%. It is possible to predict the success of medical expulsive treatment using RI levels. We anticipate that in patients who are not likely to pass the stones spontaneously with medical treatment, surgery should not be postponed to avoid irreversible kidney damage.

Serum cystatin C is an independent biomarker associated with the renal resistive index in patients with chronic kidney disease.

Cystatin C is a cysteine protease inhibitor that is produced by nearly all human cells. The serum level of cystatin C is a stronger predictor of the renal outcome and the risk of cardiovascular events than the creatinine level. The resistive index (RI) on renal Doppler ultrasonography is a good indicator of vascular resistance as well as the renal outcomes in patients with chronic kidney disease (CKD). However, it is unclear whether serum cystatin C is associated with signs of vascular dysfunction, such as the renal RI. We measured the serum cystatin C levels in 101 CKD patients and investigated the relationships between cystatin C and markers of vascular dysfunction, including the renal RI, ankle-brachial pulse wave velocity (baPWV), intima-media thickness (IMT), and cardiac function. The renal RI was significantly correlated with the serum cystatin C level (p < 0.0001, r = 0.6920). The serum cystatin C level was found to be a significant determinant of the renal RI (p < 0.0001), but not the baPWV, in a multivariate regression analysis. The multivariate odds ratio of the serum cystatin C level for a renal RI of more than 0.66 was statistically significant (2.92, p = 0.0106). The area under the receiver-operating characteristic curve comparing the sensitivity and specificity of cystatin C for predicting an RI of more than 0.66 was 0.882 (cutoff value: 2.04 mg/L). In conclusion, the serum cystatin C level is an independent biomarker associated with the renal RI in patients with CKD.

Better Renal Resistive Index Profile in Subjects with Beta Thalassemia Minor

Objective: Beta thalassaemia minor is a common genetic disorder without any characteristic symptoms except mild anemia. It is found to be associated with some cardiovascular risk factors such as insulin resistance and diabetes mellitus. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to evaluate the RRI in subjects with beta thalassemia minor (BTM). Subjects and Methods: A total of 253 subjects were included in this cross-sectional study. The study group consisted of 148 subjects with BTM and the control group consisted of 105 healthy subjects. BTM was diagnosed by a complete blood count and hemoglobin electrophoresis. Blood pressure measurement and biochemical tests were performed. The RRI of all subjects was measured using renal Doppler ultrasonography. Results: Subjects with BTM had lower renal resistive indices compared to healthy subjects (0.58 ± 0.04 vs. 0.60 ± 0.06, p = 0.0016). Additionally, the RRI levels of subjects with BTM were correlated with systolic blood pressure (p = 0.017, r = 0.194). Conclusion: In this study, lower RRI were found in subjects with BTM. This may be associated with a decreased vascular resistance and blood viscosity in these subjects.

Should renal color Doppler ultrasonography be a routine test in newly diagnosed hypertensive patient?

: European Society of Hypertension/European Society of Cardiology guidelines recommend calculation of estimated glomerular filtration rate and evaluation of urinary albumin excretion rate as routine tests in the initial evaluation and during the follow-up of all hypertensive patients. However, from a clinical point of view, renal ultrasound - a noninvasive, readily available and cheap imaging modality - could contribute to the better evaluation of a hypertensive patient by identifying common causes of secondary hypertension (HTN) originating from the kidney and more recently by detecting renal injury in severe or long-standing essential HTN by measuring renal resistive indexes. The purpose of this review is to summarize the actual evidence which could support a larger use of renal ultrasound in the work-up of patients with newly diagnosed HTN.

Role of renal Doppler sonography as a diagnostic tool in patients with various renal disease

Role of renal Doppler sonography as a diagnostic tool in patients with various renal disease

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy.

This longitudinal prospective observational type study was conceived with the aim to examine the impact on renal resistive index (RRI) of the variables that we can manipulate with therapeutic and or dietetic interventions in a chronic kidney disease population in order to known which of these variables was statistically related to changes in RRI and therefore could become the object of the greatest therapeutic effort. This study was undertaken between May 2016 to May 2017 in the outpatient nephrology and urology clinic of San Donato Hospital in Arezzo. The study population (84 patients: 47 males and 37 females) was randomly selected among the chronic kidney patients (with various degrees of renal impairment) affected by hypertension and or diabetes mellitus. After a comprehensive medical examination these patients were submitted to determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and finally renal Doppler ultrasonography. Then the patients were submitted to a full therapeutic and dietetic intervention to ameliorate the renal impairment by a wide range of actions and after on average a one-year interval were submitted again to a new medical examination and a second determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and a new renal Doppler ultrasonography too. The comparison between basal and final data revealed a slight reduction in the mean of bilateral renal resistance indices (Delta RRI: -0.0182 ± 0.08), associated to a slight increase in the mean glomerular filtration rate (Delta GFR: 0.8738 ± 10.95 ml/min/1.73 m2), a reduction in mean body weight (Delta weight: -1.9548 ± 5.26 Kg) and mean BMI (Delta BMI: -0.7643 ± 2.10 Kg/m2) as well as a reduction in the mean systolic blood pressure (Delta systolic blood pressure: -8.8333 ± 25.19 mmHg). Statistical analysis showed statistically significant correlations (p < 0.05) between Delta RRI and Delta weight (p < 0.03), Delta BMI (p < 0.02) and Delta systolic blood pressure (p < 0.05). Despite the many limitations the our study clearly identifies the targets (yet widely known) to act on to prevent kidney alterations related to RRI and provides further evidence, if any, of the utility of RRI as a key parameter in monitoring patients with chronic renal failure and as a valuable tool to drive the clinical efforts to contrast the kidney disease.

Impact of Propranolol on Preventing Renal Dysfunction in Patients with Cirrhosis.

BACKGROUND One of the earliest diagnostic signs of hepatorenal syndrome in patients suffering from liver cirrhosis is an increase in the renal vascular resistive index (RI). In this study, the impact of propranolol on decreasing this index and to postpone the probability of hepatorenal syndrome has been investigated. METHODS In the current research, 30 patients with liver cirrhosis with different age and sexes have been enrolled. Demographic data and complete medical history have been collected using a specific questionnaire. At first, renal artery Doppler ultrasonography was performed to determine the RI. The patients were then treated with propranolol, and under supervision, the dose of the drug was increased gradually every 3 to 5 days to reach the target of 25% decrease in resting heart rate. One month after reaching the target dose of the medicine, Doppler ultrasonography was repeated for the patients and the second RI was compared with the pretreatment ones. RESULTS According to our results after treatment with propranolol, a significant decrease of RI was observed (p < 0.01). However, there was no significant difference in the glomerular filtration rate (GFR) before and after treatment with propranolol (p = 0.290). In our study, we found that administering propranolol was associated with significant changes in RI and GFR between the patients with compensated and decompensated cirrhosis (mean change: -0.005 ± 0.017 vs. -0.058 ± 0.045; p < 0.01 for RI and -4.226 ± 17.440 vs. 13.486 ± 12.047; p < 0.01 for GFR in patients with compensated and decompensated cirrhosis, respectively). CONCLUSION Propranolol reduces renal vascular RI in patients with cirrhosis. The response rates in the patients with decompensating cirrhosis were significantly higher than the patients with compensating cirrhosis

Successful En-Bloc Kidney Transplantation from a 5-Month-Old Donor to a 63-Year Old Recipient

Introduction Pediatric deceased donor kidney transplantation (DDKT) has been increasing gradually as a donor pool expansion method. In addition, the outcomes of pediatric DDKT over the last 20 years have shown excellent results with an active practice of en-bloc KT (EBKT) which increases kidney volume. We report pediatric en-bloc KT performed with organ donation from the youngest 5-month-old infant in our institution. Presentation of Case En-block kidney of a 5-month-old female infant with a body weight of 3.2 kg diagnosed with brain death due to hypoxic injury was transplanted into a 63-year old female patient with a body weight of 56 kg, who was receiving continuous ambulatory peritoneal dialysis (CAPD) for IgA nephropathy end-stage renal disease. The human leukocyte antigen mismatches were 3 and both panel reactive antibody and donor-specific antibody were negative. Basiliximab was used as the induction immunosuppressant. Results Cold ischemia times were 187 minutes. Both kidneys weighed 56 g and distal ends of the donor aorta and vena cava were anastomosed to internal iliac artery and external iliac vein of the recipient. Tacrolimus, mycophenolate mofetil, and prednisolone were used as the maintenance immunosuppressant. Postoperative renal doppler sonography showed mild hydronephrosis in one kidney and small amount perinephric free fluid collection, but both improved in follow-up examination. On the 20th day of KT, the serum creatinine level decreased to 1.23 mg/dL with estimated glomerular filtration (eGFR) 44.1 mL/min/1.73 m2 and CAPD catheter was removed. At 5 months after KT, serum creatinine was 0.90 mg/dL and eGFR was 63.0 mL/min/1.73 m2. Conclusion This case report highlights the successful KT to an adult with en-bloc kidney of a 5-month-old infant. And long-term follow-up on whether small kidneys of 56 g adapt appropriately and function well in adult is needed.

Percutaneous US-guided renal cryoablation using 3D modeling.

The article describes the first experience of performing percutaneous ultrasound (US)-guided cryoablation of renal tumor and assesses the safety and short-term results of treatment. Twelve patients were subjected to US-guided cryoablation of renal tumor in 2015. The tumor size in 11 patients was up to 3.0 cm (T1а); in one female patient, 4.5 cm (T1b). Tumors were assessed according to the PADUA score. In eight patients, it was 6-7 (low); in three patients, 8-9 (average); in one, 10 (high). All the patients underwent US examination using a FlexFocus 800 apparatus with convex abdominal transducers. Before surgery and 6 months later, all the patients underwent renal Doppler US and contrast-enhanced computed tomography. The average cryoablation time was 60 min. Seven operations were performed under spinal anesthesia and five operations under local anesthesia. The follow-up period lasted 8 months on average. According to the ultrasonography and Doppler findings, after 6 months, the tumor (T1a) in 11 patients reduced in size by an average of 7-8 mm and had no blood supply.T1b patient's mass size reduces from 4.5 to 3.7 cm; however, a 1.5 cm area with a high attenuation gradient of the contrast medium was visualized. Later, the patient was subjected to laparoscopic renal resection. Histological finding revealed clear-cell carcinoma. We consider percutaneous US-guided cryoablation as a method of choice for patients with stage T1a renal tumor localized on the posterior or lateral surface in the inferior or middle segment without sinus involvement and PADUA <9.

Effect of Paracentesis and Albumin on Non-azotemic Renal Dysfunction in Children With Cirrhosis

Background and Aim: Prevalence of renal dysfunction (RD) is unknown in cirrhotic children. Renal resistive index is a non-invasive tool to detect early RD before azotemia sets in. We aimed to detect RD in children with chronic liver disease by renal doppler ultrasonography (DU) and observe the effect of paracentesis and albumin infusion on renal resistive index Methods: Consecutive non-azotemic cirrhotics with normal glomerular filtration rate were prospectively enrolled. Decompensated patients underwent single time large volume paracentesis (LVP). Groups compared were decompensated albumin infusion group (AG) and non-albumin group (NAG) versus compensated cirrhotic group. Study flow is shown in Figure 1. Resistive indices were derived from bilateral renal artery velocity (upper, mid and lower poles) on DU by a single blinded sonologist. RD was defined as RI >0.7 from the average of all poles. All cases were followed up for 3 months for complications and mortality. Results: Compensated (n = 20) vs. decompensated (n = 20) group comparison showed age of presentation [10(7–18) vs 11(6–18) years, P = 0.8], PELD score [15(9–21) vs. 35(13–54) P < 0.001], prevalence of baseline RD [0% vs. 55%, P < 0.001]. Table 1 shows the comparison of AG vs. NAG. Both groups were similar in terms of etiology, PELD score and baseline RI. RI at 48 h and D7 significantly improved from baseline in AG. At follow-up, 30% developed azotemia and 25% died among the decompensated cirrhotics. All these patients had RI >0.7. None of the compensated patients developed azotemia in 3 months.Table 1Comparison of Decompensated Group With Large Volume Paracentesis (Albumin and Non-albumin Infusion Groups).AG (n = 10)NAG (n = 10)PEtiology • Autoimmune liver diseaseN = 4N = 5 • Budd-chiari syndromeN = 2N = 2– • Wilson diseaseN = 4N = 4PELD score34 (13–51)37 (26–54)0.50Baseline RI0.71 (0.46–0.78)aIn AG intergroup comparisons, statistical significance was seen with baseline RI vs. 48h (P=0.001), day 7 (P=0.001), day 30 (n=0.06), day 90 (n=0.97). No statistical significance was seen with in the NAG intergroup comparison.0.68 (0.50–0.82)0.0848 h after LVP0.67 (0.50–0.73)0.65 (0.53–0.75)0.43Day 7 of LVP0.64 (0.51–0.73)0.61 (0.55–0.78)0.43Day 30 of LVP0.59 (0.51–0.75) (n = 9)0.57 (0.53–0.64) (n = 9)0.86Day 90 of LVP0.59 (0.52–0.61) (n = 6)0.58 (0.52–0.60) (n = 9)0.38Development of abnormal GFRbAbnormal GFR defined as GFR <60mL/min/1.73m2 by Schwartz formula. in 3 months5 (50%)3 (30%)–Development of azotemiacAzotemia defined rise in serum creatinine ≥ 2 times the baseline value or >1mg/dL irrespective of age at any point of time on follow-up. RI: resistive index; LVP: large volume paracentesis; GFR: glomerular filtration rate; AG: albumin group; NAG: non-albumin group; PELD: pediatric end-stage liver disease. in 3 months4 (40%)2 (20%)–Mortality in 3 months4 (40%)1 (10%)–a In AG intergroup comparisons, statistical significance was seen with baseline RI vs. 48 h (P = 0.001), day 7 (P = 0.001), day 30 (n = 0.06), day 90 (n = 0.97). No statistical significance was seen with in the NAG intergroup comparison.b Abnormal GFR defined as GFR <60 mL/min/1.73 m2 by Schwartz formula.c Azotemia defined rise in serum creatinine ≥ 2 times the baseline value or > 1 mg/dL irrespective of age at any point of time on follow-up. RI: resistive index; LVP: large volume paracentesis; GFR: glomerular filtration rate; AG: albumin group; NAG: non-albumin group; PELD: pediatric end-stage liver disease. Open table in a new tab Conclusions: LVP overall improves the RI in cirrhotics. Those receiving albumin infusion have significant but transient improvement in renal dysfunction. A significant proportion of patients with RI develop azotemia in follow-up. Hence resistive index is reliable method to detect impending azotemia in cirrhotics. The authors have none to declare.

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Diagnosis of Pulmonary Embolism

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Diagnosis of Pulmonary Embolism

Aortic coarctation disclosed in a middle-aged hypertensive patient by tardus parvus waveform in renal Doppler ultrasonography

Aortic coarctation disclosed in a middle-aged hypertensive patient by tardus parvus waveform in renal Doppler ultrasonography

The Effectiveness of Real-Time Feedback with an Audible Pulse: A Preliminary Study in Renal Doppler Ultrasonography.

PurposeThe effectiveness of real-time feedback using an audible pulse in renal Doppler ultrasonography was evaluated.MethodsThis study was approved by the institutional review board of our hospital. Written informed consent was provided by all volunteers at enrollment. The 26 healthy volunteers enrolled in this study underwent Doppler ultrasound of both kidneys using audible and inaudible pulses in randomized order and at 1-week intervals. Doppler waveforms were obtained at the interlobar or arcuate arteries using a 2-mm Doppler gate. Each session was considered complete when reproducible waveforms were obtained for 5 s in three predefined regions of the kidney. The scan times needed to obtain waveforms of the right and left kidneys were recorded separately. Measurements were compared using a paired t-test and a two-sample Wilcoxon rank-sum test.ResultsThe total recorded Doppler sonography scan time for each kidney ranged from 33 to 146 s. The mean scan time was 56.83 s (right, 58.19 s; left, 55.46 s) in the audible session and 72.58 s (right, 72.08 s; left, 73.08 s) in the inaudible session. The scan times were significantly shorter in the audible than inaudible session (p<0.001), whereas the difference in the scan times between the right and left kidneys was not significant. The order of the sessions had no effect on the total scan time.ConclusionReal-time feedback using an audible pulse may encourage patient cooperation during breath-holding and can shorten the time needed to perform Doppler ultrasonography.

Overview of point-of-care abdominal ultrasound in emergency and critical care.

Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.

Renal Resistive İndeks’in Hafif Orta Böbrek Yetersizliği Olan Koroner Arter Hastalarında Hastalık Şiddetini Belirlemedeki Yeri

Objectives: The aim of this study was to determine the renal resistive index (RRI) in patients with mild to moderate renal insufficiency, and to investigate the relationship between RRI and the severity of coronary artery disease (CAD) and renal function. Materials and Methods: The study included 76 patients diagnosed with CAD on coronary angiography. The patients comprised 41 males and 35 females. Renal resistive index was determined using renal Doppler ultrasonography (RDU). Renal length, width, and parenchymal thickness was measured. The severity of CAD was graded according to Gensini score, and the patients were divided into two groups: mild atherosclerosis (Gensini score <20 points) and severe atherosclerosis (Gensini score ≥20 points). The estimated glomerular filtration rate (eGFR) was calculated for each patient. Based on GFR stage, the patients were divided into three groups, and the relationship between RRI and GFR stage was investigated. Results: Gensini scores indicated that the RRI was significantly higher in the patients with severe CAD compared to those with mild CAD [0.62 (0.58-0.71)] vs. [0.71 (0.63-0.78)], p <0.001). No significant differences were observed in renal length, width, and parenchymal thickness. The eGFR was significantly lower in the patients with severe CAD compared to those with mild CAD ( p =0.02). Grading of the patients based on GFR values indicated a significant correlation between GFR and RRI. RRI was [0.63(0.59-0.68)] in patients with stage 1 (GFR ≥ 90), was [0.77(0.71-0.84)]in patients with stage 2 (GFR 60–89) and was [0.81(0.73-0.85)]in patients with stage 3 (GFR 30–59) ( p <0.001). The sensitivity and specificity of RRI in the diagnosis of CAD severity were 80.60% and 66.70%, respectively. Conclusion: RRI shows a parallel increase with the severity of CAD and with the severity of renal insufficiency. RRI, as determined with non-invasive RDU, may provide additional information on the severity of CAD, kidney function and microcirculation.

Evaluation of Kidney Allograft in the Early Posttransplant Period Using Ultrasonography.

The aim of this study was to evaluate the kidney allograft after transplant to assess restoration of blood flow, the time required to functionally recovery after surgery, and the ability to differentiate normal from pathologic grafts using color Doppler ultrasonography in the early posttransplant period. Sixteen kidney recipients underwent renal color Doppler ultrasonography examinations 1, 2, 3, 7, 15, and 30 days after transplant. We evaluated the clinical and biochemical test results of recipients and the functioning allografts and evaluated the acute pathology. Results of resistive index in color Doppler ultrasonography were compared with blood test results. During the early postoperative period after kidney transplant, the average size of the kidney was 10.7 × 5.1 cm, with parenchyma at 1.7 cm. The structure of the parenchyma was nonhomogeneous in 14 patients and homogeneous in 2 patients. The medullary pyramid layer was prominent in 6 patients, moderately prominent in 7 patients, and not prominent in 3 patients. The pyelocaliceal system was condensed in 1 patient. Hematoma in the perinephrium was found in 5 patients, and free fluid was found in 5 patients. Satisfactory vascularization of allografts occurred in 14 patients, with resistive index sensitivity of 93% and specificity of 83%. Color Doppler ultrasonography and resistive index results were useful in evaluating kidney allografts during the early postoperative period and in confirming their condition despite excessive blood parameter values.

Associations between increased renal resistive index and cardiovascular events.

Chronic kidney disease is a risk factor for cardiovascular disease (CVD). Renal resistive index (RI) measured by Doppler ultrasonography is associated with renal impairment. We investigated the relationship between RI and cardiac function, and evaluated the utility of RI for predicting cardiac events in patients with CVD. Renal Doppler ultrasonography and echocardiography were performed in a total of 452 patients with CVD. Correlations of RI with serum creatinine and estimated glomerular filtration rate (eGFR) were significant but not strong (r = 0.37, p < 0.001; r = -0.42, p < 0.001, respectively). RI correlated positively with age, left atrial volume index, left ventricular mass index, and early transmitral velocity to mitral annular early diastolic velocity (e') ratio (E/e'), and showed significant negative correlations with e' and diastolic blood pressure. Between two subgroups-112 patients hospitalized with cardiovascular events (Group A) and 200 age- and eGFR-matched controls (Group B)-RI was significantly higher in Group A than in Group B, although age and eGFR were similar. RI reflects the impairment of intrarenal hemodynamics that cannot be adequately elucidated by eGFR alone. Assessment of renal RI may be useful in conjunction with prognostic estimates for patients with CVD.