Renal Resistive Index Research Articles

Twenty-Four Hour Blood Pressure Response to Empagliflozin and Its Determinants in Normotensive Non-diabetic Subjects.

BackgroundSodium–glucose co-transport 2 inhibitors (SGLT2i) lower blood pressure (BP) in normotensive subjects and in hypertensive and normotensive diabetic and non-diabetic patients. However, the mechanisms of these BP changes are not fully understood. Therefore, we examined the clinical and biochemical determinants of the BP response to empagliflozin based on 24-h ambulatory BP monitoring.MethodsIn this post-hoc analysis of a double-blind, randomized, placebo-controlled study examining the renal effects of empagliflozin 10 mg vs. placebo in untreated normotensive non-diabetic subjects, the 1-month changes in 24 h ambulatory BP were analyzed in 39 subjects (13 placebo/26 empagliflozin) in regard to changes in biochemical and hormonal parameters.ResultsAt 1 month, empagliflozin 10 mg decreased 24-h systolic (SBP) and diastolic (DBP) BP significantly by −5 ± 7 mmHg (p < 0.001) and −2 ± 6 mmHg (p = 0.03). The effect on SBP and DBP was more pronounced during nighttime (resp. −6 ± 11 mmHg, p = 0.004; −4 ± 7 mmHg, p = 0.007). The main determinants of daytime and nighttime SBP and DBP responses were baseline BP levels (for daytime SBP: coefficient −0.5; adj. R2: 0.36; p = 0.0007; for night-time SBP: coefficient −0.6; adj. R2: 0.33; p = 0.001). Although empaglifozin induced significant biochemical changes, none correlated with blood pressure changes including urinary sodium, lithium, glucose and urate excretion and free water clearance. Plasma renin activity and plasma aldosterone levels increased significantly at 1 month suggesting plasma volume contraction, while plasma metanephrine and copeptin levels remained the same. Renal resistive indexes did not change with empagliflozin.ConclusionSGLT2 inhibition lowers daytime and nighttime ambulatory systolic and diastolic BP in normotensive non-diabetic subjects. Twenty-four jour changes are pronounced and comparable to those described in diabetic or hypertensive subjects. Baseline ambulatory BP was the only identified determinant of systolic and diastolic BP response. This suggests that still other factors than sustained glycosuria or proximal sodium excretion may contribute to the resetting to lower blood pressure levels with SGLT2 inhibition.Clinical Trial Registration:[https://www.clinicaltrials.gov], identifier [NCT03093103].

Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin

BackgroundAfter kidney transplantation neurologic manifestations may develop, including Parkinson’s disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD.MethodsIn renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed.ResultsRTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations.ConclusionRTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.

STUDY OF RENAL RESISTIVITY INDEX IN LIVER CIRRHOSIS IN PREDICTING THE INCIDENCE OF HEPATORENAL SYNDROME

In patients with End Stage Liver Disease (ESLD) with ascites,Hepatorenal syndrome (HRS) is a complication with grave prognosis.Doppler evaluation of Renal Resistive Index (RRI) is a simple way of prognostication of patients with high risk of developing HRS.We evaluated 50 consecutive cirrhosis patients with ascites who fulfilled the inclusion criteria and measured RRI index on admission and found that it is a reliable marker of progression to HRS and predicting the renal function at 3 months. Methods: 50 patients of liver cirrhosis from K R Hospital,Mysuru,who met the inclusion criteria were studied from January 2018 to June 2019. Detailed history and physical examination were done. Liver function, renal function test,PT-INR,ultrasound abdomen including RRI was done.Child-Turcotte-Pugh (CTP) score and Model for End stage Liver Disease (MELD) score were calculated. Results: This study included 50 subjects with liver cirrhosis.In our study,5 of the patients (10%) developed HRS during the follow up period of 3 months.3 of them showed increased RRI (&gt;0.7),while 2 of them showed normal RRI (p &lt; 0.002). In those subjects with a normal creatinine during follow up,RRI was elevated in 8 % of the subjects (p &lt; 0.002).Mean RRI in subjects who developed HRS was 0.77 ± 0.11.Mean RRI in patients who did not have HRS was 0.61 ± 0.04. Interpretation and conclusion: In our study, we noted that intrarenal Resistive Index values measured at the time of admission were significantly increased in cirrhotic patients who developed HRS during the 3 months follow up period.

Renal Restrictive Index (RRI) Versus Urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for early prediction of acute kidney injury (AKI) in adults undergoing elective cardiac surgeries with cardiopulmonary bypass: A prospective randomized observational study

ABSTRACT Background Acute kidney injury (AKI) complicates most cardiac surgery patients. This study assessed the accuracy of urine neutrophil gelatinase-associated lipocalin (uNGAL) and Renal Resistive Index (RRI) to early predict (AKI) after cardiopulmonary bypass (CPB). Methods This work enrolled 57 cases of elective cardiac surgery with CPB. Urinary NGAL and RRI were measured preoperatively and at 1, 6 and 24 h postoperatively. The primary outcome was AKI, defined by Acute Kidney Injury Network Classification (AKIN) System. The secondary aim was to assess the diagnostic accuracy, cut-off point of uNGAL and RRI, and their relation with AKI severity. Results AKI developed in 22 patients (38.5%), with 2 cases required dialysis. Mean uNGAL significantly increased by 10 folds at 1h and 15 folds at 6h postoperatively. As regard uNGAL,the 1 h diagnostic accuracy was 94.8%, The area under the curve (AUC) was 0.888, using a cut-off value of 194.3 ng/ml. The 6 h diagnostic accuracy was 96.5%, AUC was 0.995 at a cut-off value 67.1 ng/ml. The 1 and 6 h uNGAL were unrelated to AKI severity. As regard RRI, AKI patients had significantly higher 1 h and 6 h RRI. The diagnostic accuracy at 1 h was 93.0%, AUC was 0.991, using a cut-off value of 0.72. The diagnostic accuracy at 6 h was 94.8%, AUC 0.995 at a cut-off value of 0.71. Values of RRI were significantly related only to severe cases requiring dialysis. Conclusion Urinary NGAL and RRI are early accurate indicators of AKI. High RRI can predict dialysis-requirement.

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.

Impact of intra-abdominal pressure on early kidney transplant outcomes

Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index [r = 0.213; P = 0.003] and lower urine output [r = − 0.237; P < 0.001]. 72 h mean IAP was an independent risk factor for delayed graft function [OR: 1.31; 95% CI: 1.13–1.51], postoperative complications [OR: 1.17; 95% CI: 1.03–1.33], and absence of graft function recovery [HR for graft function recovery: 0.94; 95% CI: 0.88–0.99]. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.

Analysis of Ultrasound as a Predictor of Renal Impairment in Patients with HCV Infection

Background: Renal arterial waveform analysis done via renal Duplex Doppler Ultrasound gives a safe, trustworthy, and real time assessment of renal hemodynamics without any delay and ambiguity as it removes various components that make estimation of renal function problematic. Objective: To evaluate the clinical validity of RI and to identify the relationship between RI and RFT’s for evaluation of renal function in patient. Analytical cross sectional examination was done at DHQ teaching hospital Sargodha from 2020 to 2021. The it had 158 hepatitis C positive patients and 79 healthy volunteers following approval of summary. After validation of inclusion and exclusion criteria, patients were broken in into 4 groups (A to D) according to stage of disease and controls were kept in Group E. Grey scale ultrasonography test for renal measurements and renal echogenicity was done. Sagittal and axial scans was done in supine posture from anterior approach utilizing liver and spleen as an acoustic window. The size and texture of liver was also assessed. Color Doppler was done to calculate Resistive Index (RI) using conventional curvilinear probe. Results: The serum creatinine and urea levels in the diseased groups were greater than those in the control group. It was individuals in Group-D who had the highest creatinine levels, which were followed by those in Groups C, B, and A, respectively. The greatest Urea level was found in Group-D, at 49.6714.19, while the lowest was found in Group-A. The mean RI in sick groups (the highest was in Group D, with values of 0.78 and 0.81 in the right and left kidneys, respectively) was similarly statistically substantially greater. Conclusion: An important connection exists between RI and RFT. The use of Doppler duplex ultrasonography for the study of renal hemodynamics in cirrhotic patients with HCV is a reliable, non-invasive, simple, immediate, and cost-effective method for examining renal hemodynamics in these patients. It is not essential to have clinical symptoms or deviations from RFTs for this test to be more accurate than RFTs at predicting disease development. Keywords: Renal Doppler Duplex Ultrasound, Renal Resistive Index (RI), Renal function tests, Urea, Creatinine, Cirrhosis, HCV

Can we predict early renal impairment in pediatric cirrhosis?

Published literature on renal dysfunction (RD) in pediatric cirrhosis are limited. We aimed to detect early RD in cirrhotic children by renal resistive index (RI) and plasma aldosterone (PA). We evaluated the effects of large-volume paracentesis (LVP) and albumin infusion on the same. Non-azotemic cirrhotic children with tense ascites (undergoing LVP with albumin infusion) were prospectively enrolled. Blood biochemistry and doppler ultrasonography for RI and PA were measured at regular intervals. RI >0.7 was considered as RD. Outcomes were noted at D90 and 1 year. Chronic liver disease children without ascites were included as controls. Of the 99 cirrhotic children, tense ascites (n=51) had higher baseline RI than controls (n=48) (p<0.001). Overall, baseline RD was observed in 32% and was significantly higher in tense ascites compared to controls (59% vs. 4%, p<0.001). Tense ascites with RD at admission had higher chances of acute kidney injury (AKI) (p=0.009), ascites recurrence (p=0.043), hospital readmission (p=0.048), and mortality (p=0.009) compared to patients without RD by D90. Significant reduction in RI was noted at 48 h, D7, D30, and D90 compared to baseline after LVP with albumin. Pediatric End-stage Liver Disease (PELD) score and PA had a strong positive correlation with baseline RI (R2=0.51, R2=0.47). Using multivariate analysis, PELD score and PA were predictors of AKI (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.04-1.24; p=0.003) and mortality (OR: 1.82; 95% CI: 1.22-2.72; p=0.004), respectively. Abnormal baseline RI can be used as an early predictor of RD and predict long-term renal ouctomes in pediatric cirrhosis. Baseline RI correlated well with the severity of liver disease and PA. Paracentesis and albumin infusion effectively reduced RI.

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.

Renal-Resistive Index and Acute Kidney Injury in Aortic Surgery: An Observational Pilot Study

Acute kidney injury (AKI) is a common perioperative complication in patients undergoing cardiovascular surgery, increasing mortality, morbidities, and costs. Recently, growing interest has risen in the use of the renal-resistive index (RRI) as a predictor of perioperative AKI. The aim of this study was to evaluate the role of RRI variation to identify postoperative AKI. An observational, prospective, pilot study. Department of Vascular Surgery, University Hospital of Padova. The study authors included 53 consecutive patients undergoing aortic surgery from September 2018 to June 2019. Basal and daily postoperative serum creatinine and urine output were assessed. RRI was measured preoperatively and on the first postoperative day. AKI was defined using Kidney Disease Improving Global Outcome criteria. Twelve patients out of 53 developed AKI. The RRI percentage increase (%RRI) was associated with the development of AKI by univariate regression (p=0.01). The receiver operating characteristic curve showed an overall diagnostic accuracy of 0.75 (95% confidence interval [CI], 58.2-92.6). The cutoff of 7 percentage points in the %RRI resulted in early identification of AKI onset with 90% specificity (95% CI, 76.9-97.3). The net benefit of postoperative RRI-based management was 11%. RRI variation could be a useful tool to investigate kidney function in patients undergoing aortic surgery. The %RRI in the perioperative time seems to detect AKI onset early and potentially could enhance renal-protective management within 24 hours after surgery.

Utility of Renal Resistive Index in Children with Nephrotic Syndrome

Background: Renal resistive index (RRI) is one of the Doppler parameters that provide information about arterial impedance. While its utility has been explored in chronic kidney disease and obstructive uropathy, its role in glomerular diseases remains less defined. Aim: This study aimed to measure RRI in children (6–18 years) with nephrotic syndrome, both steroid sensitive (SSNS) and steroid resistant (SRNS), currently in remission. Setting and Design: This cross-sectional study was done over 1 year at a tertiary care teaching hospital from March 2017 to March 2018. Methods: Renal Doppler ultrasound was done and RRI was measured at the main renal, arcuate, and interlobar arteries for both the kidneys during disease remission. Detailed information of disease type, biopsy, and therapy was recorded. Baseline biochemical investigations were done to confirm disease remission. Results: Fifty patients (25 each with SSNS and SRNS) were enrolled; the mean age was 12.6 years. The mean RRI at the interlobar and arcuate arteries was elevated in SRNS in all three poles of both the kidneys as compared to the SSNS with a significant difference at midpole (P = 0.04). RRI values were higher in children having focal segmental glomerulosclerosis (FSGS) compared to those with minimal change disease. The percentage of patients having an RRI value &gt;0.6 was significantly higher in those who had received cyclosporine for &gt;2 years as compared to those who received it for &lt;2 years. Conclusions: Doppler RRI values were elevated for patients with SRNS compared to SSNS; changes were significant at the midpole of both kidneys. Children with FSGS and those on calcineurin inhibitors for more than 2 years are more likely to have higher RRI values.

Novel predictors of response to therapy with terlipressin and albumin in Hepatorenal Syndrome-Acute Kidney Injury

Background and Aim: Prognostication of response to pharmacological treatment of Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI), is crucial to identify patients with a low likelihood of treatment response, and fast track them for liver transplantation. We assessed the response rates to terlipressin-albumin therapy in HRS-AKI and determined early predictors of treatment response and survival. Methods: 84 patients diagnosed to have HRS-AKI (as per new ICA definition) and treated with terlipressin-albumin were included. Demographic, clinical, and laboratory variables obtained at baseline and changes during treatment were analyzed as predictors of HRS reversal by logistic regression analysis. Cox-regression models were used for assessing the association of variables with overall survival. Results: A complete response to therapy was seen in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (Delta-RRI) by day 3 of treatment. Variables with independent predictive value of HRS reversal were the presence of SIRS at baseline (p=0.022;OR-15.749(CI:1.478-167.82)) and Delta-RRI >5% by day 3 (p=0.048;OR=6.67(CI:1.021-43.625)). Non-responders had higher mortality as compared to treatment responders at one month (27% vs 9%) and six months (74% vs 45%). Mean transplant-free survival at six months was significantly longer in complete responders (148 days vs 90 days,p<0.001). Response to treatment(HR-0.527;p=0.004) and MELD Na > 23(HR-1.071; p=0.018) were independent predictors of six-month mortality. Conclusions: SIRS and Delta-RRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation. In HRS-AKI, renal resistive index is a measure of the intrarenal vasoconstriction, and SIRS reflects the exaggerated systemic inflammation, both of which are reversed by terlipressin, leading to enhanced treatment response.

Contrast-Enhanced Ultrasound and Protein Shakes Are No Alternatives for Inulin Clearance and Meat to Assess Renal Functional Reserve in Humans

Introduction: The measurement of renal functional reserve (RFR) can unmask glomerular hyperfiltration in residual nephrons, but its determination is time-consuming. In this study, we assessed whether contrast-enhanced ultrasound (CEUS) is a valuable alternative to the gold standard inulin clearance and whether L-arginine or protein shakes lead to similar changes in glomerular filtration rate (GFR) as animal proteins in men and women. Methods: Changes in GFR and renal microperfusion were studied in 25 healthy subjects (8 men, 17 women) by simultaneously performing inulin clearance and CEUS (perfusion index, PI) before and 1 and 2 h after different protein loads (L-arginine, protein shake or meat). The Doppler parameters – renal resistive index (RRI) and pulsatility index (PuI) – were also measured. Results: None of the oral protein loads induced significant changes in CEUS-assessed PI. Only meat increased inulin clearance (from 111.2 ± 16.0 to 149.8 ± 27.2 mL/min, p < 0.05) and mobilized RFR, while L-arginine decreased GFR (106.7 ± 45.3 to 86.3 ± 42.6 mL/min, p < 0.05). Protein shakes had a neutral effect. There were no correlations between changes in inulin clearance and PI. At Doppler, RRI and PuI increased after meat intake (from 0.647 ± 0.029 to 0.694 ± 0.050 a.u., p < 0.05 and from 1.130 ± 0.087 to 1.318 ± 0.163 a.u., p < 0.05, respectively), but their changes also did not correlate with changes in inulin clearance. Results were similar in both sexes. Conclusions: CEUS is not a valuable alternative for inulin clearance to measure RFR. Meat ingestion leads to modest changes in renal Doppler parameters and to glomerular hyperfiltration in both women and men, while protein shakes and L-arginine do not.

A retrospective study of acute kidney injury in dogs with renal resistive index as a prognostic indicator

Doppler ultrasonography is relatively a new method for evaluation of the renal diseases in dogs. This study was conducted to evaluate the efficacy of renal resistive index (RRI) in diagnosis and prognosis of acute kidney injury (AKI) in dogs and to ascertain its correlationwith other renal parameters. Twenty-seven dogs with AKI along with ten clinically healthy dogs were evaluated. The aetiology of AKI was multifactorial which included viper snake envenomation, pyometra, Babesiagibsoni infection, canine parvo viral infection, Ehrlichiacanis infection, leptospiral infection, bone meal poisoning and tetracycline-induced nephrotoxicity. Dogs with AKI were characterized into five gradesas per the guidelines provided by International Renal Interest Society. Parameters such asblood urea nitrogen (BUN), creatinine, urine output, urine protein-creatinine (UPC) ratio and blood pressure were estimated. Both BUN and creatinine was significantly higher in affected dogs. Majority of the dogs with AKI were oliguric and had the presence of proteinuria, occult blood and leucocytes on urine dipstick examination. Urine Protein-Creatinine ratio was increased whereas no significant variation was noticed in blood pressure of dogs with AKI.B-mode ultrasonography of kidneys revealedrenomegaly, hyperechoic cortex, decreased cortico-medullary differentiation and loss of architecture in majority of the dogs with AKI. Renal resistive index was significantly increased inAKI and a positive correlation was established between RRI and serumcreatinine but not with UPC ratio, blood pressure and size of kidneys. Re-evaluation of RRIseven days post treatment showed considerablereduction. It wasconcludedthat an increase in RRIwas associated with severity of renal parenchymal injuryin AKI and reduction of RRI post-treatment indicated favorable prognosis.

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.

Renal Resistive Index and Intraabdominal Pressure as Predictors of Hepatorenal Syndrome in Decompensated Chronic Liver Disease: A Prospective Cohort study

Background/Aims: Hepatorenal Syndrome(HRS) is a life-threatening complication of cirrhosis characterized by renal arterial vasoconstriction, which preceeds clinically manifest renal dysfunction.Renal Resistive Index(RRI) is used to assess intrarenal arterial vasoconstriction.Raised Intra Abdominal Pressure(IAP) is known to cause reduction in renal blood flow thereby compromising renal function.

Laparoscopic Donor Nephrectomy with Terminal Hand Assisted Technique: Experience in 60 Donors and Recipients

Introduction: The limitation of cadaveric organ donations and the rapidly increasing number of patients with end stage renal disease awaiting kidney transplantation made living kidney donation indispensable. An important contribution to the revolution in living nephrectomy technique is hand assisted donor nephrectomy. Herein, we report our experience in hand assisted donor nephrectomy technique and its effect on the graft outcome. Methods: During the period from January 2012 till December 2015, 60 cases of hand-assisted laparoscopic donor nephrectomies were performed including 35 females and 25 males with a median age of 46.3±11.6 years. Results: Our mean operative donors' time was 93±21.8 minutes, and mean warm ischemia time was 48±9.1 seconds. Donor hospitalization time was between 3 and 5 days (mean 4 days). Follow up of the graft function after one year revealed mean serum creatinine of 1.56±1.03 mg/dl, mean GFR of 39.8±10.9 ml/min/1.73m and renal Doppler resistive index of 0.62±0.15. Conclusion: Laparoscopic donor nephrectomy with terminal hand assisted technique is a minimally invasive surgery that may improve donor acceptance and can become the procedure of choice in the near future. Also this technique has a good outcome concerning both warm ischemia time and graft outcome.

To determine the role of renal resistive index in differentiating type of acute kidney injury in decompensated cirrhosis

Background and Aim: Acute kidney injury (AKI) is common in patients with decompensated cirrhosis, and is associated with mortality. The three common types of AKI are pre-renal azotemia (PRA), acute tubular necrosis (ATN) and hepatorenal syndrome (HRS). It is important to determine type of AKI, since prognosis and treatment depend on it. Biomarkers like Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) have been found to be useful for differentiating types of AKI. However, urine NGAL is not available routinely.

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.