Renal RI Research Articles

Comparative assessment of renal volume and doppler velocimetric indices among subjects with sickle cell disease and controls in Benin, Nigeria

Background: Sickle Cell Disease (SCD), a hereditary blood disorder caused by an abnormality in haemoglobin can be complicated by impairment of renal function. Renal Doppler ultrasound has been found to be an effective method of evaluating reno-vascular events prior to abnormal laboratory renal function tests.
 Aim and Objectives: This study aimed to evaluate and compare the renal volume (RV), intra-renal resistive and pulsatility indices (RI, PI) among sickle cell patients and controls in UBTH, Benin City using ultrasonography.
 Materials and Method: This was a cross-sectional comparative study of renal volume, intra-renal resistive and pulsatility indices among 50 sickle cell disease patients attending sickle cell clinic of the University of Benin Teaching Hospital and equal number of “Age and Sex” matched controls. The study was conducted using a 2-8MHz curvilinear transducer of a SONOACE X6 (Medison Inc., Korea 2010) Doppler ultrasound machine.
 Data analysis: Collated data was analysed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp, Armonk. N.Y., USA)
 Results: The mean age for the HbSS subjects was 22.4±3.7years while that of the control group was 23.3 ±4.5 years. The left RV was higher than the right RV in HbSS and HbAA: 169.3±40.2 cm3 versus 162.2±40.3 cm3 and 153.9±30.9cm3 versus 134.7±26.4 cm3 respectively. The mean RV, RI and PI was significantly higher in HbSS than controls (RV: 165.8±39.8cm versus 122.9±13.4 cm3 ; p = 0.0001, RI: 0.74±0.02 versus 0.61±0.04; p= 0.0001, PI: 1.43±0.06 cm3 versus 0.90±0.05; p = 0.0001).
 Conclusion: Renal volume, RI and PI were statistically significantly higher in HbSS patients than controls.

Doppler velocity of fetal renal arteries in case of oligohydramnios

Background: Oligohydramnios is a relatively common complication of pregnancy and such a case is often encountered in clinical practice. Oligohydramnios is often to describe pregnancies with AFI <5 and borderline/ low normal amniotic fluid volume to describe pregnancies with AFI 5 to 8 (4) Alternatively, some clinicians prefer the single vertical pocket (SVP) with severe oligohydramnios defined as SVP less than 1 and mild oligohydramnios defined as SVP 1 to 2 Aim of this current study sought to determine the relation of fetal renal artery Doppler with normal pregnancies and pregnancies complicated by oligohydramnios.Methods: Sample size was 50 patients in the 2nd trimester; they subdivided into two groups based on the amount of the amniotic fluid as follow: Group I: Control group (AFI 5-25) N = 25 cases.Group II: Oligohydramnios group (AFI less than 5) N = 25 cases.All patients in this study subjected to the following:Ultrasound study: Measurement of fetal biometry, Detection of congenital malformation. And Amniotic fluid index measurement. Doppler study: Renal artery (RA) and Umbilical artery (UA).Results: There was statistically significant difference between groups according to Renal and umbilical artery Doppler indices PI & RI in Gestational Age 26 weeks, statistically significant difference over the periods through renal artery Doppler indices RI, statistically significant difference over the periods through umbilical artery Doppler indices PI in each group and Renal Artery PI Which was 2.681, with sensitivity of 44.6% specificity of 53% with diagnostic accuracy of 47%, (p-value >0.05 NS). Renal Artery RI Which was 0.989, with sensitivity of 43.5% specificity of 43% with diagnostic accuracy of 33%, (p-value >0.05 NS). Umbilical Artery PI Which was 1.044, with sensitivity of 42.1% specificity of 39.5% with diagnostic accuracy of 29.7%, (p-value >0.05 NS). Umbilical Artery RI Which was 0.645, with sensitivity of 48.5% specificity of 42.1% with diagnostic accuracy of 41.6%, (p-value >0.05 NS). Conclusions: We recommend introducing renal artery resistance index as auxiliary ante partum test for women with Amniotic fluid abnormalities in addition to other ante partum fetal wellbeing tests to predict fetuses at risk of hypoxia.

Compact Point of Care Ultrasound Reveals Hemodynamic Abnormalities in Children with Sickle Cell Disease

In sickle cell disease (SCD), kidney related morbidity and mortality are significant, with ~80% of patients displaying signs of chronic kidney disease (CKD) by age 401 and kidney related mortality being the third leading cause of death (16.4%)2. Children with SCD are also prone to kidney disease with 20% of 12 years-old displaying microalbuminuria4 and enuresis and hyposthenuria commonly observed in infants4. Current clinical guidelines are insufficient as they ignore pediatric disease until the development of late signs like proteinuria or large drops in eGFR have occurred5. A major limitation in the assessment of kidney disease in children with SCD is the incomplete understanding of disease progression and the lack of suitable biomarkers to discriminate health and disease. Serum creatinine based eGFR is the most common biomarker of kidney function but is poorly validated and relatively insensitive in SCD patients due low muscle mass and hyperfiltration6. Point of care ultrasound (POCUS) offers a non-invasive alternative to blood based biomarkers. POCUS has proven clinical utility in decreasing primary and secondary stroke7. Additionally, POCUS technology now offers compact, cartless systems, with tablet and smartphone compatibility, multiprobe functionality in a single probe and an economical price point (<3000$)8. Therefore, the goals of this study were two-fold. 1) Determine the feasibility of renal assessment using compact POCUS in children with SCD in a clinical setting. 2) Establish normative values for possible compact POCUS biomarkers that could supplement existing biomarkers of kidney disease in SCD. Methods: Studies were performed with informed consent under an IRB approved protocol. 18 patients with SCD were recruited during their routine clinical visit to undergo a 10-20 minute ultrasound examination. All POCUS exams were performed in supine position, on the right kidney by an experienced imaging researcher (AB, +10 years). Images were acquired with a Butterfly IQ+ (Burlington, MA, USA) system and an Apple Smartphone (Cupertino, CA, USA). The abdominal preset and B-mode imaging was used to determine the long axis renal length and echogenicity of the renal/liver parenchyma. The cardiac preset, pulsed Doppler mode was used to determine the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI = (PSV-EDV)/PSV) of the main right renal artery. Images were saved to a cloud based, HIPPA protected database, downloaded to a local workstation and processed using custom MATLAB scripts. An angle correction of 1/cos(60°) was applied to the uncorrected velocity values. Results: Renal length and serum creatinine was measured in 18 patients with SCD (3 HbSC, 15 HbSS) and pulsed Doppler estimates were obtained in 14 of 18 subjects (hemoglobin 9.9±2.3,12 male). The average renal length was 8.7±1.3 cms and serum creatinine was 0.69±0.16 and showed a statistically significant increase with respect to age (Figure 1). The average angle corrected main renal artery PSV was 74.5±64.4 cm/s and RI was 0.49±0.33 and both decreased with respect to age (Figure 1). The average echogenicity ratio between kidney and liver parenchyma was 0.64±0.14 and was uncorrelated with age. Discussion: This work demonstrates that high quality structural and hemodynamic images can be acquired with low cost, compact POCUS in a clinical setting. The age dependent increase in serum creatinine9 and kidney length10 were in good agreement with prior cart-based sonography work in healthy children. Conversely, the age dependent drop in main renal artery PSV and RI was in opposition to work in healthy children that showed no change11 or an increase with age12. The clinical significance of abnormally elevated velocity in young children with SCD and its impact on the development of sickle nephropathy should be studied in more detail. Future work comparing cross-sectional and longitudinal variability in compact POCUS and physiologic biomarkers of kidney function in both pediatric and adult subjects with and without SCD is ongoing.

Analysis of Correlation between Hyper-Uricemia and Renal Resistivity Index in Normoglycemic Normotensive Patients

Introduction: Hyperuricemia is associated strongly with the development of renal disease and progression. Medical therapy decreases serum uric acid levels by inhibiting the enzyme xanthine oxidase. Objective of the study: To evaluate correlation of mean uric acid level and Renal Resistive Index in normoglycemic and normotensive adult subjects. Material and methods: This descriptive cross-sectional study was conducted in THQ Hospital Fort Abbas during 31-10-2018 to 30-04-2019. One hundred (n=100) non-diabetic, non-hypertensive, recently diagnosed hyperuricemic otherwise healthy subjects irrespective of gender between age 20-40 years were included in the study. After complete history taking and full physical examination laboratory testing including: serum uric acid, serum creatinine to exclude renal decompensation patients, fasting blood sugar and 2 h post prandial were advised. Results: 55.0% (n=55) of patients were males with the mean age of 33.40 years ± 3.85 SD and 45.0% (n=45) of patients were females with mean age of 34.67 years ± 3.33 SD. Cumulative mean age was 33.97 years ± 3.66 SD. The mean value of the RI of the renal arterial vasculature was 0.765 ± 0.0155 SD. The maximum, minimum and range values of the RI were 0.79, 0.74, and 0.04 respectively. The mean serum uric acid value found to be 10.947±0.562 SD. The maximum, minimum and range values of the RI were 0.79, 0.74 and 0.05 respectively. Correlation between the serum uric acid and renal arterial RI prior to the medical therapy and 3 weeks after therapy. A positive correlation was found between both values with a Pearson’s correlation coefficient = 0.103 and p-value 0.308. Conclusions: It is concluded that that medical treatment of hyperuricemia results in lowering of serum uric acid which correlates with the decrease in renal resistive index.

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

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

REAL TİME ELASTOGRAFİNİN ETKİNLİĞİ: KORTİKOMEDÜLLER STRAİN ORANI ÜRİNER OBSTRÜKSİYONUN TANI VE TAKİBİNDE KULLANILABİLİR Mİ?

Aim: To investigate the utility of corticomedullary strain ratio (SR) in the diagnosis and follow-up of urinary obstruction Material and Methods: Forty volunteer patients (26 males, 14 females) aged between 18-60 years, who were admitted to our outpatient urology clinic with renal colic due to stone and diagnosed as unilateral urinary tract obstruction via CT, were included in the study. Contralateral intact kidneys of the same patients were accepted as control group. The age, gender, duration of renal colic, blood pressure and BMI of the all patients were also recorded. Patients were examined with renal ultrasonography, doppler ultrasonography and Real Time Elastography (RTE) by a single radiologist with 8 years of experience in abdominal radiology. The average of these three measurements was used in statistical analysis. Strain ratio (SR) was measured by marking the region of interest in the medulla and cortex determined in B mode during the decompression phase. Results: No difference was observed in terms of age between the groups. We found a positive correlation between renal pelvic diameter and RI in obstructed kidney (p=0.006 ve r=0.446). There was a statistically significant difference between mean corticomedullary SR values of hydronephrotic kidneys (0.38 ± 0.43) and mean SR values of contralateral intact kidneys (0.61 ± 0.69) (p=0.025). Also, we observed statistically significant difference between the mean arterial doppler values of the hydronephrotic kidneys (0.64 ± 0.06) and the arterial doppler values of intact kidneys (0.60 ± 0.05) (p=0.026). Conclusion: The measurement of renal corticomedullary SR by RTE, which is a noninvasive method, can be used in the diagnosis and follow-up of urinary obstruction. This finding is supported by increased arterial RI data in urinary obstruction described in the literature.

Portal hypertension evolving from sickled hepatopathy: Could hepatic venous Doppler ultrasound be beneficial in its evaluation?

PurposeSickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound. MethodsThis is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19–43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities. ResultsAll the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18–25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney. ConclusionDoppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

PRIMARY ALDOSTERONISM: THE RESULTS OF THE TREATMENT ACCORDING TO THE DATA OF RENAL ARTERIES DUPLEX SCANNING

&#x0D; &#x0D; &#x0D; In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.&#x0D; &#x0D; &#x0D;

Factors associated with renal Doppler resistive index in critically ill patients: a prospective cohort study

BackgroundThe renal Doppler resistive index (renal RI) is a noninvasive tool that has been used to assess renal perfusion in the intensive care unit (ICU) setting. However, many parameters have been described as influential on the values of renal RI. Therefore, we proposed this study to evaluate the variables that could impact renal RI in critically ill patients.MethodsA prospective observational study was performed in a 14-bed medical–surgical adult ICU. All consecutive patients admitted to the ICU during the study period were evaluated for eligibility. Renal RI was performed daily until the third day after ICU admission, death, or renal replacement therapy (RRT) requirement. Clinical and blood test data were collected throughout this period. Acute kidney injury (AKI) reversibility was categorized as transient (normalization of renal function within 3 days of AKI onset) or persistent (non-resolution of AKI within 3 days of onset or need for RRT). A linear mixed model was applied to evaluate the factors that could influence renal RI.ResultsEighty-three consecutive patients were included. Of these, 65% were male and 50.6% were medical admissions. Mean SAPS 3 was 47 ± 16. Renal RI was significantly different between no-AKI (0.64 ± 0.06), transient AKI (0.64 ± 0.07), and persistent AKI groups (0.70 ± 0.08, p < 0.01). Variables associated with renal RI variations were mean arterial pressure, lactate, age, and persistent AKI (p < 0.05). No association between serum chloride and renal RI was observed (p = 0.868).ConclusionsMean arterial pressure, lactate, age, and type of AKI might influence renal RI in critically ill patients.

Hepatorenal arterial resistive and pulsatility indexes in dogs with ascites

Ascites is one of the complications in cirrhosis. Prognosis depends on systemic hemodynamics. This study was designed for determination of the liver and kidney hemodynamics in dogs with ascites via Doppler Ultrasonography (USG). 20 dogs with ascites and 10 healthy dogs were included. CBC, biochemical profile, USG and Doppler measurement were taken. Increased hepatic and renal RI and PI were statistically significant (p Less than 0,01-0,001). There were positive correlations between ALP and hepatic PI, between urea and renal RI, negative correlations between ALP and renal RI, between creatinine and hepatic and renal PI values (p less than 0,05-0,01). In conclusion, liver and kidney Doppler findings will help determination of the prognosis and implementation of effective treatment.

Evaluation of Split Renal Function for Children with Kidney Diseases by Renal and Vascular Color Ultrasonography

Renal dynamic imaging and radionuclide renography use radioactivity to evaluate split renal function. We aimed to investigate the use of renal vascular color Doppler ultrasonography for evaluation of split renal function in children. Thirty-five children with unilateral kidney diseases were enrolled. For patients with unilateral renal tumor, peak systolic velocity (Vmax = 113.04 ± 13.59 cm/s) and resistance index (RI = 0.73 ± 0.02) were higher on abnormal compared with normal sides (Vmax = 86.03 ± 6.49 cm/s, RI = 0.62 ± 0.01), and blood perfusion was good, indicating compensatory enhancement in split renal function. For unilateral renal cyst, Vmax (58.20 ± 7.38 cm/s) was lower on the abnormal compared with the normal (87.71 ± 14.83 cm/s) size, and perfusion was poor. For unilateral hydronephrosis and renal atrophy, the parameters were similar to those of renal cyst, suggesting a weakening of renal function. For unilateral renal agenesis, Vmax (106.07 ± 13.07 cm/s) and RI (0.71 ± 0.05) were higher, and perfusion was good. Renal vascular color Doppler ultrasonography was superior in the evaluation of split renal function in children, without being invasive or radioactive.

SONOGRAPHIC FINDINGS OF PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: To describe the morphologic and hemodynamic changes of renal interlobar artery on ultrasonography, and to evaluate the relationship between RI and kidney size, glomerular filtration rate, and causes of chronic kidney disease. Materials and methods: A cross-sectional study of 50 chronic kidney disease patients from stage 3, and 50 healthy individuals. RI, peak systolic velocity (PSV), end diastolic velocity (EDV) of renal interlobar artery, renal size was measured. Results: The mean RI in chronic kidney disease group and healthy group was 0.68 ± 0.05 and 0.57 ± 0.04 (p &lt;0.05), respectively. RI increases with the stage of chronic kidney disease. There were statistically significant differences in RI of renal lobar arteries between chronic pyelonephritis and chronic glomerulonephritis (p &lt;0.05). There was strong negative correlation and a statistically significant difference between renal lobar renal artery RI with kidney size (horizontal, vertical and thickness) and glomerular filtration level. Conclusion: Renal artery resistance index in patients with chronic kidney disease was higher than in the healthy group. The greater the kidney failure is, the more reduction in size and renal function, and the more increase in renal artery resistance index. Key words: morphologic, hemodynamic, chronic kidney disease, ultrasonography

Early detection with renal Doppler resistive index measurements of hemorrhagic shock in polytrauma patients

Background: Poly trauma is a major cause of morbidity and mortality in both developed and developing countries. The aim was to investigate whether renal Doppler RI changes occur early with posttraumatic bleeding and whether the renal Doppler RI may enable accurate prediction of occult hypoperfusion and thus be predictive of the development of hemorrhagic shock in polytrauma patients.Methods: It was a prospective study involving patients admitted in the causality and evaluated by radiology department. Study was done in a period of 6 months from June 2016-December 2016. Renal Doppler RI was measured in 48 hemodynamically stable adult patients admitted in emergency because of polytrauma.Results: 26 patients developed hemorrhagic shock, and 22 did not. Hemorrhagic shock group, as compared with the nonhemorrhagic shock group, had higher renal Doppler RI (mean, 0.79±0.11 [standard deviation] vs 0.61±0.2; P&lt;0.01), injury severity score (mean, 33±12 vs 25±9; P&lt;0.01), and standard base excess (mean, -4.0mEq/L±4 vs 1mEq/L±3; P≤0.05) values. At logistic regression analysis, a renal Doppler RI greater than 0.9 was the only independent risk factor for progression to hemorrhagic shock (P&lt;0.001).Conclusions: Renal Doppler RI measurement may represent a clinically useful non-invasive method for the early detection of occult hemorrhagic shock.

The Role of Renal Resistive Index in Assessment of Functional Renal Impairment in Patients with Liver Cirrhosis

Background and study aim: Renal dysfunction often develops in patients with liver cirrhosis. Hepatorenal syndrome (HRS) represents the end-stage of reduction in renal perfusion. Duplex Doppler ultrasonography of the kidneys is a non-invasive method to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction. This study aimed to assess the role of renal resistive index as a non-invasive marker for early detection of functional renal impairment in patients with liver cirrhosis. Patients and Methods: This study was conducted on 20 patients with liver cirrhosis without ascites vs. Session [CurrentTestPartID] patients with liver cirrhosis and ascites and 20 healthy subjects as control group. Patients and control were subjected to complete blood picture, liver and kidney functions, serum electrolytes, twenty four hours urinary sodium, abdominal ultrasonography and duplex Doppler evaluation of the renal arteries with calculation of mean renal RI. Results: Highly significant difference between cirrhotic patients with ascites and cirrhotic patients without ascites and controls regarding mean renal resistive index for both kidneys (P<0.001). At Cutoff point of renal RI 0.71, the sensitivity, specificity and accuracy to predict HRS were 100%, 80% and 82% respectively with AUC= 0.997. A statistical high significant positive correlation between RI and serum creatinine, child class, MELD score and MELD-Na (r=0. 0.818, r= 0. 0.539, r= 0.739 r= 0.807 respectively and P<0.001). A statistical high significant negative correlation between RI and serum sodium, Session [UserIDID] hours urinary sodium, and platelets (r= -0.778, r= 0. -0.688, r= -0.422 respectively and P<0.001). Conclusion: Renal duplex Doppler ultrasound is useful as a non-invasive method for the evaluation of the renal hemodynamic changes in cirrhotic patients and can predict HRS.

Duplex Doppler ultrasound for detection of significant renal artery stenosis in transplant kidney with end to side arterial anastomosis

Abstract Objective To evaluate the accuracy of velocity parameters and to define optimum threshold values of these parameters in detection of >60% renal artery stenosis in patients with end to side arterial anastomosis. Methods The study group composed of 17 patients of transplant renal artery stenosis confirmed by CT angiography; and 25 control patients with normal Doppler study. Doppler parameters like PSV in main transplanted renal artery, PSV in interlobar artery, PSV in iliac artery, acceleration time, and resistive index were evaluated. Pre-PSV ratio and Post-PSV ratio were calculated. Patients were divided into group A (>60% stenosis) and B ( t test. Receiver operating curve was performed to determine optimal parameter for diagnosis of >60% stenosis. Results Considering better sensitivity and specificity for diagnosis of >60% stenosis the best threshold for Intrarenal RI, acceleration time, PSV, Pre-PSV ratio and Post-PSV ratio were determined to be 0.058, 0.071 s, 3.1 m/s, 2 and 10 respectively. P value of acceleration time between group B and C; and P value of PSV in main renal artery, Pre-PSV ratio and Intrarenal RI between group A and B is >0.05. Conclusion Post-PSV ratio is the best parameter for diagnosis of significant stenosis and its optimum threshold value is 10.

1D.07

Objective: The benefit of revascularization for renal artery stenosis is currently unclear. A number of prospective, randomised studies showed no advantage of interventional revascularization (PTA) over medical therapy apart from a reduction in the number of antihypertensive drugs. A predictor of a more positive response to interventional treatment is urgently needed. We have shown that patients with a high resistive index (RI, > 80) by Doppler ultrasonography have inferior outcome after interventional revascularization for renal artery stenosis. We here obtained long-term follow up data from the original study collective and compared this to a matched group of recent patients with high resistive index which did not undergo revascularization but had improved medical therapy.Design and method: We measured the renal RI with Doppler ultrasonography in segmental arteries of both kidneys. 131 patients underwent renal angioplasty, 35 of these had renal RI values > 80. A further group of 31 patients with RI > 80 and renal artery stenosis > 65% did not undergo angioplasty. The combined endpoint was > 50 percent decrease in eGFR, end stage renal failure, or death. Mean (± SD) follow-up was 8.8 ± 4 years. Results: In patients with high RI (> 80), a decrease in renal function occurred in 74% patients after PTA and 77% without PTA compared to 19% of those with PTA and low RI. 71% and 52% of patients, compared to 17%, required dialysis, and 89% and 48% compared to 31% died (p<0.001 high RI compared to low RI). A total of 94% and 90% with high RI reached the combined endpoint as compared to 39% of those with low RI (multivariate relative risk 16, CI 3.7 to 68; P < 0.001 high RI vs low RI). Conclusions: Patients with renal artery stenosis and a high renal resistive index do not benefit from angioplasty in long-term follow up for renal and patient survival. Patients with high resistive index continue to suffer a poor prognosis even under improved medical therapy.

Clinical effect of high-intensity focused ultrasound in the treatment of chylumia

Objective To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) in treatment of chyluria.Methods Retrospectively analyze the HIFU-based treatment results of 131 patients with chyluria received treatment between Jan 2010 and Jun 2011.The patients' age ranges from 23 to 83 years old,with average 59.The patients consisted of 59 male patients and 72 female patients.74 cases were on the left side,right side 51 cases,6 cases bilateral.There were 47 patients with chylous hematuria,22 cases of recurrence after renal pedicle lymphatic vessel ligation,5 cases of recurrence after laparoscopic ligation of renal lymphatic,1 cases of recurrent pelvic perfusion after silver nitrate.The treatment was carried out according to the following procedure.The affected kidney pedicle and superior segment of ureter,after being divided into two or three irradiation layers,were irradiated daily from deep to superficial layers which completely cover the affected kidney pedicle and superior segment of ureter.The technical parameters of the treatment were:focal region size 4 mm×4 mm×7 mm,Ultrasonic power 800-1100 W,Unit firing time 0.15s,Dutv time 0.18s,Single point total transmit 50 times.The patients were followed up and re-examined within one to five years after treatment.Statistical analyses were conducted on the data of Color doppler ultrasound images on kidney pedicle and renal function tests before and after the treatment,blood routine examination and routine urianlysis.Results 116 patients were followed up and the treatment to 96 of them was deemed effective in which 85 patients completely recovered (73.3％ recovering rate) and 11 patients became better (9.5％).The other 20 patients (17.2％) was ineffective.With regard to the time required to cure chyluria,67 patients (69.8％) required one week,13 (13.5％) required two weeks,11 (11.5％) required four weeks,and 5 (7.5％) required five weeks.Results of color doppler ultrasound images on kidney pedicle and renal function tests were as follows.The volume of kidney,the inner diameter of renal artery,Vmax,RI,inner diameter and blood flow rate of renal vein and serum Cr,serum BUN had no significant difference before and after the treatment (P＞0.05).Results of anemia,hematuria,microscopic hematuria and urinary protein positive were significantly different from the before-treatment results (P＜0.05).During the treatment process,all patients had stable vital signs without serious complications.Conclusions Treating chyluria with HIFU could be a safe and effective method. Key words: Chyluria; High intensity focused ultrasound; Hot irradiation; Treatment

AB0666 Renal resistive index in lupus nephritis: Correlation with renal function and association with histological features

BackgroundResistive Index (RI) is a simple parameter used to calculate the resistance of the walls of an artery calculated in color-Doppler ultrasonography (US) as [(peak-systolic velocity - end-diastolic velocity)/peak-systolic velocity]....

Splenic Doppler Resistive Index for Early Detection of Occult Hemorrhagic Shock After Polytrauma in Adult Patients

The objective of this study was to evaluate whether direct assessment of splenic circulation by splenic Doppler resistive index (Doppler RI) is a clinically useful noninvasive method for an early detection of occult hemorrhagic shock after polytrauma in adult patients. Splenic Doppler RI was measured in 49 hemodynamically stable adult patients admitted to the emergency department because of polytrauma. Renal Doppler RI was also determined in 20 patients. Spleen size, Injury Severity Score, systolic blood pressure, heart rate, blood lactate, standard base excess, pH, hemoglobin, and inferior vena cava diameter values were recorded at admission and at 24 h. Patients were grouped according to whether signs of hemorrhagic shock did (n = 22) or did not (n = 27) occur within the first 24 h from admission. Patients who developed hemorrhagic shock had significantly higher splenic and renal Doppler RI, higher Injury Severity Score, and lower standard base excess at admission. By multivariate logistic regression, splenic Doppler RI resulted to be a predictor of hemorrhagic shock development within the first 24 h from admission. Splenic Doppler RI may represent a clinically useful noninvasive method for early detection of occult hemorrhagic shock and persistent occult hypoperfusion after polytrauma in adult patients.

Effects of TIPS on global end-diastolic volume and cardiac output and renal resistive index in ICU patients with advanced alcoholic cirrhosis

The transjugular porto-systemic stent-shunt (TIPS) reduces portal pressure in cirrhotic patients and is used as a nonsurgical treatment for refractory ascites, recurrent variceal hemorrhage or hepatorenal syndrome. There are concerns regarding a negative impact on cirrhotic cardiomyopathy and deterioration of hyperkinetic circulatory dysfunction. We analyzed a prospectively maintained database containing hemodynamic data on cirrhotic ICU patients. Hemodynamic monitoring was performed using transpulmonary thermodilution (PiCCO, Pulsion Medical Systems, Munich, Germany). Renal perfusion was assessed by Doppler ultrasound during studies of portal and TIPS perfusion before and after the procedure. Complete data sets of 8 patients (4 male, 4 female, age 60 years (52-67), Child-Pugh-Turcotte score 10 (8-12)) were available. After TIPS, there was a substantial increase of GEDVI (646 ml/m2 (580-737) to 663 mL/m2 (643-792); p=0.036) that was even more pronounced at 24 hours (716 mL/m2 (663-821); P=0.012). CI increased from 3.3 L/min/m2 (3.1-4.2) to 3.9 L/min/m2 (3.6-5.3) (p=0.012) and 3.9 L/min/m2 (3.7-5.2) (p=0.017), respectively. There was a significant decrease of renal RI from 0.810 (0.781-0.864) to 0.746 (0.710-0.798) (p=0.028) and a transient increase of fractional excretion of sodium. SVRI (1737 dyn*s/cm5/m2 (1088 - 2115) vs. 1917 dyn*s/cm5/m2 (1368-2177) was not significantly altered immediately after TIPS but decreased to 1495 dyn*s/cm5/m2 (833-1765) at 24 hours (p=0.036)). There were no significant changes of mean arterial pressure (MAP). In conclusion, TIPS resulted in a pronounced increase of central blood volume. The observed hemodynamic effects are compatible with a preload driven increase of cardiac output and secondary decreases in SVRI and RI.