Renal Artery Resistance Index Research Articles

Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease.

To evaluate the immediate effects of traditional local thermal therapy with indirect moxibustion on renal hemodynamics in patients with chronic kidney disease (CKD) by using Doppler ultrasonography (US). Examiner-blinded crossover study. Forty-three participants with CKD (mean age ± standard deviation [SD], 44 ± 15 years; estimated glomerular filtration rate, 69.5 ± 25.5 mL/min per 1.73 m(2); 20 men and 23 women). Participants received three successive treatment sessions of indirect moxibustion bilaterally at BL 23, a crucial acupuncture point, in the session. In the control session, the examiner was blinded by using smoke and aroma produced by moxibustion performed in an ashtray placed near the patient's body. The main outcome measure was resistive index (RI) in the renal segmental arteries. Blood flow parameters, including RI, were measured for six renal segmental arteries by using Doppler US at rest (baseline), immediately after completion of moxibustion (post 1), and 10 minutes later (post 2). Adverse events were monitored during intervention. In the control session, RI at post 1 (median [first, third quartile]: 0.587 [0.562, 0.626]) and post 2 (0.583 [0.567, 0.629]) did not change significantly compared with baseline (0.592 [0.563, 0.636]), while in the treatment session, RI at post 1 (0.565 [0.530, 0.618]) and post 2 (0.561 [0.533, 0.614]) decreased significantly compared with baseline (0.590 [0.550, 0.652]) (p < 0.001 and p < 0.001, respectively). The reduction in RI from baseline to post 2 in treatment session was significantly greater than in control session (mean ± SD, -0.026 ± 0.028 versus -0.003 ± 0.028; mean difference, -0.023 [95% confidence interval, -0.036 to -0.010]; p = 0.001]. No adverse events, such as burns, were observed during the study period. Renal vascular resistance was decreased after indirect moxibustion therapy in patients with CKD.

The correlation analysis between renal artery resistance index and renal function in patients with thrombotic microangiopathy

Objective To explore the correlations between renal artery resistance index(RRI)and renal function in patients with thrombotic microangiopathy (TMA)so as to provide the clinical basis for predictable diagnosis and treatment in patients with acute kidney injury(AKI). Methods Patients diagnosed with thrombotic microangiopathy admitted to department of emergency of Peking Union Medical College Hospital between August 1st, 2014 and March 31th, 2015 were enrolled. Intrarenal arteries resistive index of right kidney was detected in all cases on admission by color Doppler flow image. The serum creatinine(SCR) and glomerular filtration rate(GFR)were measured at the same time. According to the diagnostic criteria of the guideline ofKidney Disease: Improving Global Outcomes 2012(KDIGO-AKI 2012), patients were divided into non-AKI group and AKI group. The intergroup difference was compared and the correlation between RRI and SCR as well as between RRI and GFR were assessed. RRI, SCR and GFR were measured again at the most severe stage of kidney injury. The above index were marked as RRI*, SCRmax and GFRmin. At the same time, ΔRRI(RRI*-RRI), ΔSCR(SCRmax-SCR)and ΔGFR(GFR-GFRmin)were calculated. According to the stage classification of KDIGO-AKI 2012, 36 patients diagnosed with AKI during their hospitalization were divided into KDIGO-1 group(n=10), KDIGO-2 group(n=10) or KDIGO-3 group(n=16). The intergroup difference of RRI* was compared and the correlation between ΔRRI and ΔSCR as well as between ΔRRI and ΔGFR were assessed. Results When RRI>0.7 was used as the diagnostic threshold for AKI, the sensitivity was 92.3% and the specificity was 80.1%. RRI was positively correlated with SCR(r1=-0.728, P<0.01; r2=-0.709, P<0.01)and negatively correlated with GFR(r1=-0.728, P<0.01; r2=-0.709, P<0.01)in all patients at the time of admission and the most severe stage of kidney injury. While there was a significant difference in the RRI* among KDIGO-1, KDIGO-2 and KDIGO-3 groups(F=37.979, P=0.001), and there was no significant difference in ΔRRI (F=0.634, P=0.537). The ΔRRI was not correlated with ΔGFR or ΔSCR. Conclusions RRI can be used as a marker for diagnosis of AKI and the evaluation of renal function in patients with TMA, but it is not helpful to reflect the trends of renal injury especially for the critically ill patients. Key words: Thrombotic microangiopathy; Renal resistive index; Acute kidney injury; Diagnosis; Correlation

Evaluation of Vitamin C Supplementation on Kidney Function and Vascular Reactivity Following Renal Ischemic Injury in Mice

Background/Aims: Renal ischemia/reperfusion injury (IRI) is a very common clinical event and usually leads to ischemic acute renal failure (ARF). In the present study, we investigated the protective role of vitamin C in renal function and renal arterial relaxation following ischemic injury. Methods: IRI model in mice was used. Various biochemical parameters including nitric oxide (NO), reduced glutathione (GSH), total reactive oxygen species (ROS) level and superoxide dismutase (SOD) were examined. Doppler was used to investigate renal arterial resistance. The isolated renal arterial rings served for hypoxia/reoxygenation analysis. Acetylcholine (ACh) and sodium nitroprusside (SNP)-induced relaxations of isolated renal arterial rings were exerted. Results: Vitamin C supplementation preserved kidney morphology and renal function following IRI. It was shown that pretreatment with vitamin C for mice subjected to IRI significantly elevated renal NO and GSH levels after reperfusion. Meanwhile, vitamin C administration decreased resistance index of renal artery and ameliorated oxidative stress secondary to IRI. The total ROS level in renal artery was decreased whereas the renal arterial SOD expression was increased by vitamin C supplementation following IRI. Pretreatment with vitamin C significantly potentiated the ACh and SNP-induced relaxations in both control and hypoxic renal arterial rings. Conclusion: Vitamin C protects kidney function and renal arterial reactivity against IRI. The protective role of vitamin C is linked to ROS, SOD, GSH and NO levels in renal ischemic injury.

The Relationship between Central Retinal Artery Resistive Index and Measures of Renal Function in Type 2 Diabetes

Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arteries may be assessed by using measures such as resistive index, which is a non-invasive measure of the resistance in vessels. The association between retinopathy and nephropathy has been conflicting. This study assessed the relationship between resistive index of the central retinal artery and indices of nephropathy in type 2 diabetes. Method: This cross-sectional study examined 74 Nigerian diabetics who were selected consecutively from the out-patient diabetic clinic of a tertiary hospital in South-West Nigeria. Doppler ultrasound was used to determine the resistive index of the central retinal artery along with the right renal artery. The urinary and serum biochemical parameters were also done to determine the urinary albumin excretion and the glomerular filtration rate. Results: The mean age of participants was 59.62 ± 9.55 years. The mean central retinal artery resistive index (CRARI) was 0.77 ± 0.06, with 65 (87.8%) of the participants having elevated CRARI. There was no statistical difference between patients with normal CRARI and elevated CRARI in respect of their urinary albumin excretion (p = 0.796). There was no significant correlation between CRARI and estimated glomerular filtration rate (r = 0.120; p = 0.309) and right renal artery resistive index (r = 0.068; p = 0.564). Conclusion: This study demonstrates that central retinal artery resistive index (CRARI) may not be a predictor of renal function in diabetics.

Renal artery injury caused by Kawasaki disease

To investigate renal artery injury caused by Kawasaki disease (KD). Forty-three children with KD were enrolled in the study. According to the blood pressure in the acute stage, these children were classified into normal blood pressure subgroup and increased blood pressure subgroup. Eighteen children with fever caused by acute upper respiratory tract infection were enrolled as the control group. The diameter of the origin of the main renal artery, hemodynamic parameters of the main renal artery and the renal interlobar artery, rennin activity, and levels of angiotensin II and aldosterone were compared between groups. During the acute stage of KD, both subgroups had a significantly smaller diameter of the origin of the main renal artery, a significantly higher resistance index (RI) of the main renal artery, and a significantly lower end-diastolic velocity (EDV) than the control group (P<0.05).The increased blood pressure subgroup had a significantly lower EDV of the interlobar artery than the normal blood pressure subgroup, a significantly higher RI than the normal blood pressure subgroup and the control group, as well as a significantly higher rennin activity and significantly higher levels of angiotensin II and aldosterone than the normal blood pressure subgroup (P<0.05). A significantly increased EDV and a significantly reduced RI of the renal interlobar artery were observed in the increased blood pressure subgroup in the subacute stage compared with the acute stage (P<0.05). KD may cause renal artery injury and early hemodynamic changes, resulting in a transient increase in blood pressure in some patients.

Renal evaluation with B-mode and Doppler ultrasound in captive tufted capuchins (Sapajus apella).

This study aimed to evaluate, by B-mode ultrasound and Doppler ultrasound, the kidneys of one Neotropical primate maintained in captivity. Ten adult intact tufted capuchins (Sapajus apella) were evaluated. The morphometric parameters of both kidneys were evaluated and kidney volumes calculated. Color Doppler was used to evaluate renal vascular architecture and to identify arteries of the left kidney. Spectral Doppler was used to measure peak-systolic velocity, end-diastolic velocity, and resistive index (RI). Both kidneys presented homogeneous cortical echogenicity and homogeneous echotexture with preserved corticomedullary differentiation. There was no statistically significant difference between right and left kidneys for all morphometric parameters. RI of the left renal, interlobar, and arcuate arteries were, respectively, 0.75 (SD, 0.07), 0.70 (SD, 0.08), and 0.70 (SD, 0.06). Both kidneys showed similar morphometric parameters by B-mode ultrasound, whereas RI by spectral Doppler decreased progressively from renal artery to interlobar and arcuate arteries.

Microvascular resistance in response to iodinated contrast media in normal and functionally impaired kidneys.

SummaryContrast‐induced nephropathy (CIN) is considered to result from intrarenal vasoconstriction, and occurs more frequently in impaired than in normal kidneys. It was hypothesized that iodinated contrast media would markedly change renal blood flow and vascular resistance in functionally impaired kidneys. Thirty‐six patients were enrolled (32 men; mean age, 75.3 ± 7.6 years) undergoing diagnostic coronary angiography and were divided into two groups based on the presence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min per 1.73 m2 (CKD and non‐CKD groups, n = 18 in both). Average peak velocity (APV) and renal artery resistance index (RI) were measured by Doppler flow wire before and after administration of the iodinated contrast media. The APV and the RI were positively and inversely correlated with the eGFR at baseline, respectively (APV, R = 0.545, P = 0.001; RI, R = −0.627, P < 0.001). Mean RI was significantly higher (P = 0.015) and APV was significantly lower (P = 0.026) in the CKD than in the non‐CKD group. Both APV (P < 0.001) and RI (P = 0.002) were significantly changed following contrast media administration in the non‐CKD group, but not in the CKD group (APV, P = 0.258; RI, P = 0.707). Although renal arterial resistance was higher in patients with CKD, it was not affected by contrast media administration, suggesting that patients with CKD could have an attenuated response to contrast media.

Abstract 073: Expression of Axl in Innate Immune Cells Contributes to Kidney Dysfunction and Onset of Hypertension

Introduction: We previously reported that expression of the receptor tyrosine kinase Axl in hematopoietic cells is critical for kidney dysfunction in early hypertension. Here we investigated the role of Axl expression in innate immune cells in deoxycorticosterone acetate (DOCA)-salt induced hypertension. Methods and Results: RAG1-/- mice lack adaptive immune cells and displayed the same (~25 mmHg) increase in systolic blood pressure (BP) as C57BL/6J mice after 1 week of DOCA-salt. While in metabolic cages RAG1-/- drank more (14.3±0.9 mL) than C57BL/6J mice (10.6±2.5 mL) per day after 1 week of DOCA-salt. Ultrasound imaging confirmed that RAG1-/- had ~20 % larger kidneys vs. C57BL/6J mice after DOCA-salt. RAG1-/- kidneys accumulated 2 times more fluid (2.8±0.1 %) compared to C57BL/6J mice (1.4±0.5 %) after DOCA-salt. Flow cytometry on kidneys from RAG1-/- confirmed absence of T and B lymphocytes, while DOCA-salt increased presence of macrophages (1.1±0.3 x10 9 ) compared to C57BL/6J mice (0.6±0.1 x10 9 ). We successfully generated Axl/RAG1 double knockout mice and subjected the littermates to 1 week of DOCA-salt. Increases in systolic BP were the same in Axl/RAG1+/+ and Axl/RAG1-/- littermate mice. No differences were found in kidney volumes between the Axl/RAG1 genotypes as well. However, 24 hrs excretion volumes increased in Axl/RAG1-/- (50±6 %) compared to Axl/RAG1+/+ (31±6 %) littermates. Finally, renal artery blood flow velocity (611±52 mm/s) and resistive index (0.62±0.03) were reduced in Axl/RAG1+/+ but not in Axl/RAG1-/- mice (665±45 mm/s and 0.68±0.01, respectively) when compared to their controls. Conclusions: Our findings suggest that mice lacking lymphocytes compensate by increasing kidney macrophages that contribute to initial increase in BP. Depletion of Axl in innate immune cells partially reverses kidney dysfunction by improving renal artery function in early hypertension.

Relation between hyper-uricemia and renal resistivity index in non diabetic non hypertensive patients

BackgroundRelationship between uric acid and renal artery resistive index (RRI) in hypertensive subjects was recently suggested. AimThe aim was to evaluate the effect of hyper-uricemia on RRI in adult Egyptian subjects with no other risk factors of renal vascular disease, and to assess the impact of therapeutic control of serum uric acid on the RRI. Patients and methods50 adult hyper-uricemic subjects were included in this study, who underwent abdominal ultrasound with Doppler examination of the kidneys. The RI was automatically calculated by the US equipment. Intra-renal resistance was measured at inter-lobar arteries three times in different regions of each kidney (upper, middle, and lower zones) and the mean RI value was calculated. Each case had its pre and post 3 and 6weeks treatment duplex measurement of RI together with uric acid measurement and correlation. ResultsMean value of the baseline RI was 0.768±0.01355 SD, and mean serum uric acid value was 10.86±0.65 SD, with a positive significant correlation between both values. Mean value of the difference of the serum uric acid level and RRI prior to and 3weeks after treatment was 2.68±0.49, 0.04±0.01 respectively, with positive significant correlation between the two values p-value: 0.001. Mean value of the difference of the serum uric acid level and RRI 3 and 6weeks after treatment was 2.18±0.5 and 0.06±0.01 respectively, with significant positive correlation between the two values and p-value 0.00. Mean value of the total change of serum uric acid and RRI over the treatment period was: 2.38±0.43 and 0.049±0.01 with positive significant correlation between the two values and p-value: 0.00. ConclusionSerum uric acid significantly correlates with RRI in the absence of other risk factors affecting renal vasculature. Improvement of serum uric acid is accompanied by the improvement in RRI.

Renoprotective effects of berberine as adjuvant therapy for hypertensive patients with type 2 diabetes mellitus: Evaluation via biochemical markers and color Doppler ultrasonography.

Diabetes and hypertension are complex and serious diseases that may ultimately lead to renal complications. Adequate control of blood glucose and blood pressure contributes to decreased renal risks, but may not be sufficient for certain patients. The current study was undertaken to investigate the renoprotective effects of berberine as an adjuvant therapy to standard hypotensive and hypoglycemic treatment in hypertensive patients with type 2 diabetes mellitus (T2DM). In this 2-year clinical study, 69 hypertensive patients with T2DM, whose blood pressure and fasting plasma glucose (FPG) were adequately controlled by hypotensive and oral hypoglycemic agents prior to the study, were enrolled and randomly assigned into control (33 cases) and add-on (36 cases) groups. Berberine was orally administrated to the patients in the add-on group concomitantly with standard hypotensive and hypoglycemic treatment. Baseline characteristics, including the levels of FPG, glycated hemoglobin, systolic blood pressure, diastolic blood pressure, serum creatinine, urinary albumin-to-creatine ratio (UACR), urinary osteopontin and kidney injury molecule-1 (KIM-1) were determined. Furthermore, the oxidative stress markers malondialdehyde, urinary 8-hydroxy-2'-deoxyguanosine, superoxide dismutase, glutathione peroxidase and total-antioxidant capacity, and the inflammatory parameters vascular adhesion molecule-1, C-reactive protein and high molecular weight-adiponectin were evaluated. In addition, ultrasonographic parameters, including peak systolic velocity, end diastolic velocity and renal arterial resistance index were determined. After treatment, it was observed that the control and add-on treatments were able to adequately control blood pressure and blood glucose. Patients in the add-on group exhibited significant reductions in renal damage biochemical markers (UACR, urinary osteopontin and KIM-1) and improved renal hemodynamics, in addition to reduced inflammation and oxidative stress. The present results suggest that berberine is beneficial for hypertensive patients with T2DM as add-on therapy to standard hypotensive and hypoglycemic agents.

The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate.

The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary adaption in the giraffe kidney allows normal for size renal haemodynamics and glomerular filtration rate (GFR) despite a MAP double that of other mammals. Fourteen anaesthetized giraffes were instrumented with vascular and bladder catheters to measure glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological characteristics of vascular and renal tissues were determined. GFR averaged 342 ± 99 mL min(-1) and ERPF 1252 ± 305 mL min(-1) . RIHP varied between 45 and 140 mmHg. Renal pelvic pressure was 39 ± 2 mmHg and renal venous pressure 32 ± 4 mmHg. A valve-like structure at the junction of the renal and vena cava generated a pressure drop of 12 ± 2 mmHg. RI was 0.27. The renal capsule was durable with a calculated burst pressure of 600 mmHg. Plasma renin and AngII were 2.6 ± 0.5 mIU L(-1) and 9.1 ± 1.5 pg mL(-1) respectively. In giraffes, GFR, ERPF and RI appear much lower than expected based on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP.

2: Renal Haemodynamics and Acute Kidney Injury During Therapeutic Hypothermia and Re-Warming in Neonates with Hypoxic-Ischaemic Encephalopathy

Birth asphyxia is associated with acute kidney injury (AKI); severity may correspond with degree of hypoxia. Previous work by our group demonstrated lower cardiac output in neonates undergoing therapeutic hypothermia (TH). The relevance of these changes to AKI remains unknown. To describe longitudinal renal haemodynamic changes during TH and re-warming (RW) and evaluate their relationship with cardiac output in neonates with and without AKI. Prospective observational study of 18 term and near-term infants with hypoxic-ischaemic encephalopathy (HIE) who received TH. Doppler ultrasound was used to assess left ventricular output (LVO) and renal artery (RA) blood flow parameters – systolic and end-diastolic velocity (Vs and Vd), and resistive index (RI) during cooling [TH I (24 h) and II (72 h)] and post re-warming [RW I (12 h) and II (>24 h)]. AKI was defined as anuria/oliguria (100 mmol/L; or anuria/oliguria for >36 h; or any serum creatinine >125 mmol/L; or rising serum creatinine postnatally. There was no difference in baseline demographics or severity of HIE between neonates with (n=8) vs without (n=10) AKI. All 18 infants survived till discharge. Neonates who developed AKI had higher RA RI 24 h after TH was initiated [Table 1]. There was a temporal increase in LVO in both groups (P<0.01, two-way ANOVA), without intergroup difference. Neonates in the non-AKI group only showed an increase in RI (P=0.01) and a trend towards increase in RA Vs over time (P=0.05). Early changes in end-diastolic flow (EDF) were seen in both groups, which normalized over time. Elevated RA RI at 24 h after introduction of TH is associated with and predicts AKI. The fall in cardiac output and renal systolic flow after TH is not associated with AKI.

0163: Renal arterial resistance index versus biomarkers for predicting acute kidney injury in acute heart failure

Acute kidney injury (AKI) is frequent during acute heart failure (AHF) and worsens the outcome. To predict AKI is important but remains challenging. The aim of this study was to analyze Doppler-derived renal arterial resistance index (RRI) during AHF as well as its determinants and its predictive value of AKI as compared to renal biomarkers comprehensive echocardiographic examination and Doppler measurement of RRI were performed on admission, at day 3 and at discharge. RRI was the ratio (peak systolic velocity – end diastolic velocity)/ peak systolic velocity of interlobar blood flow. Serial assessment of clinical parameters as well as creatinine, cystatin C, blood NGAL, urinary NGAL and electrolytes was also obtained. AKI was defined by an increase in creatinine ≥ 0.3 mg/l relative to the admission level. Exclusion criteria was eGFR < 15 ml/min/1.73m² and atrial fibrillation. among the 26 included patients, AKI occurred in 8 patients at day 3 and in 10 patients at discharge. Mean RRI values were 0.71±0.08 on admission, 0.71±0.09 at day 3 and 0.74±0.08 at discharge. RRI was related to age, creatinine and cystatin C (p≤0.05 for all) but not to other clinical or echocardiographic variables or BNP or NGAL levels. Only admission RRI was significantly associated with AKI at day 3 (table) as well as RRI at day 3 for AKI at discharge (0.77±0.07 vs 0.67±0.8; p=0.02). this pilot study describes RRI values as well as its early changes and determinants during AHF. Doppler-derived RRI measurement appears to be a relevant tool for predicting AKI. Abstract 0163 – Table Admission variables No AKI AKI p Age 60±17 69±14 0.29 LVEF 25±8 33±17 0.78 Blood Pressure 122±18 118±19 0.63 eGFR 62±24 52±20 0.35 Cystacin C 1.4±0.6 1.8±0.7 0.08 NGAL blood 125±84 147±130 0.76 NGAL urinary 13±17 9 ±4 0.79 BNP 1979±1815 1562±881 0.95 IRR 0.68±0.08 0.76±0.06 0.03

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances.

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure (CHF) which are independently associated with poor patient outcome. The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index (a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.

Intrarenal resistance index (RI) as a predictor of early renal impairment in patients with liver cirrhosis.

Despite its functional nature, hepatorenal syndrome (HRS) is associated with a poor prognosis and the only effective treatment is liver transplantation. It is very important to diagnose renal impairment in cirrhosis patients at an early stage before overt HRS develops. In patients with cirrhosis the early renal impairment or renovascular vasoconstriction can be predicted by renal arterial resistance index (RI). Our study aimed to compare RI in healthy controls versus patients with liver cirrhosis with and without ascites and assess its value for predicting subsequent renal status. Patients were divided into 2 groups with 50 patients in each group. Group 1 contained patients with cirrhosis without ascites and group 2 contained cirrhosis patients with ascites. All patients were subjected to detailed clinical examination, laboratory investigations and abdominal doppler ultrasound with renal RI measurements. Patients were followed for 6 months. RI was significantly higher in cirrhotic patients as compared to healthy controls (0.62 vs. 0.52, p< 0.01). In patients with cirrhosis, RI was significantly greater in patients with ascites than those without ascites (0.70 vs. 0.62, p < 0.01). RI >0.70 was significant independent predictor of subsequent HRS development (p = 0.006) CONCLUSIONS: Intrarenal RI measurement can be used as a predictor of HRS and may be further validated for regular monitoring of cirrhotic patients at risk of developing renal impairment.

Cystatin C serum concentration combined with renal artery resistance index determination for early diagnosis of hepatorenal syndrome value

肝肾综合征(HRS)是终末期肝病(MELD)的严重并发症,临床常分为Ⅰ型HRS:其特征为快速进行性肾功能损害2周内血清肌酐(Scr)较基线升高2倍以上并＞221μmol/L;Ⅱ型HRS:特征为稳定或非进行性肾功能损害,Scr在133 ～ 221 μmol/L之间,或血清肌酐清除率(Ccr)＜40％[1].引起HRS的机制主要是肾动脉显著收缩及体循环舒张调节功能紊乱,从而导致动脉血压降低,肾动脉灌注严重不足,肾小球滤过率(GFR)明显降低所致.肝肾综合征为功能性肾脏损害,因此早期预防、诊断及积极合理治疗有可能逆转肾功能衰竭(AKI)[2].本研究对肝肾综合征患者采用动态监测血清胱抑素C(cystian C,CyC)及肾动脉血流阻力指数(RI)在肝肾综合征的早期诊断及治疗上取得了一定的临床价值及经验,现总结如下. 关键词：肝肾综合征;肝硬化;血清胱抑素C;肾动脉血流阻力指数

Ultrasonographic Evaluation of Renal Resistive Index in Patients with Lupus Nephritis: Correlation with Histologic Findings

We analyzed the association between the renal arterial resistive index (RI) and the histologic features of lupus nephritis. All consecutive patients with systemic lupus erythematosus (SLE) who required a kidney biopsy were enrolled. The study protocol included ultrasonographic assessment to measure the RI and kidney biopsy (International Society of Nephrology/Renal Pathology Society classification). A RI > 0.7 was considered pathologic. Patients with non-renal SLE and healthy patients were studied as control groups. We enrolled 42 patients with renal SLE, 10 with non-renal SLE and 14 healthy patients: their mean (±standard deviation) RI values were 0.64 ± 0.08, 0.60 ± 0.04 and 0.59 ± 0.01, respectively (p = not significant). RIs > 0.7 were recorded only in patients with renal SLE (5/42, 11.9%). The percentage of patients with a pathologic RI was significantly higher in class IV nephritis in comparison with other classes (p < 0.009). In conclusion, we found a significant correlation between pathologic RI and class IV nephritis, suggesting a role for RI as a severity marker.

Abstract 231: Hydrogen Sulfide Promotes Macrophage Polarization to Reduce Renal Inflammation in Angiotensin-II Induced Hypertension

Ageing is associated with structural and functional changes in the kidney and the presence of hypertension in this population further contributes to renal complications leading to renovascular sclerosis. Emerging evidence suggests that hydrogen sulfide (H 2 S) pathway participates in the pathogenesis of hypertension. Furthermore, chronic inflammation is known to play a critical role in ageing and development of hypertension. In this study, we hypothesized that angiotensin-II (Ang-II)-induced hypertension causes renal fibrosis by sustained activation of pro-inflammatory M1 macrophage promoting the release of inflammatory cytokines and treatment with H 2 S attenuates renal injury and fibrosis by promoting alternate activation of anti-inflammatory M2 macrophage. C57BL/6J (wild type, WT) mice, aged 18 months, were infused with Ang-II (1000ng/Kg/min) or saline using osmotic pumps for 4 weeks and treated without or with H 2 S in drinking water (30μM/L). Animal groups were 1) Saline, 2) Saline + H 2 S, 3) Ang-II, 4) Ang-II + H 2 S. Blood pressure was measured weekly and renal ultrasound was done to measure hemodynamic parameters. Systolic and diastolic blood pressure was increased in mice receiving Ang-II (160.73 ± 4.5 and 129.10 ± 4.9 respectively) and treatment with H 2 S showed significant reduction (134.5 ± 4.8 and 101.1 ± 4.5 respectively). Ultrasound revealed increased renal artery and intra-renal cortical artery resistive index in Ang-II mice (0.73 ± 0.03) which was significantly decreased following H2S treatment (0.61 ± 0.2). Ang-II increased the protein expression and mRNA levels of pro-inflammatory M1 macrophage marker, CD40, and TNF-α and MCP-1, whereas, H2S treatment increased the expression of anti-inflammatory M2 macrophage marker, CD206, and IL-10. Fluorescent probe H2DCF-DA showed increased intracellular reactive oxygen species with Ang-II treatment which was abrogated with H2S treatment. Our data suggests that H 2 S treatment in Ang-II-induced hypertension attenuates inflammation and hypertension by reducing classical activation of inflammatory M1 macrophage and promotes alternate activation of anti-inflammatory M2 macrophage.

Application value of color Doppler ultrasound in the early diagnosis of diabetic nephropathy

Objective To investigate the clinical value of color Doppler in the early diagnosis of diabetic nephropathy （DN）.Methods 69 cases of DN Phase I,II patients （group A） and 75 cases Phase III （B group） all underwent renal artery line Doppler flow imaging inspection .Renal aorta （ MRA） ,interlobar artery （ IRA） ,renal seg-mental artery blood flow （SRA） peak systolic velocity （Vsmax）,resistance index （RI） and diastolic minimum speed （ Vdmin） and other hemodynamic parameters of two groups were analyzed .Results The Doppler spectrum renal blood flow characteristics of early renal damage were：between group A,B,the main renal artery （MRA）,the kidney arterial segment Vdmin significantly reduce ,RI was significantly higher;the interlobar artery Vsmax （t=3.562 5,P=0.000 5）,Vdmin （t=5.252,P=0.000 0） were significantly lower,RI was significantly higher （t=9.166 0,P=0.000 0）;with the severity of renal dysfunction ,kidney color flow imaging reduce ,the kidney volume was significantly reduced in patients with stage Ⅲ.Conclusion Color Doppler ultrasound can clearly show the size of the patient′s kidney and renal artery blood flow parameters ,which has certain value in the diagnosis of early DN . Key words: Diabetic nephropathies; Ultrasonography,doppler,color

Traditional thermal therapy with indirect moxibustion decreases renal arterial resistive index.

To evaluate the immediate effects of indirect moxibustion, a traditional local thermal therapy, on renal hemodynamics by using Doppler ultrasonography (US). Prospective observational study of postintervention changes in several variables. Gifu University Hospital, Gifu, Japan. Eleven healthy persons (7 men and 4 women; mean age±standard deviation, 32.6±5.7 years) were enrolled. Indirect moxibustion was applied for 4 minutes to bilateral lower back acupuncture points (BL23). Each participant received 3 successive treatments. The main outcome measurement was resistive index (RI) in the renal segmental arteries. Blood flow variables, including RI, were measured for 6 renal segmental arteries by Doppler US at rest (baseline), immediately after completion of moxibustion (post 1), and 10 minutes later (post 2). Participants were monitored for adverse events during the intervention. The mean RI was 0.578±0.037 at baseline, 0.546±0.027 at post 1, and 0.547±0.032 at post 2. RI decreased significantly between post 1 and baseline (95% confidence interval [CI], -0.053 to -0.011; p=0.003) and between post 2 and baseline (95% CI, -0.052 to -0.009; p=0.005). No adverse events, such as burns, were observed. This study of the short-term effects of indirect moxibustion on renal hemodynamics in healthy persons showed that renal vascular resistance was reduced after the therapy.