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Towfighi S, Bajaj S, Aggarwal T, Nguan C, Pang E. An evaluation of the contribution of routine ultrasound when performed with multiphase CT in renal donor imaging assessment. Eur Radiol 2023; 33:6592-6598. [PMID: 37017701 DOI: 10.1007/s00330-023-09578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/14/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES We sought to examine the contribution of routine ultrasound when performed with computed tomography in identifying exclusion criteria in potential living kidney donors. METHODS We performed a 10-year retrospective cohort study including all cases of potential renal donors at our center. For each case, the donor workup ultrasound (US) and multiphase computed tomography (MPCT) original reports and imaging were reviewed by a fellowship-trained abdominal radiologist in consultation with a transplant urologist and placed into one of 3 groups: (1) no significant US contribution, (2) US was useful to characterize an incidental finding (either US exclusive or US aided in CT interpretation) but did not impact donor eligibility, and (3) an US exclusive finding contributed to donor exclusion. RESULTS A total of 432 potential live renal donors were evaluated (mean age 41, 263 women). In total, 340 (78.7%, group 1) cases had no significant US contribution. In 90 cases (20.8%, group 2), US helped to characterize one or more incidental findings but did not contribute to donor exclusion. In 1 (0.2%, group 3) case, an US exclusive finding (suspected medullary nephrocalcinosis) contributed towards donor exclusion. CONCLUSION US provided limited contribution to renal donor eligibility decisions when performed routinely with MPCT. CLINICAL RELEVANCE Routine ultrasound could potentially be omitted in the live renal donor workup, with alternative strategies including a selective approach to incorporating ultrasound and an expanded role of dual-energy CT. KEY POINTS • Ultrasound is performed routinely with CT for renal donor assessment in some jurisdictions; however, this practice has come into question particularly with advances in dual-energy CT. • Our study found that routine use of ultrasound provided limited contribution, primarily assisting CT in characterization of benign findings with only 1/432 (0.2%) potential donors in a 10-year period excluded based in part on an ultrasound exclusive finding. • The role of ultrasound can be narrowed to a targeted approach for certain at-risk patients, and can be further reduced if dual-energy CT is utilized.
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Affiliation(s)
- Sohrab Towfighi
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sargun Bajaj
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Aggarwal
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Nguan
- Department of Urology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Emily Pang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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Zhou Q, Yu Y, Qin W, Pu Y, Hu S, Tang M, Xu X, Zhao H. Current Status of Ultrasound in Acute Rejection After Renal Transplantation: A Review with a Focus on Contrast-Enhanced Ultrasound. Ann Transplant 2021; 26:e929729. [PMID: 33941759 PMCID: PMC8106257 DOI: 10.12659/aot.929729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Renal transplantation has developed into the best treatment for end-stage renal disease, but severe cases can even lead to loss of renal allograft function due to rejection and complications caused by surgical procedures. If a series of postoperative complications can be reduced or even avoided, the quality of life of recipients will be significantly improved. Acute rejection in a transplanted kidney is one of the main complications after renal transplantation. Early detection and diagnosis will significantly help the prognosis of transplanted kidney patients. As a seminal morphological and hemodynamic examination method, ultrasound can monitor the tissue structure and arteriovenous blood flow of the transplanted kidney, providing information on the transplanted kidney’s gross shape and blood perfusion. Ultrasound is a commonly used detection method after renal transplantation. At present, two-dimensional ultrasound, color Doppler ultrasound, three-dimensional ultrasound, and contrast-enhanced ultrasound have been applied in the monitoring of complications after renal transplantation. Contrast-enhanced ultrasound, as a non-invasive, radiation-free, and easy to perform examination technique, can qualitatively and quantitatively evaluate the microcirculatory blood perfusion of the transplanted kidney. It can reflect the function of the transplanted kidney more objectively and sensitively. In recent years, contrast-enhanced ultrasound has attracted attention as a new technology that can quantitatively monitor the transplanted kidney’s microcirculation perfusion. A large number of studies have shown that contrast-enhanced ultrasound has unique advantages in monitoring acute rejection after renal transplantation compared with other imaging methods, providing a reliable basis for clinical intervention. This article reviews the current status of and recent research on contrast-enhanced ultrasound in acute rejection after renal transplantation.
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Affiliation(s)
- Qiang Zhou
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Yanjie Yu
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Wenhan Qin
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Youmin Pu
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Shuang Hu
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Maozhi Tang
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Xiaosong Xu
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
| | - Hongwen Zhao
- Department of Nephrology, Chongqing Southwest Hospital, Chongqing, China (mainland)
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Viyannan M, Kappumughath Mohamed S, Nagappan E, Balalakshmoji D. Doppler sonographic evaluation of resistive index of intra-renal arteries in acute ureteric obstruction. J Ultrasound 2020; 24:481-488. [PMID: 33210264 DOI: 10.1007/s40477-020-00539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acute ureteric colic is one of the most commonly encountered acute abdominal conditions. Diagnosis of obstruction caused by ureteric calculus occasionally becomes challenging if there is inadequate dilation of the urinary tract proximal to obstruction. In such a situation, intra-renal artery Doppler parameters can be used as a diagnostic tool. Our study compared intra-renal arterial Doppler in patients with obstructed and non-obstructed kidneys presenting within 24 h of onset of symptoms of unilateral acute renal colic. RESULTS The resistivity index (RI) in the segmental arteries of all 54 patients with obstructed kidneys was significantly higher than in those with non-obstructed kidney: 0.75 vs. 0.56, with a p value less than 0.001, a sensitivity of 85% and a specificity of 93%. CONCLUSION Doppler ultrasound is a useful diagnostic tool in the evaluation of acute renal obstruction, thus enabling practitioners to avoid ordering unnecessary CT and exposing patients to ionizing radiation. An RI value > 0.7 has good sensitivity and specificity in our study. The results obtained in the study were comparable to those of pioneer studies conducted worldwide.
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Affiliation(s)
- Maheswaran Viyannan
- Department of Radiology, No.3 Aaradhana, Gandhi Nagar, Masakalipalayam, Uppilipalayam, Coimbatore, 641015, Tamilnadu, India.
| | - Shamsa Kappumughath Mohamed
- Department of Radiology, No.3 Aaradhana, Gandhi Nagar, Masakalipalayam, Uppilipalayam, Coimbatore, 641015, Tamilnadu, India
| | - Elango Nagappan
- Department of Radiology, No.3 Aaradhana, Gandhi Nagar, Masakalipalayam, Uppilipalayam, Coimbatore, 641015, Tamilnadu, India
| | - Devanand Balalakshmoji
- Department of Radiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India
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Drudi FM, Cantisani V, Granata A, Angelini F, Messineo D, De Felice C, Ettorre E. Multiparametric ultrasound in the evaluation of kidney disease in elderly. J Ultrasound 2019; 23:115-126. [PMID: 31197634 DOI: 10.1007/s40477-019-00390-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/29/2019] [Indexed: 01/15/2023] Open
Abstract
After the age of 30 years, GFR progressively declines at an average rate of 8 mL/min/1.73 m/decade. A problem of advanced age is that the evaluation of renal function on the basis of indicators valid in young adults, such as creatininemia, is unreliable. In fact, many patients with chronic renal failure may have serum creatinine levels within the normal range even if they have a significant reduction in renal function. Ultrasound has become a routine method of investigation in renal disease: kidney size and parenchymal echogenicity are considered markers of renal function, so US is useful in assessing the presence and degree of renal failure. CEUS is useful in the evaluation of kidney disease in the elderly: the increased hemodynamic resistance of renal microvessels reduces perfusion in the renal cortex, so fewer microbubbles enter the renal cortex. EcoColor and EcoDoppler are also useful in the evaluation of senile alterations: here, the distribution of color-signals, as compared to that in the young adult population, appears more attenuated, limited to intersegmental and interlobar districts. Among the ecoDoppler parameters, the resistance index can be considered a marker of renal damage progression, with attention needing to paid to possible concomitant confounding factors. Ultrasonography, color-Doppler and CEUS are a non-invasive and convenient modality for managing kidney disease; their integration with anamnestic, objective and laboratory data permits fast and reliable clinical, diagnostic, and therapeutic classification. It also allows early therapeutic intervention and, ultimately, improvements in patient management.
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Affiliation(s)
- Francesco Maria Drudi
- Department of Radiological, Oncological and Path. Sciences, Sapienza University of Rome, Rome, Italy.
| | - Vito Cantisani
- Department of Radiological, Oncological and Path. Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Granata
- Department of Nephrology and Dyalisis, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Flavia Angelini
- Department of Radiological, Oncological and Path. Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Messineo
- Department of Radiological, Oncological and Path. Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo De Felice
- Department of Radiological, Oncological and Path. Sciences, Sapienza University of Rome, Rome, Italy
| | - Evaristo Ettorre
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
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Comai G, Baraldi O, Cuna V, Corradetti V, Angeletti A, Brunilda S, Capelli I, Cappuccilli M, LA Manna G. Increase in Serum Amylase and Resistive Index After Kidney Transplant Are Biomarkers of Delayed Graft Function. ACTA ACUST UNITED AC 2018; 32:397-402. [PMID: 29475927 DOI: 10.21873/invivo.11252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both amylase and resistive index (RI) are routinely measured after kidney transplant and proposed as markers of delayed graft function (DGF). MATERIAL AND METHODS This retrospective cross-sectional study analyzed amylase and RI in 269 renal transplant recipients before and after transplantation, and at discharge. An increase above 20% of total amylase with/without RI>0.7 were evaluated as prognostic markers of DGF, hospitalization length and risk of rejection. RESULTS Serum amylase increase >20% was found in 103/269 (38.3%) patients who showed DGF (45.6% vs. 25.3%, p=0.001) and had lower estimated glomerular filtration rate compared to those with an amylase increase <20% (42.0±21.7 vs. 49.8±23.2 ml/min, p=0.007). The double condition consisting of concomitant amylase increase >20% and RI>0.7 was associated with higher DGF occurrence (65% vs. 24%, p<0.001), longer hospital stay, lower eGFR at discharge, and higher risk of rejection. CONCLUSION Patients with concomitant amylase increase >20% and RI>0.7 might require closer monitoring to diagnose DGF early and modify the therapeutic approach accordingly.
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Affiliation(s)
- Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Olga Baraldi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vania Cuna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valeria Corradetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Seidju Brunilda
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gaetano LA Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Haberal M, Boyvat F, Akdur A, Kırnap M, Özçelik Ü, Yarbuğ Karakayalı F. Surgical Complications After Kidney Transplantation. EXP CLIN TRANSPLANT 2017. [PMID: 27934557 DOI: 10.6002/ect.2016.0290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.
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Affiliation(s)
- Mehmet Haberal
- Department of General Surgery and Transplantation, Baskent University, Ankara, Turkey
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Melek E, Baskın E, Gulleroglu K, Uslu N, Kırnap M, Moray G, Haberal M. The predictive value of resistive index obtained by Doppler ultrasonography early after renal transplantation on long-term allograft function. Pediatr Transplant 2017; 21. [PMID: 27900821 DOI: 10.1111/petr.12860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
DUSG is a useful diagnostic tool for the follow-up of renal transplant recipients. The measurement of intrarenal arterial RI by DUSG has been proven to predict short-term AF. The aim of the study was to evaluate the predictive value of DUSG performed during the early after RTx on long-term AF. Seventy patients were enrolled into study. DUSG was performed at third and seventh days after RTx. Patients were divided into two groups according to rate of recovery of graft function as patients with normal graft function and abnormal graft function. Although the RI values were correlated with the AF early after transplantation, they were not correlated with long-term AF. However, the rate of recovery of graft function at early period after RTx was correlated with creatinine level at first year and with glomerular filtration rate at first year and last visit. Although the RI has no predictive value for long-term AF, the rate of recovery of graft function at early post-transplantation period has predictive value for long-term AF; patients with higher RI values early after RTx should be followed carefully for the development of chronic allograft injury.
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Affiliation(s)
- Engin Melek
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey.,Division of Pediatric Nephrology, Balcali Hospital, Cukurova University, Adana, Turkey
| | - Esra Baskın
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey
| | - Kaan Gulleroglu
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey
| | - Nihal Uslu
- Division of Radiology, Baskent University, Ankara, Turkey
| | - Mahir Kırnap
- Division of General Surgery, Baskent University, Ankara, Turkey
| | - Gokhan Moray
- Division of General Surgery, Baskent University, Ankara, Turkey
| | - Mehmet Haberal
- Division of General Surgery, Baskent University, Ankara, Turkey
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