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Nikolaev AV, Fang Y, Essers J, Panth KM, Ambagtsheer G, Clahsen-van Groningen MC, Minnee RC, van Soest G, de Bruin RW. Pre-transplant kidney quality evaluation using photoacoustic imaging during normothermic machine perfusion. PHOTOACOUSTICS 2024; 36:100596. [PMID: 38379853 PMCID: PMC10877941 DOI: 10.1016/j.pacs.2024.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Abstract
Due to the shortage of kidneys donated for transplantation, surgeons are forced to use the organs with an elevated risk of poor function or even failure. Although the existing methods for pre-transplant quality evaluation have been validated over decades in population cohort studies across the world, new methods are needed as long as delayed graft function or failure in a kidney transplant occurs. In this study, we explored the potential of utilizing photoacoustic (PA) imaging during normothermic machine perfusion (NMP) as a means of evaluating kidney quality. We closely monitored twenty-two porcine kidneys using 3D PA imaging during a two-hour NMP session. Based on biochemical analyses of perfusate and produced urine, the kidneys were categorized into 'non-functional' and 'functional' groups. Our primary focus was to quantify oxygenation (sO2) within the kidney cortical layer of depths 2 mm, 4 mm, and 6 mm using two-wavelength PA imaging. Next, receiver operating characteristic (ROC) analysis was performed to determine an optimal cortical layer depth and time point for the quantification of sO2 to discriminate between functional and non-functional organs. Finally, for each depth, we assessed the correlation between sO2 and creatinine clearance (CrCl), oxygen consumption (VO2), and renal blood flow (RBF). We found that hypoxia of the renal cortex is associated with poor renal function. In addition, the determination of sO2 within the 2 mm depth of the renal cortex after 30 min of NMP effectively distinguishes between functional and non-functional kidneys. The non-functional kidneys can be detected with the sensitivity and specificity of 80% and 85% respectively, using the cut-off point of sO2 < 39%. Oxygenation significantly correlates with RBF and VO2 in all kidneys. In functional kidneys, sO2 correlated with CrCl, which is not the case for non-functional kidneys. We conclude that the presented technique has a high potential for supporting organ selection for kidney transplantation.
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Affiliation(s)
- Anton V. Nikolaev
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Yitian Fang
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jeroen Essers
- Department of Molecular Genetics, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Department of Radiotherapy, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Department of Vascular Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Kranthi M. Panth
- Department of Molecular Genetics, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Gisela Ambagtsheer
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Marian C. Clahsen-van Groningen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Robert C. Minnee
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Gijs van Soest
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Department of Precision and Microsystems Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Van Mourilk Broekmanweg 6, 2628 XE, Delft, the Netherlands
- Wellman Center for Photomedicine, Massachusetts General Hospital, 40 Blossom Street, Boston, MA 02114, USA
| | - Ron W.F. de Bruin
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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Ng KH, Wong JHD, Leong SS. Shear wave elastography in chronic kidney disease - the physics and clinical application. Phys Eng Sci Med 2024; 47:17-29. [PMID: 38078996 DOI: 10.1007/s13246-023-01358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/15/2023] [Indexed: 03/26/2024]
Abstract
Chronic kidney disease is a leading public health problem worldwide. The global prevalence of chronic kidney disease is nearly five hundred million people, with almost one million deaths worldwide. Estimated glomerular filtration rate, imaging such as conventional ultrasound, and histopathological findings are necessary as each technique provides specific information which, when taken together, may help to detect and arrest the development of chronic kidney disease, besides managing its adverse outcomes. However, estimated glomerular filtration rate measurements are hampered by substantial error margins while conventional ultrasound involves subjective assessment. Although histopathological assessment is the best tool for evaluating the severity of the renal pathology, it may lead to renal insufficiency and haemorrhage if complications occurred. Ultrasound shear wave elastography, an emerging imaging that quantifies tissue stiffness non-invasively has gained interest recently. This method applies acoustic force pulses to generate shear wave within the tissue that propagate perpendicular to the main ultrasound beam. By measuring the speed of shear wave propagation, the tissue stiffness is estimated. This paper reviews the literature and presents our combined experience and knowledge in renal shear wave elastography research. It discusses and highlights the confounding factors on shear wave elastography, current and future possibilities in ultrasound renal imaging and is not limited to new sophisticated techniques.
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Affiliation(s)
- Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, UCSI University, Port Dickson, Negeri Sembilan, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook Sam Leong
- Centre for Medical Imaging Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia.
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Candemir B, Cuce F, Akın S, Gulcelik NE. Ultrasound-based quantitative tools in predicting renal involvement in asymptomatic primary hyperparathyroidism. J Endocrinol Invest 2024:10.1007/s40618-023-02284-0. [PMID: 38280162 DOI: 10.1007/s40618-023-02284-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE Asymptomatic primary hyperparathyroidism (aPHPT) has been recognized as a condition that can lead to renal complications. Timely identification of prognostic indicators for renal impairment holds the potential to facilitate proactive monitoring and treatment strategies in these patients. This study aims to investigate the utility of acoustic radiation force impulse (ARFI) imaging and renal resistive index (RRI), in identifying renal parenchymal and vascular changes in patients with aPHPT. METHODS Forty-two patients with aPHPT and 42 controls matched for age, sex, and body mass index were included in the study. The presence of renovascular changes was evaluated by RRI measurement with Doppler ultrasonography, and the presence of renal parenchymal involvement was evaluated by ARFI quantification, given as shear wave velocity (SWV). RESULTS In aPHPT patients, both the mean RRI and mean SWV values exhibited substantial elevation compared to the control group (P < 0.001 for both). Significant associations were observed between SWV values and serum calcium, parathyroid hormone (PTH), and adenoma size within the patient group (P < 0.001, P < 0.001, P = 0.016, respectively). Similarly, the mean RRI demonstrated positive correlations with serum calcium and PTH levels in the patient group (P< 0.001, P = 0.011, respectively). Multivariate linear regression analysis underscored the connection between mean RRI and mean SWV values with serum calcium levels within the patient group. In addition, serum PTH levels affected mean SWV positively and significantly. CONCLUSION The use of ARFI imaging and RRI measurements appears to hold potential in identifying renal involvement in patients with aPHPT.
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Affiliation(s)
- B Candemir
- Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, University of Health Sciences, Keçiören, 06010, Ankara, Turkey.
| | - F Cuce
- Gulhane Faculty of Medicine, Department of Radiology, University of Health Sciences, Ankara, Turkey
| | - S Akın
- Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, University of Health Sciences, Keçiören, 06010, Ankara, Turkey
| | - N E Gulcelik
- Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, University of Health Sciences, Keçiören, 06010, Ankara, Turkey
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Danielewski M, Rapak A, Kruszyńska A, Małodobra-Mazur M, Oleszkiewicz P, Dzimira S, Kucharska AZ, Słupski W, Matuszewska A, Nowak B, Szeląg A, Piórecki N, Zaleska-Dorobisz U, Sozański T. Cornelian Cherry ( Cornus mas L.) Fruit Extract Lowers SREBP-1c and C/EBPα in Liver and Alters Various PPAR-α, PPAR-γ, LXR-α Target Genes in Cholesterol-Rich Diet Rabbit Model. Int J Mol Sci 2024; 25:1199. [PMID: 38256272 PMCID: PMC10816641 DOI: 10.3390/ijms25021199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Cornelian cherry (Cornus mas L.) fruits, abundant in iridoids and anthocyanins, are natural products with proven beneficial impacts on the functions of the cardiovascular system and the liver. This study aims to assess and compare whether and to what extent two different doses of resin-purified cornelian cherry extract (10 mg/kg b.w. or 50 mg/kg b.w.) applied in a cholesterol-rich diet rabbit model affect the levels of sterol regulatory element-binding protein 1c (SREBP-1c) and CCAAT/enhancer binding protein α (C/EBPα), and various liver X receptor-α (LXR-α), peroxisome proliferator-activated receptor-α (PPAR-α), and peroxisome proliferator-activated receptor-γ (PPAR-γ) target genes. Moreover, the aim is to evaluate the resistive index (RI) of common carotid arteries (CCAs) and aortas, and histopathological changes in CCAs. For this purpose, the levels of SREBP-1c, C/EBPα, ATP-binding cassette transporter A1 (ABCA1), ATP-binding cassette transporter G1 (ABCG1), fatty acid synthase (FAS), endothelial lipase (LIPG), carnitine palmitoyltransferase 1A (CPT1A), and adiponectin receptor 2 (AdipoR2) in liver tissue were measured. Also, the levels of lipoprotein lipase (LPL), visceral adipose tissue-derived serine protease inhibitor (Vaspin), and retinol-binding protein 4 (RBP4) in visceral adipose tissue were measured. The RI of CCAs and aortas, and histopathological changes in CCAs, were indicated. The oral administration of the cornelian cherry extract decreased the SREBP-1c and C/EBPα in both doses. The dose of 10 mg/kg b.w. increased ABCA1 and decreased FAS, CPT1A, and RBP4, and the dose of 50 mg/kg b.w. enhanced ABCG1 and AdipoR2. Mitigations in atheromatous changes in rabbits' CCAs were also observed. The obtained outcomes were compared to the results of our previous works. The beneficial results confirm that cornelian cherry fruit extract may constitute a potentially effective product in the prevention and treatment of obesity-related disorders.
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Affiliation(s)
- Maciej Danielewski
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (W.S.); (A.M.); (B.N.); (A.S.)
| | - Andrzej Rapak
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, R. Weigla 12, 53-114 Wroclaw, Poland; (A.R.); (A.K.)
| | - Angelika Kruszyńska
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, R. Weigla 12, 53-114 Wroclaw, Poland; (A.R.); (A.K.)
| | - Małgorzata Małodobra-Mazur
- Department of Forensic Medicine, Division of Molecular Techniques, Wroclaw Medical University, M. Sklodowskiej-Curie 52, 50-369 Wroclaw, Poland;
| | - Paweł Oleszkiewicz
- Department of Radiology and Imaging Diagnostics II, Lower Silesian Center of Oncology, Pulmonology and Hematology, Grabiszynska 105, 53-439 Wroclaw, Poland;
| | - Stanisław Dzimira
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, C. K. Norwida 31, 50-375 Wroclaw, Poland;
| | - Alicja Z. Kucharska
- Department of Fruit, Vegetable, and Plant Nutraceutical Technology, Wroclaw University of Environmental and Life Sciences, J. Chelmonskiego 37, 51-630 Wroclaw, Poland;
| | - Wojciech Słupski
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (W.S.); (A.M.); (B.N.); (A.S.)
| | - Agnieszka Matuszewska
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (W.S.); (A.M.); (B.N.); (A.S.)
| | - Beata Nowak
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (W.S.); (A.M.); (B.N.); (A.S.)
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland; (W.S.); (A.M.); (B.N.); (A.S.)
| | - Narcyz Piórecki
- Bolestraszyce Arboretum and Institute of Physiography, Bolestraszyce 130, 37-722 Wyszatyce, Poland;
- Institute of Physical Culture Sciences, Medical College, University of Rzeszow, Cicha 2A, 35-326 Rzeszow, Poland
| | - Urszula Zaleska-Dorobisz
- Department of General and Pediatric Radiology, Wroclaw Medical University, M. Sklodowskiej-Curie 50/52, 50-369 Wroclaw, Poland;
| | - Tomasz Sozański
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland;
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Di Marco M, Scilletta S, Miano N, Marrano N, Natalicchio A, Giorgino F, Di Mauro S, Filippello A, Scamporrino A, Tribulato P, Bosco G, Di Giacomo Barbagallo F, Scicali R, Milluzzo A, Ballirò T, Frittitta L, Castellino P, Purrello F, Piro S, Di Pino A. Cardiovascular risk and renal injury profile in subjects with type 2 diabetes and non-albuminuric diabetic kidney disease. Cardiovasc Diabetol 2023; 22:344. [PMID: 38093293 PMCID: PMC10720121 DOI: 10.1186/s12933-023-02065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND In the last years, the classical pattern of diabetic kidney disease (DKD) has been partially overcome, because of the uncovering of a new DKD phenotype with significant renal dysfunction without presence of albuminuria: the non-albuminuric DKD (NA-DKD). To date, the cardiovascular risk associated with this phenotype is still debated. We investigated the cardiovascular risk and renal injury profile of NA-DKD subjects in comparison with other DKD phenotypes. METHODS Pulse wave velocity (PWV), intima-media thickness, presence of carotid atherosclerotic plaque, renal resistive index (RRI), and a panel of urinary biomarkers of kidney injury were evaluated in 160 subjects with type 2 diabetes, stratified according to estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR) into four groups: controls (UACR < 30 mg/g and eGFR ≥ 60 mL/min/1.73 m2), A-DKD (Albuminuric-DKD, UACR ≥ 30 mg/g and eGFR ≥ 60 mL/min/1.73 m2), NA-DKD (UACR < 30 mg/g and eGFR < 60 mL/min/1.73 m2), AL-DKD (Albuminuric and Low eGFR-DKD; UACR ≥ 30 mg/g and eGFR < 60 mL/min/1.73 m2). RESULTS Subjects with NA-DKD showed a higher PWV (11.83 ± 3.74 m/s vs. 10.24 ± 2.67 m/s, P = 0.045), RRI (0.76 ± 0.11 vs. 0.71 ± 0.09, P = 0.04), and prevalence of carotid atherosclerotic plaque (59% vs. 31%, P = 0.009) compared with controls. These characteristics were similar to those of subjects with AL-DKD, whereas the profile of A-DKD subjects was closer to controls. After multiple regression analyses, we found that RRI, that is in turn influenced by eGFR (β = - 0.01, P = 0.01), was one of the major determinants of PWV (β = 9.4, P = 0.02). Urinary TreFoil Factor 3, a marker of tubular damage, was higher in NA-DKD subjects vs. controls (1533.14 ± 878.31 ng/mL vs. 1253.84 ± 682.17 ng/mL, P = 0.047). Furthermore, after multiple regression analyses, we found that urinary osteopontin was independently associated with PWV (β = 2.6, P = 0.049) and RRI (β = 0.09, P = 0.006). CONCLUSIONS Our data showed a worse cardiovascular and renal injury profile in NA-DKD subjects. This finding emphasizes the central role of eGFR in the definition of cardiovascular risk profile of diabetic subjects together with albuminuria.
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Affiliation(s)
- Maurizio Di Marco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sabrina Scilletta
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicoletta Miano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicola Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Annalisa Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Stefania Di Mauro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agnese Filippello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Paola Tribulato
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giosiana Bosco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agostino Milluzzo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Teresa Ballirò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Frittitta
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Vella A, Labate V, Carenini G, Alfonzetti E, Milani V, Bandera F, Oliva O, Guazzi M. Phenotyping congestion in acute heart failure by renal flow and right heart to pulmonary circulation coupling. ESC Heart Fail 2023; 10:3546-3558. [PMID: 37743691 PMCID: PMC10682856 DOI: 10.1002/ehf2.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
AIMS In acute heart failure (AHF), kidney congestion is basic to treatment and prognosis. Its aetiology is manifold and quite unexplored in details mainly regarding the right heart to pulmonary circulation (Pc) coupling. We investigated the right heart to kidney interrelationship by Doppler renal flow pattern, right atrial dynamics, and right ventricular (RV) function to Pc coupling in AHF. METHODS AND RESULTS In 119 AHF patients, echocardiographic and renal Doppler data were analysed. Univariate and multivariate regression models were performed to define the determinants of a quantitative parameter of renal congestion, the renal venous stasis index (RVSI). When grouped according to different intra-renal venous flow patterns, no differences were observed in haemodynamics and baseline renal function. Nonetheless, patients with renal Doppler evidence of congestion showed a reduced RV function [tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity, and fractional area change], impaired RV to Pc coupling [TAPSE/pulmonary artery systolic pressure (PASP) ratio], and right atrial peak longitudinal strain (RAPLS), along with signs of volume overload [increased inferior vena cava (IVC) diameters and estimated right atrial pressure]. Univariate and multivariate regression analyses confirmed TAPSE/PASP, RAPLS, and IVC diameter as independent determinants of the RVSI. RVSI was the only variable predicting the composite outcome (cardiac death, heart failure hospitalization, and haemodialysis). An easy-to-use echo-derived right heart score of four variables provided good accuracy in identifying kidney congestion. CONCLUSIONS In AHF, the renal venous flow pattern combined with a right heart study phenotypes congestion and clinical evolution. Keys to renal flow disruption are an impaired right atrial dynamics and RV-Pc uncoupling. Integration of four right heart echocardiographic variables may be an effective tool for scoring the renal congestive phenotype in AHF.
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Affiliation(s)
| | | | | | | | | | | | | | - Marco Guazzi
- Department of Biological SciencesUniversity of Milan School of MedicineMilanItaly
- Cardiology DivisionSan Paolo HospitalMilanItaly
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7
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Karaaslan M, Yılmaz M, Polat ME, Şirin ME, Ölçücüoğlu E, Ölçücüoğlu E. The Impact of COVID-19 on Renal Resistive Index in Kidney Transplant Recipients. Transplant Proc 2023; 55:1862-1865. [PMID: 37127517 PMCID: PMC10076514 DOI: 10.1016/j.transproceed.2023.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is a lack of renal resistive index (RRI)-based data on the effects of COVID-19 in transplant patients. We aimed to investigate the effect of COVID-19 on the RRI of renal transplant recipients and to review the outcomes of patients who underwent renal transplantation (RT) before and during the COVID-19 pandemic. METHODS The data of 90 recipients were retrospectively reviewed. The age, sex, body mass index, dialysis time before transplantation, history of COVID-19, postoperative serum creatinine levels (1, 6, and 12 months), and complications of the recipients were recorded. The before and after COVID-19 RRI values of 13 recipients at 1 week after transplant and 3 months after COVID-19 were compared. The outcomes and complications of recipients who underwent RT before the COVID-19 pandemic (group 1, n = 47) and during the COVID-19 pandemic (group 2, n = 43) were also compared. RESULTS There was a statistically significant difference in terms of the median RRI values of 13 recipients before and after COVID-19 (0.6 [0.53-0.76] vs 0.7 [0.62-0.9], respectively [P = .032]). At the 12-month follow-up, the serum creatinine and estimated glomerular filtration rate levels were found to be statistically significantly higher in group 1 than in group 2 (P = .001 and P = .004, respectively). There was no statistically significant difference between group 1 and group 2 regarding complication rates (53.2% vs 60.5%, respectively; P > .05). CONCLUSIONS We found that COVID-19 affected RRI values in RT recipients. Our findings show that the outcomes of kidney transplants performed during the COVID-19 pandemic were no worse than those of transplants performed before the pandemic.
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Affiliation(s)
| | - Mehmet Yılmaz
- Urology, Asklepios Klinik Triberg, Triberg, Germany.
| | - Muhammed Emin Polat
- Department of Urology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Emin Şirin
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Esin Ölçücüoğlu
- Department of Radiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Erkan Ölçücüoğlu
- Department of Urology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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8
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George R, Sonika U, Mahajan B, Sharma A, Dalal A, Sachdeva S, Kumar A. Diagnostic utility of urine neutrophil gelatinase-associated lipocalin and renal resistive index in patients of decompensated cirrhosis with acute kidney injury. Dig Liver Dis 2023; 55:1230-1235. [PMID: 37244788 DOI: 10.1016/j.dld.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The differentiation between types of acute kidney injury(AKI) in decompensated cirrhosis(DC) patients in clinical practice is done by clinical adjudication. Biomarkers have good diagnostic accuracy for predicting acute tubular necrosis(ATN), however they are not available routinely. AIMS We compared the diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin(UNGAL) and renal resistive index(RRI) in predicting type of AKI among DC patients. METHODS Consecutive DC patients with AKI stage≥1B seen between June/2020 to May/2021 were evaluated. UNGAL levels and RRI were measured at diagnosis of AKI(Day 0) and 48hrs(Day 3) after volume expansion. Diagnostic accuracy of UGNAL and RRI was compared for differentiating ATN and non-ATN AKI by area under receiver operating characteristic curve(AUROC), using clinical adjudication as gold standard. RESULTS 388 DC patients were screened, 86 patients(Pre-renal AKI[PRA] n=47,55%; Hepatorenal syndrome[HRS] n=25,29%;ATN n= 14,16%) were included. The AUROC of UNGAL for differentiating ATN-AKI and non-ATN AKI at day 0 was 0.97(95%CI, 0.95-1.0) and on day 3 was 0.97(95%CI, 0.94-1.0). The AUROC of RRI for differentiating ATN and non-ATN AKI at day 0 was 0.68(95%CI, 0.55-0.80) and on day 3 was 0.74(95%CI, 0.63-0.84). CONCLUSION UNGAL has an excellent diagnostic accuracy in predicting ATN-AKI in DC patients both at day 0 and 3.
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Affiliation(s)
- Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Sharma
- Department of Radiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India.
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9
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Das PK, Maurya SK, Nath SS, Kumar T, Rao N, Shrivastava N. Furosemide Stress Test and Renal Resistive Index for Prediction of Severity of Acute Kidney Injury in Sepsis. Cureus 2023; 15:e44408. [PMID: 37791174 PMCID: PMC10543092 DOI: 10.7759/cureus.44408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction The furosemide stress test (FST) predicts the severity and the need for renal replacement therapy (RRT) in patients with sepsis-associated acute kidney injury (S-AKI). The renal resistive index (RRI) indicates renal vascular resistance. Objectives The primary objective was to find the correlation between FST and RRI in S-AKI. The secondary objectives were to evaluate the role of FST and RRI on the progression of S-AKI. Methods A total of 154 consenting adult patients with S-AKI were administered FST. Renal echography was performed within the first 12 hours of admission, and RRI was calculated. The patients were grouped either into progressors or non-progressors to AKI-KDIGO stage 3. Results Of the patients who had RRI at Day 1 less than 0.73, 60% recovered, 34.3% needed RRT, and 35.5% died, whereas in those who had RRI at Day 1 greater than 0.73, only 22% recovered, 46.6% required RRT, and 51.6% died. RRI value of 0.73 predicted the need for RRT with a sensitivity of 35.1%, specificity of 80.4% and accuracy of 69.1%. The highest number of patients of KDIGO stage 3 (50%), followed by stage 2 (28.1%) and stage 1 (21.9%), presented technical difficulties in measuring the RRI. Conclusion FST is an economical and easily administered test to assess renal tubular function and can predict the occurrence and progression of S-AKI. RRI is a modest marker for predicting the need for RRT or persistent AKI.
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Affiliation(s)
- Pravin K Das
- Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Sudeep K Maurya
- Anaesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Soumya Sankar Nath
- Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Tushant Kumar
- Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Namrata Rao
- Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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Abubakar U, Ugwu AC, Mbah GCE, Tivde T, Sidi M, Luntsi G, Ochie K, Ali AM, Mohammed A. Imperatives of Mathematical Model of Arterial Blood Dynamics for Interpretation of Doppler Velocimetry: A Narrative Review. J Med Ultrasound 2023; 31:188-194. [PMID: 38025000 PMCID: PMC10668903 DOI: 10.4103/jmu.jmu_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 12/01/2023] Open
Abstract
Clinicians frequently study arterial Doppler velocimetric waveforms depicted by Doppler sonography of the kidneys, the heart, the brain, and the feto-maternal circulation to assess the well-being of the aforementioned vital organs. The waveform interpretation of the Doppler indices can be studied using a mathematical model. The developed models serve as teaching tools and for easy comprehension of the regulatory mechanism of the organs. It will also obtain accurate wall shear stress (WSS) and likely atherosclerotic sites can be predicted early. The aim of this review is to reveal the imperatives of mathematical models in the study of the physical interpretation of Doppler velocimetry. The models will explore sonographic Doppler velocimetry and computational fluid dynamics (CFD) in determining the segments of the arteries that are prone to the development of atheromatous plaque. It will be achieved by comparing and computing the measurement differences of the WSS. A thorough literature review was carried out between 1971 and 2021 on the mathematical modeling of blood dynamics and Doppler velocimetry of different blood vessels, across various electronic databases including NC AHEC Digital Library, PUBMED, ERIC, MEDLINE, Free Medical Journals, and EMBASE. The results of the literature search were presented using the PRISMA flow chat. The narrative review of the mathematical models of arterial blood dynamics is based on incompressible Navier-Stokes equations, the Windkessel model, and CFD. It was deduced that the blood flow velocity decreased with time across the varying frequency from 0.2Hz to 0.50Hz in the interlobar arterial channels. The review also revealed that adult humans' Doppler indices of the renal-interlobar artery agree with developed models of renal interlobar arterial blood dynamics. The mathematical model measurements of the great vessels matched the sonographic Doppler velocimetry with <15% variation. In our fast-paced world of epidemiological transition, the imperatives of mathematical modeling of arterial flow dynamics based on the Navier-Stokes equations to represent various physiologic and pathologic situations cannot be overstated. The practical consequences include the possibility of mathematical models to acquire precise WSS distribution and early detection of potential atherosclerotic sites during cardiovascular Doppler sonography.
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Affiliation(s)
- Umar Abubakar
- Department of Radiography, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Anthony Chukwuka Ugwu
- Department of Radiography and Radiation Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Tertsegha Tivde
- Department of Mathematics, University Agriculture, Makurdi, Nigeria
| | - Mohammed Sidi
- Department of Medical Radiography, College of Medical Sciences, Bayero University, Kano, Nigeria
| | - Geofery Luntsi
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Kalu Ochie
- Department of Radiography and Radiation Sciences, Evangel University Akaeze, Akaeze, Ebonyi State, Nigeria
| | - Alhaji Modu Ali
- Department of Radiology, Federal Neuro-Psychiatric Hospital, Maiduguri, Nigeria
| | - Anas Mohammed
- Department of Radiology, Specialist Hospital Gombe, Maiduguri, Nigeria
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11
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Moriconi D, Mengozzi A, Duranti E, Cappelli F, Taddei S, Nannipieri M, Bruno RM, Virdis A. The renal resistive index is associated with microvascular remodeling in patients with severe obesity. J Hypertens 2023; 41:1092-1099. [PMID: 37071436 PMCID: PMC10242520 DOI: 10.1097/hjh.0000000000003434] [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: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity. METHODS We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive reno-metabolic examination, paired with Doppler ultrasound and measurement of the renal resistive index (RRI). On the day of the surgery, visceral fat biopsies were collected to perform an ex-vivo complete microcirculatory assessment. Media-to-lumen ratio (M/L) and vascular response to acetylcholine (ACh), alone or co-incubated with N G -nitro arginine methyl ester (L-NAME), were measured. RESULTS Patients were stratified according to their normotensive (NT) or hypertensive (HT) status. HT had lower estimated glomerular filtration rate and higher RRI compared to NT, while the presence and extent of albuminuria were similar between the two groups. Concerning microcirculatory assessment, there were no differences between groups as regards the microvascular structure, while the vasorelaxation to ACh was lower in HT ( P = 0.042). Multivariable analysis showed a relationship between M/L and RRI ( P = 0.016, St. β 0.37) and between albuminuria and the inhibitory response of L-NAME to Ach vasodilation ( P = 0.036, St. β = -0.34). Notably, all these correlations were consistent also after adjustment for confounding factors. CONCLUSIONS The RRI and albuminuria relationship with microvascular remodeling in patients affected by severe obesity supports the clinical implementation of RRI to improve risk stratification in obesity and suggests a tight pathophysiologic connection between renal haemodynamics and microcirculatory disruption.
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Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Katayama IA, Huang Y, Garza AE, Brooks DL, Williams JS, Nascimento MM, Heimann JC, Pojoga LH. Longitudinal changes in blood pressure are preceded by changes in albuminuria and accelerated by increasing dietary sodium intake. Exp Gerontol 2023; 173:112114. [PMID: 36738979 PMCID: PMC10965150 DOI: 10.1016/j.exger.2023.112114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dietary sodium is a well-known risk factor for cardiovascular and renal disease; however, direct evidence of the longitudinal changes that occur with aging, and the influence of dietary sodium on the age-associated alterations are scarce. METHODS C57BL/6 mice were maintained for 13 months on a low (LS, 0.02 % Na+), normal (NS, 0.3 % Na+) or high (HS, 1.6 % Na+) salt diet. We assessed 1) the longitudinal trajectories for two markers of cardiovascular and renal dysfunction (blood pressure (BP) and albuminuria), as well as hormonal changes, and 2) end-of-study cardiac and renal parameters. RESULTS The effect of aging on BP and kidney damage did not reach significance levels in the LS group; however, relative to baseline, there were significant increases in these parameters for animals maintained on NS and HS diets, starting as early as month 7 and month 5, respectively. Furthermore, changes in albuminuria preceded the changes in BP relative to baseline, irrespective of the diet. Circulating aldosterone and plasma renin activity displayed the expected decreasing trends with age and dietary sodium loading. As compared to LS - higher dietary sodium consumption associated with increasing trends in left ventricular mass and volume indices, consistent with an eccentric dilated phenotype. Functional and molecular markers of kidney dysfunction displayed similar trends with increasing long-term sodium levels: higher renovascular resistance, increased glomerular volumes, as well as higher levels of renal angiotensin II type 1 and mineralocorticoid receptors, and lower renal Klotho levels. CONCLUSION Our study provides a timeline for the development of cardiorenal dysfunction with aging, and documents that increasing dietary salt accelerates the age-induced phenotypes. In addition, we propose albuminuria as a prognostic biomarker for the future development of hypertension. Last, we identified functional and molecular markers of renal dysfunction that associate with long-term dietary salt loading.
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Affiliation(s)
- Isis Akemi Katayama
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory of Experimental Hypertension, Department of Internal Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Yuefei Huang
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Garza
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Danielle L Brooks
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariana M Nascimento
- Laboratory of Experimental Hypertension, Department of Internal Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Joel C Heimann
- Laboratory of Experimental Hypertension, Department of Internal Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luminita H Pojoga
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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13
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Córdova-Sánchez BM, Ñamendys-Silva SA, Pacheco-Bravo I, García-Guillén FJ, Mejía-Vilet JM, Cruz C, Barraza-Aguirre G, Ramírez-Talavera WO, López-Zamora AR, Monera-Martínez F, Vidal-Arellano LJ, Morales-Buenrostro LE. Renal arterial resistive index, monocyte chemotactic protein 1 and neutrophil gelatinase-associated lipocalin, for predicting acute kidney injury in critically ill cancer patients. Int Urol Nephrol 2023:10.1007/s11255-023-03504-5. [PMID: 36753015 DOI: 10.1007/s11255-023-03504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE We evaluated the renal arterial resistive index (RRI), urine monocyte chemotactic protein 1 (uMCP-1), and urine neutrophil gelatinase-associated lipocalin (uNGAL) to predict acute kidney injury (AKI) in critically ill cancer patients. METHODS In this prospective study, we included patients without AKI. We compared the area under the curve (AUC) of RRI, uMCP-1, and uNGAL to predict any stage of AKI and stage-3 AKI with the DeLong method, and we established cutoff points with the Youden index. RESULTS We included 64 patients, and 43 (67.2%) developed AKI. The AUC to predict AKI were: 0.714 (95% CI 0.587-0.820) for the RRI, 0.656 (95% CI 0.526-0.770) for uMCP-1, and 0.677 (95% CI 0.549-0.789) for uNGAL. The AUC to predict stage-3 AKI were: 0.740 (95% CI 0.615-0.842) for the RRI, 0.757 (95% CI 0.633-0.855) for uMCP-1, and 0.817 (95% CI 0.701-0.903) for uNGAL, without statistical differences among them. For stage 3 AKI prediction, the sensitivity and specificity were: 56.3% and 87.5% for a RRI > 0.705; 70% and 79.2% for an uMCP-1 > 2169 ng/mL; and 87.5% and 70.8% for a uNGAL > 200 ng/mL. The RRI was significantly correlated to age (r = 0.280), estimated glomerular filtration rate (r = - 0.259), mean arterial pressure (r = - 0.357), and serum lactate (r = 0.276). CONCLUSION The RRI, uMCP-1, and uNGAL have a similar ability to predict AKI. The RRI is more specific, while urine biomarkers are more sensitive to predict stage 3 AKI. The RRI correlates with hemodynamic variables. The novel uMCP-1 could be a useful biomarker that needs to be extensively studied.
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Affiliation(s)
| | - Silvio A Ñamendys-Silva
- Instituto Nacional de Cancerología, Mexico City, Mexico
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
- Hospital Medica Sur, Mexico City, Mexico
| | | | | | - Juan Manuel Mejía-Vilet
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
| | - Cristino Cruz
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
| | | | | | | | | | | | - Luis Eduardo Morales-Buenrostro
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico.
- Hospital Medica Sur, Mexico City, Mexico.
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14
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Aizawa K, Hughes AD, Casanova F, Gates PE, Mawson DM, Gooding KM, Gilchrist M, Goncalves I, Nilsson J, Khan F, Colhoun HM, Palombo C, Parker KH, Shore AC. Reservoir Pressure Integral Is Independently Associated With the Reduction in Renal Function in Older Adults. Hypertension 2022; 79:2364-2372. [PMID: 35993228 DOI: 10.1161/hypertensionaha.122.19483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial hemodynamic parameters derived from reservoir-excess pressure analysis exhibit prognostic utility. Reservoir-excess pressure analysis may provide useful information about an influence of altered hemodynamics on target organ such as the kidneys. We determined whether the parameters derived from the reservoir-excess pressure analysis were associated with the reduction in estimated glomerular filtration rate in 542 older adults (69.4±7.9 years, 194 females) at baseline and after 3 years. METHODS Reservoir-excess pressure parameters, including reservoir pressure integral, excess pressure integral, systolic, and diastolic rate constants, were obtained by radial artery tonometry. RESULTS After 3 years, and in a group of 94 individuals (72.4±7.6 years, 26 females), there was an estimated glomerular filtration rate reduction of >5% per year (median reduction of 20.5% over 3 years). A multivariable logistic regression analysis revealed that higher baseline reservoir pressure integral was independently associated with a smaller reduction in estimated glomerular filtration rate after accounting for conventional cardiovascular risk factors and study centers (odds ratio: 0.660 [95% CIs, 0.494-0.883]; P=0.005). The association remained unchanged after further adjustments for potential confounders and baseline renal function (odds ratio: 0.528 [95% CIs, 0.351-0.794]; P=0.002). No other reservoir-excess pressure parameters exhibited associations with the reduction in renal function. CONCLUSIONS This study demonstrates that baseline reservoir pressure integral was associated with the decline in renal function in older adults at 3-year follow-up, independently of conventional cardiovascular risk factors. This suggests that reservoir pressure integral may play a role in the functional decline of the kidneys.
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Affiliation(s)
- Kunihiko Aizawa
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Alun D Hughes
- MRC unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
| | - Francesco Casanova
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Phillip E Gates
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - David M Mawson
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Kim M Gooding
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Mark Gilchrist
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Isabel Goncalves
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.).,Department of Cardiology, Skåne University Hospital, Malmö, Sweden (I.G.)
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.)
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, United Kingdom (F.K.)
| | - Helen M Colhoun
- Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (H.M.C.)
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy (C.P.)
| | - Kim H Parker
- Department of Bioengineering, Imperial College, London, United Kingdom (K.H.P.)
| | - Angela C Shore
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
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15
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Sveceny J, Charvat J, Hrach K, Horackova M, Schuck O. In essential hypertension, a change in the renal resistive index is associated with a change in the ratio of 24-hour diastolic to systolic blood pressure. Physiol Res 2022; 71:341-348. [PMID: 35616036 DOI: 10.33549/physiolres.934860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An increase in the renal resistive index (RRI) in patients with essential hypertension (EH) predicts deterioration in renal function. In patients with EH, changes in hemodynamic parameters significantly affect the RRI. This study aimed to define changes in Ambulatory Blood Pressure Monitoring (ABPM) parameters that are significantly associated with a change in RRI in patients with EH. We evaluated ABPM and the RRI in 96 patients with EH without organ extrarenal changes at baseline and after two years of follow-up. The relationships between changes in ABPM parameters and the RRI over the period were evaluated. After two years of follow-up, the increase in RRI was consequential. Simultaneously, 24-h systolic blood pressure increased significantly and 24-h diastolic blood pressure decreased. In the whole group and in the group with calculated cystatin C clearance (eGFRcyst) >/=90 ml/min/1.73 m2, the change in RRI significantly negatively correlated with the change in the ratio of 24-h diastolic to systolic blood pressure (D/S ratio), but also with the change in 24-h pulse blood pressure. However, in patients with eGFRcyst>90 ml/min/1.73 m2, only the change in the 24-h D/S ratio significantly correlated with the change in RRI. Based on the backward stepwise regression analysis, the change in RRI was significantly dependent only on the change in 24-h D/S ratio and not on the change in 24-h pulse pressure. A change in the ratio of diastolic to systolic pressure better reflects a change in RRI than a change in pulse pressure.
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Affiliation(s)
- J Sveceny
- Department of Internal Medicine, Masaryk Hospital, Usti nad Labem, Czech Republic; Department of Internal Medicine, Second Faculty Medicine of Charles University and Faculty Hospital Prague Motol, Prague, Czech Republic.
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Azzouz S, Chen A, Ekmekjian T, Cantarovich M, Baran D, Sandal S. The role of renal resistive index as a prognostic tool in kidney transplantation: a systematic review. Nephrol Dial Transplant 2022; 37:1552-1565. [DOI: 10.1093/ndt/gfac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
In kidney transplant recipients (KTRs), observational data have reported conflicting findings about the utility of renal resistive index (RRI) in determining outcomes. We aimed to synthesize the current literature and determine the prognostic role of RRI in KTRs.
Methods
We conducted a systematic review to assess the role of RRI in predicting death, graft failure, graft function, and proteinuria. Of the 934 titles/abstracts reviewed, 26 studies were included. There was significant heterogeneity in RRI measurements and thresholds as well as in analytic methods and a meta-analysis could not be performed.
Results
All included studies were observational and included 7049 KTRs. Eight studies analyzed death, of which five reported a significant association with higher RRI. In the remaining three, small sample sizes and lower/multiple RRI thresholds may have limited detection of a statistically significant difference. Three studies investigated all-cause graft failure and an association with RRI was reported but varied by time of RRI measurement. Three out of five studies that analyzed a composite of patient and graft outcomes reported an association with RRI. Evidence analyzing death-censored graft failure, graft failure (unclear if death-censored or all-cause), measures of graft function, and proteinuria were conflicting. Most studies had a moderate to high risk of bias.
Conclusions
RRI likely has a prognostic role in predicting patient outcomes, reflecting patient systemic vascular disease burden rather than graft hemodynamics. Since cardiovascular diseases are a major cause of death and graft loss, RRI may be explored as a non-invasive tool to risk stratify KTRs.
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Affiliation(s)
- Safaa Azzouz
- Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Anjellica Chen
- Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Dana Baran
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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The Predictive Ability of the Renal Resistive Index and its Relationship to Duplex Ultrasound Waveform Propagation in the Aorta and Renal Arteries. Ann Vasc Surg 2022; 86:349-357. [DOI: 10.1016/j.avsg.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
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18
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Wang Y, Li Y, Wang S, Ma N, Ren J. Role of Contrast-Enhanced Ultrasound in the Evaluation of Patients With Suspected Renal Arterial Stenosis. Front Cardiovasc Med 2022; 9:721201. [PMID: 35342746 PMCID: PMC8942781 DOI: 10.3389/fcvm.2022.721201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives To explore the role of Contrast-enhanced ultrasound (CEUS) in the evaluation of patients with suspected renal artery stenosis and analyze the causes of the misdiagnosis and missed diagnosis. Methods The data of 40 patients (80 renal arteries) diagnosed with RAS by CEUS in Beijing Hospital from September 2018 to October 2020 were compared with their digital subtraction angiography (DSA) results to analyze the causes underlying missed diagnosis and misdiagnosis of RAS by CEUS. Results 1. Compared with the gold standard DSA results, the AUC of the ROC curve of CEUS in detecting normal renal artery and renal artery stenosis was 0.961, the sensitivity was 96.4%, the specificity was 95.8%, and the Kappa value of the consistency analysis was 0.912 (P < 0.01); 2. Compared with the gold standard DSA results, the ROC curve of CEUS in distinguishing renal artery stenosis ≥70% from <70% stenosis has an AUC of 0.916, a sensitivity of 90.9%, a specificity of 92.3%, and the Kappa value of the consistency analysis is 0.77 (P < 0.01); 3. CEUS missed two cases (one for mild stenosis and one for moderate stenosis), and the detection rate of renal artery stenosis was 97.5% (78/80); A total of 65 renal arteries diagnosed by CEUS were consistent with DSA, and the diagnostic accuracy of CEUS for the degree of stenosis was 81.25% (65/80); Among the 13 misdiagnosed renal arteries, 4 of them can be corrected to the same degree as DSA by the reference to hemodynamic index, and the diagnosis rate of the degree of renal artery stenosis by ultrasonography (combined with CEUS and hemodynamic indicators) can be improved to 86.25%. Conclusions 1. CEUS can clearly show the renal arteries, and is consistent with DSA in distinguishing normal renal artery stenosis from renal artery stenosis, as well as renal artery stenosis ≥70% and <70% stenosis; 2. CEUS showed good performance in detecting normal renal artery and renal artery stenosis, and the missed diagnosis is concentrated on mild and moderate stenosis; 3. CEUS combined with hemodynamic indicators (Doppler ultrasound) can improve the accurate diagnosis rate of renal artery stenosis by ultrasonography; 4. The most important factor for the accurate diagnosis of renal artery stenosis by CEUS is the operator's standardized examination, which is not only related to the duration of the operator has been engaged in this inspection, but also related to whether the operator has received professional training in relevant aspects. These all indicate the necessity and importance of the standardized operation of renal artery contrast-enhanced ultrasound examination, and professional training should be given to operators.
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Radovic T, Jankovic MM, Stevic R, Spasojevic B, Cvetkovic M, Pavicevic P, Gojkovic I, Kostic M. Detection of impaired renal allograft function in paediatric and young adult patients using arterial spin labelling MRI (ASL-MRI). Sci Rep 2022; 12:828. [PMID: 35039571 PMCID: PMC8764097 DOI: 10.1038/s41598-022-04794-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022] Open
Abstract
The study aimed to discriminate renal allografts with impaired function by measuring cortical renal blood flow (cRBF) using magnetic resonance imaging arterial spin labelling (ASL-MRI) in paediatric and young adult patients. We included 18 subjects and performed ASL-MRI on 1.5 T MRI to calculate cRBF on parameter maps. cRBF was correlated to calculated glomerular filtration rate (GFR) and compared between patient groups with good (GFR ≥ 60 mL/min/1.73 m2) and impaired allograft function (GFR < 60 mL/min/1.73 m2). Mean cRBF in patients with good allograft function was significantly higher than in patients with impaired allograft function (219.89 ± 57.24 mL/min/100 g vs. 146.22 ± 41.84 mL/min/100 g, p < 0.008), showing a highly significant correlation with GFR in all subjects (r = 0.75, p < 0.0001). Also, the diffusion-weighted imaging (DWI-MRI) apparent diffusion coefficient (ADC) and Doppler measurements of peak-systolic and end-diastolic velocities and the resistive index (PS, ED, RI) were performed and both methods showed no significant difference between groups. ADC implied no correlation with GFR (r = 0.198, p = 0.464), while PS indicated moderate correlation to GFR (r = 0.48, p < 0.05), and PS and ED moderate correlation to cRBF (r = 0.58, p < 0.05, r = 0.56, p < 0.05, respectively). Cortical perfusion as non-invasively measured by ASL-MRI differs between patients with good and impaired allograft function and correlates significantly with its function.
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Affiliation(s)
- Tijana Radovic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.
| | - Milica M Jankovic
- Department of Signals and Systems, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Ruza Stevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Radiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Brankica Spasojevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Cvetkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Polina Pavicevic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Gojkovic
- Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Kostic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
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20
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Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112210612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Hypertensive nephroangiosclerosis (HN) represents the second most common cause of chronic kidney disease. Kidney damage secondary to high blood pressure favors the appearance of serum and urinary changes, but also imaging, highlighted by ultrasonography (B-mode, Doppler, Acoustic Radiation Force Impulse Elastography). Acoustic Radiation Force Impulse Elastography (ARFI) represents a new imagistic method which characterizes renal stiffness in the form of shear wave velocity (SWV). Aim: This study aims to investigate renal stiffness in HN patients, and to assess the correlations between it and urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intrarenal resistive index (RRI). Material and Methods: This cross-sectional study was performed on a group of 80 HN patients and 50 healthy, sex and age-matched, as controls. UACR (urinary immunoturbidimetry), eGFR (Jaffe method), RRI, and renal SWV (Siemens Acuson 2000) were determined in all patients and controls. Data were expressed as mean ± standard deviation. Statistical analysis was done by means Pearson’s test and t-Student test, p values of less than 0.05 were considered statistically significant. Results: UACR, eGFR, RRI and SWV showed statistically significant differences between the HN patients and controls (p < 0.0001). In the hypertensive patients group, statistically significant correlations were observed between the SWV and UACR (r = −0.7633, p < 0.00001), eGFR (r = 0.7822, p = 0.00001), and RRI (r = −0.7978, p = 0.00001). Conclusions: Kidney sonoelastography characterizes imagistically the existence of intrarenal lesions associated with essential hypertension, offering a new diagnosis method for these patients.
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21
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Petramala L, Concistrè A, Circosta F, Gigante A, Sarlo F, Schina M, Soldini M, Iannucci G, Cianci R, Letizia C. Evaluation of Intra-Renal Stiffness in Patients with Primary Aldosteronism. High Blood Press Cardiovasc Prev 2021; 29:49-56. [PMID: 34757582 DOI: 10.1007/s40292-021-00485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
INTORDUCTION Aldosterone is known to play important role in developing cardiovascular, metabolic, renal damage in hypertensive patients. AIM Aim of study was to evaluate parameters obtained by eco-color Doppler study, as non-invasive and easly performed method in asyntomatic patients with Essential Hypertension (EH) and Primary Aldosteronism (PA), without overt organ damage. METHODS From April 2019 to March 2020 we consecutively enrolled 73 hypertensive subjects (48 males, 25 women), distinguished in two groups: 30 EH patients (mean age 49.5 ± 18.7 years) and 43 PA patients (mean age 53.1 ± 11.6 years)] [23 with aldosterone-secreting adrenal adenoma (APA), 20 with idiopathic aldosteronism (IHA)]. RESULTS PA group showed higher renal filtration rate and 24-h urinary excretion of albumin respect to EH; moreover, in PA we found higher Pulsatility Index, altered percentage of Renale Resistance Index, Atrophy Index, and reducted parietal thickness than EH. The correlation study showed that plasma aldosterone were positively correlated with pulsatility index in PA group (right r = 0.35; p < 0.05; left r = 0.36; p < 0.05). CONCLUSION parameters obtained through the intra-renal eco-color Doppler examination, easly performed and non-invasive, can be useful in the early-stage identification of subclinical microvascular alterations, especially in PA, condition characterized by increased risk of cardio-vascular remodelling and metabolic alterations.
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Affiliation(s)
- Luigi Petramala
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Antonio Concistrè
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Francesco Circosta
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Antonietta Gigante
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | | | - Mauro Schina
- Department of Clinical, Intenal Medicine, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Soldini
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Gino Iannucci
- Department of Clinical, Intenal Medicine, Anesthesiologic and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Rosario Cianci
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy
| | - Claudio Letizia
- Unit of Secondary Arterial Hypertension, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Policlinico "Umberto I", Viale del Policlinico 155, 00185, Rome, Italy.
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Davis S, Murali KM, Huber D, Lambert K. Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: A retrospective cohort study. Intern Med J 2021; 52:1773-1779. [PMID: 34580977 DOI: 10.1111/imj.15542] [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: 10/12/2020] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Renal resistive index (RRI), which reflects intra-renal arterial impedance is routinely measured when undertaking renal Doppler ultrasonography (RDU). We investigated the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examined whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow-up. METHODS This retrospective observational study examined the association of elevated RRI (>0.7) with the presence of CKD (eGFR <60 mL/min for >3 months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow-up using mixed models. RESULTS Of the 346 patients undergoing RDU (median age 69.7 years, 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = -0.53, -0.51, -0.53, all p < 001). Elevated RRI was independently predicted by older age (Odds Ratio 3.29, 95% CI: 2.25-4.8, p < 0.001) and diabetes (Odds Ratio 2.65, 95% CI: 1.21-5.80, p = 0.015) but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow-up. CONCLUSION Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sarah Davis
- Department of Nephrology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Karumathil M Murali
- Department of Nephrology, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - David Huber
- Vascular Care Centre 51 Crown Street, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population, University of Wollongong, Wollongong, New South Wales, Australia
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Yang SY, Chiou TTY, Shiao CC, Lin HYH, Chan MJ, Wu CH, Sun CY, Wang WJ, Huang YT, Wu VC, Chen YC, Fang JT, Hwang SJ, Pan HC. Nomenclature and diagnostic criteria for acute kidney injury - 2020 consensus of the Taiwan AKI-task force. J Formos Med Assoc 2021; 121:749-765. [PMID: 34446340 DOI: 10.1016/j.jfma.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Acute kidney injury (AKI) is a common syndrome that has a significant impact on prognosis in various clinical settings. To evaluate whether new evidence supports changing the current definition/classification/staging systems for AKI suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline, the Taiwan AKI-TASK Force, composed of 64 experts in various disciplines, systematically reviewed the literature and proposed recommendations about the current nomenclature and diagnostic criteria for AKI. The Taiwan Acute Kidney Injury (TW-AKI) Consensus 2020 was established following the principles of evidence-based medicine to investigate topics covered in AKI guidelines. The Taiwan AKI-TASK Force determined that patients with AKI have a higher risk of developing chronic kidney disease, end-stage renal disease, and death. After a comprehensive review, the TASK Force recommended using novel biomarkers, imaging examinations, renal biopsy, and body fluid assessment in the diagnosis of AKI. Clinical issues with regards to the definitions of baseline serum creatinine (sCr) level and renal recovery, as well as the use of biomarkers to predict renal recovery are also discussed in this consensus. Although the present classification systems using sCr and urine output for the diagnosis of AKI are not perfect, there is not enough evidence to change the current criteria in clinical practice. Future research should investigate and clarify the roles of the aforementioned tools in clinical practice for AKI.
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Affiliation(s)
- Shao-Yu Yang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Terry Ting-Yu Chiou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Chung Shan Medical University School of Medicine, Taichung, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillians Saint Mary's Hospital Luodong, Saint Mary's Junior College of Medicine, Nursing and Management, Luodong, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan
| | - Hugo You-Hsien Lin
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Jen Chan
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Che-Hsiung Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chiao-Yin Sun
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Jie Wang
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Vin-Cent Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ji-Tsung Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Heng-Chih Pan
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
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24
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Wild J, Jung R, Knopp T, Efentakis P, Benaki D, Grill A, Wegner J, Molitor M, Garlapati V, Rakova N, Markó L, Marton A, Mikros E, Münzel T, Kossmann S, Rauh M, Nakano D, Kitada K, Luft F, Waisman A, Wenzel P, Titze J, Karbach S. Aestivation motifs explain hypertension and muscle mass loss in mice with psoriatic skin barrier defect. Acta Physiol (Oxf) 2021; 232:e13628. [PMID: 33590724 DOI: 10.1111/apha.13628] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 12/12/2022]
Abstract
AIM Recent evidence suggests that arterial hypertension could be alternatively explained as a physiological adaptation response to water shortage, termed aestivation, which relies on complex multi-organ metabolic adjustments to prevent dehydration. Here, we tested the hypothesis that chronic water loss across diseased skin leads to similar adaptive water conservation responses as observed in experimental renal failure or high salt diet. METHODS We studied mice with keratinocyte-specific overexpression of IL-17A which develop severe psoriasis-like skin disease. We measured transepidermal water loss and solute and water excretion in the urine. We quantified glomerular filtration rate (GFR) by intravital microscopy, and energy and nitrogen pathways by metabolomics. We measured skin blood flow and transepidermal water loss (TEWL) in conjunction with renal resistive indices and arterial blood pressure. RESULTS Psoriatic animals lost large amounts of water across their defective cutaneous epithelial barrier. Metabolic adaptive water conservation included mobilization of nitrogen and energy from muscle to increase organic osmolyte production, solute-driven maximal anti-diuresis at normal GFR, increased metanephrine and angiotensin 2 levels, and cutaneous vasoconstriction to limit TEWL. Heat exposure led to cutaneous vasodilation and blood pressure normalization without parallel changes in renal resistive index, albeit at the expense of further increased TEWL. CONCLUSION Severe cutaneous water loss predisposes psoriatic mice to lethal dehydration. In response to this dehydration stress, the mice activate aestivation-like water conservation motifs to maintain their body hydration status. The circulatory water conservation response explains their arterial hypertension. The nitrogen-dependency of the metabolic water conservation response explains their catabolic muscle wasting.
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Affiliation(s)
- Johannes Wild
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Cardiology Cardiology IJohannes Gutenberg‐University Mainz Mainz Germany
| | - Rebecca Jung
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
| | - Tanja Knopp
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
| | - Panagiotis Efentakis
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
- Faculty of Pharmacy University of AthensPanepistimiopolis of Zographou Athens Greece
| | - Dimitra Benaki
- Faculty of Pharmacy University of AthensPanepistimiopolis of Zographou Athens Greece
| | - Alexandra Grill
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
| | - Joanna Wegner
- Department of Dermatology Johannes Gutenberg‐University Mainz Mainz Germany
| | - Michael Molitor
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Cardiology Cardiology IJohannes Gutenberg‐University Mainz Mainz Germany
| | - Venkata Garlapati
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
| | - Natalia Rakova
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
| | - Lajos Markó
- Experimental and Clinical Research CenterMax Delbrück Center for Molecular Medicine Berlin Germany
| | - Adriana Marton
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
| | - Emmanuel Mikros
- Faculty of Pharmacy University of AthensPanepistimiopolis of Zographou Athens Greece
| | - Thomas Münzel
- Center for Cardiology Cardiology IJohannes Gutenberg‐University Mainz Mainz Germany
| | | | - Manfred Rauh
- Research Laboratory Division of Paediatrics University Clinic Erlangen Erlangen Germany
| | - Daisuke Nakano
- Department of Pharmacology Faculty of Medicine Kagawa University Miki‐cho Kagawa Japan
| | - Kento Kitada
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Department of Pharmacology Faculty of Medicine Kagawa University Miki‐cho Kagawa Japan
| | - Friedrich Luft
- Experimental and Clinical Research CenterMax Delbrück Center for Molecular Medicine Berlin Germany
| | - Ari Waisman
- Institute for Molecular Medicine University Medical Center of Mainz Mainz Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Cardiology Cardiology IJohannes Gutenberg‐University Mainz Mainz Germany
| | - Jens Titze
- Division of Nephrology and Hypertension University Clinic Erlangen Erlangen Germany
- Programme in Cardiovascular and Metabolic DisordersDuke‐NUS Medical School Singapore Singapore
- Division of Nephrology Duke University School of Medicine Durham NC USA
| | - Susanne Karbach
- Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg‐University Mainz Mainz Germany
- Center for Cardiology Cardiology IJohannes Gutenberg‐University Mainz Mainz Germany
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Renal doppler indices and their correlation with laboratory indices of human immunodeficiency virus sero-positive adult individuals. Radiography (Lond) 2021; 27:1014-1020. [PMID: 33875357 DOI: 10.1016/j.radi.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Renal Doppler resistive index (RI) and pulsatility index (PI) values are potentially more sensitive at detecting renal abnormalities when compared to standard laboratory indices in patients with HIV/AIDS. To the best of our knowledge, there are no published research articles on renal Doppler indices and their correlation with laboratory indices of HIV sero-positive adult individuals. This study aimed to assess the renal function of HIV-sero-positive adults using RI and PI, and correlating these indices against laboratory values. METHODS A prospective cross-sectional study was conducted from July 2019 to April 2020. A purposive sampling method was employed and included 396 HIV sero-positive adult individuals. Sampling for the renal RI and PI was performed at the level of the inter-lober arteries, in between the medullary pyramids. An RI value above 0.70 and a PI value above 1.56 were consider abnormal. Serum creatine and urea together with evidence of proteinuria were recorded at the time of scanning. RESULTS Forty-three (10.9%) men had an abnormal RI, 32 (8.1%) had abnormal PI, five (2.5%) had abnormal creatinine, two (1%) abnormal urea and eight (4.1%) with proteinuria. In women, 29 (7.3%) had abnormal RI, 22 (5.6%) abnormal PI, four (2%) abnormal creatinine and urea and six (3%) had proteinuria. There was a statistically significant weak positive correlation between RI and PI and serum creatinine and urea (r > 0.2, P < 0.05). CONCLUSION The proportion of patients with abnormal RI and PI was higher than the proportion of participants with abnormal serum urea, creatinine and proteinuria. Renal Doppler indices could be used be used in the early assessment of renal function in HIV sero-positive adults individuals. IMPLICATIONS FOR PRACTICE Serum creatinine and urea are routinely used to evaluate renal function in patients with HIV/AIDS. Findings from this initial study show that RI and PI could be used detecting early renal abnormalities when compared to standard laboratory values.
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Pessoa G, Sousa F, Rodrigues R, Moura L, Silva E, Diniz A, Souza A, Barbosa M, Araújo J, Silva A, Alves J, Alves F. B-mode and Doppler ultrasonography of abdominal structures of the peccary (Tayassu tajacu, Linnaeus 1758). ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-11968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT This study used B-mode and Doppler ultrasonography to characterize the abdominal structures of healthy peccaries raised in captivity. Fifteen peccaries were used for this study. The urinary vesicle appeared as an ovoid structure, located in the abdominal and pelvic transition, with a hyperechogenic, thin, smooth, and regular wall. The kidneys presented retroperitoneal topography and had similar sizes. The kidney/aorta ratio had an average value of 10.53±15cm (right) and 10.23±0.12 (left). The right adrenal gland had a length of 1.93±0.34cm and diameter of 0.56±0.16cm. The left adrenal gland had a length of 1.85±0.42cm and diameter of 0.52±0.11cm. The spleen had a diameter of 1.13±0.18cm. The hepatic vein demonstrated polyphasic flow in pulsed Doppler, with two retrograde peaks and an anterograde peak with a flow velocity of 25.7±0.83cm/s. The abdominal aorta had a diameter of 0.58±0.05cm and a flow velocity of 115.17±5.32cm/s. The morphological and hemodynamic study of the abdominal structures of the peccary, observed through B-mode and Doppler ultrasonography, aided in identifying the size, shape, position, echogenicity, and echotexture of the abdominal organs and in making inferences about the normal parameters for these structures in this species.
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Abstract
PURPOSE OF REVIEW This review discusses the macrocirculatory and microcirculatory aspects of renal perfusion, as well as novel methods by which to measure renal blood flow. Finally, therapeutic options are briefly discussed, including renal-specific microcirculatory effects. RECENT FINDINGS The optimal mean arterial pressure (MAP) needed for preservation of renal function has been debated but is most likely a MAP of 60-80 mmHg. In addition, attention should be paid to renal outflow pressure, typically central venous pressure. Heterogeneity in microcirculation can exist and may be mitigated through appropriate use of vasopressors with unique microcirculatory effects. Excessive catecholamines have been shown to be harmful and should be avoided. Both angiotensin II and vasopressin may improve glomerular flow through a number of mechanisms. Macrocirculatory and microcirculatory blood flow can be measured through a number of bedside ultrasound modalities, sublingual microscopy and urinary oxygen measurement, SUMMARY: Acute kidney injury (AKI) is a common manifestation of organ failure in shock, and avoidance of hemodynamic instability can mitigate this risk. Measurement of renal haemodynamics is not routinely performed but may help to guide therapeutic goals. A thorough understanding of pathophysiology, measurement techniques and therapeutic options may allow for a personalized approach to blood pressure management in patients with septic shock and may ultimately mitigate AKI.
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Abstract
Gravity affects the physiology of many animals, and the effect is, for good reason, most pronounced in tall species. The physiology-in particular, cardiovascular function-of giraffes has therefore captivated the interest of physiologists for centuries. Several studies document high mean arterial blood pressure of giraffes of about 200 mm Hg. This appears necessary to establish a cerebral perfusion pressure on the order of 100 mm Hg at the cranial end of the carotid arteries. Here, we discuss the unique characteristics of blood vessels, the heart, and the kidney of giraffes and how these functional and structural adaptations are related to very high blood pressure. We also discuss how the cerebral circulation of giraffes is established and what we know about how the blood flow and arterial and venous pressures in giraffes change when they stop to drink and subsequently lift their heads 5-6 m in one sweeping movement.
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Affiliation(s)
- Christian Aalkjær
- Department of Biomedicine, Aarhus University, Aarhus C 8000, Denmark; .,Department of Biomedical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Tobias Wang
- Department of Biology, Aarhus University, Aarhus C 8000, Denmark;
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Tancredi T, DeWaters A, McGillen KL. Renal ultrasound findings secondary to COVID-19 related collapsing focal segmental glomerulosclerosis - A case report. Clin Imaging 2020; 71:34-38. [PMID: 33171364 PMCID: PMC7644181 DOI: 10.1016/j.clinimag.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/28/2022]
Abstract
SARS-CoV-2 (COVID-19) is well known to have extrapulmonary manifestations, including acute renal failure. While radiologic findings of COVID-19 pulmonary-involvement have been described, renal findings associated with COVID-19 have not. We present a case of a 38-year-old Afro-Caribbean female diagnosed with COVID-19 whose renal ultrasound showed increased parenchymal echogenicity, decreased global color Doppler signal with elevated resistive indices, but no large vessel thrombi. Non-targeted renal biopsy demonstrated collapsing focal segmental glomerulosclerosis (FSGS), likely secondary to COVID-19 infection, which may be a specific manifestation of this disease that has been predominantly reported in Black patients. We report several findings on renal ultrasound with duplex Doppler not previously associated with COVID, specifically with FSGS, which in conjunction can be useful to both the radiologist and the clinician, potentially pointing them in the direction of this diagnosis and early treatment. Renal ultrasound provides benefit in cases of COVID-19 with acute kidney injury. Collapsing focal segmental glomerulosclerosis can occur secondary to COVID-19. This entity occurs nearly exclusively in Black patients. Ultrasound may show echogenic kidneys, elevated resistive index, altered perfusion. When these sonographic features are seen, clinicians should consider biopsy.
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Affiliation(s)
- Tyler Tancredi
- Penn State Health Milton S Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States of America
| | - Ami DeWaters
- Penn State Health Milton S Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States of America
| | - Kathryn L McGillen
- Penn State Health Milton S Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States of America.
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Ultrasound Proven Monosodium Urate Crystal Deposits in the Joints are Associated with Smaller Kidney Size, Decreased Intrarenal Blood Flow and Arteriosclerotic Type Vascular Changes. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective: To establish the association between ultrasound (US) burden with articular MSU crystals and renal morphology, blood supply, function and arteriosclerotic carotid arteries alterations in gout patients, individuals with asymptomatic hyperuricemia and no sign of inflammatory arthritis and psoriatic arthritis subjects with asymptomatic hyperuricemia.
Methods: 121 consecutive patients were included: 85 patients with gout, 27 subjects with asymptomatic hyperuricemia and 9 psoriatic arthritis patients. Subjects underwent US of both kidneys, common carotid arteries and bilateral US of the joints of the hands, elbows, knees, ankles and feet. For intrarenal blood flow we judged by measuring the renal resistive index (RRI). By US of the carotid arteries were determined intima-media thickness (IMT), common carotid artery resistive index (CCARI) and the presence of atherosclerotic plaques was registered.
Results: Individuals with articular US MSU deposits compared to those without had higher RRI (p = 0.035) and smaller kidney size (p = 0.014), but renal parenchymal thickness (p = 0.893), echogenicity (p = 0.291), IMT (p = 0.165), CCARI (p = 0.097), the frequency of nephrolithiasis (p = 0.438) and atherosclerotic plaques (p = 0.830) were similar. Subjects with US evidence of MSU crystals in two or more joint regions had the highest RRI (p = 0.002) and CCARI (p = 0.019). Compared to gout patients the risk of MSU crystal accumulation in the joints of asymptomatic hyperuricemia group was lower by 82.7%, OR = 0.173 (95% CI; 0.060 – 0.498, p = 0.001), while in psoriatic arthritis patients the risk was lower by 82%, OR = 0.180 (95% CI; 0.038-0.861, p = 0.032).
Conclusions: This study points out that subjects with larger extent of articular MSU burden have greater vascular stiffness. The accumulation of MSU crystals in the joints may be associated with the accumulation of crystals mainly in the renal interstitium.
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Prencipe MA, Fontana A, Di Giorgio C, Pellegrino AM, Mangiacotti A, Coppetti M, Aucella F. Renal Resistive Index of the Main Renal Arteries and Transmitral Flow in Hypertensive Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2700-2710. [PMID: 32703658 DOI: 10.1016/j.ultrasmedbio.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
In hypertensive patients, diastolic dysfunction is related to increased resistive index (RI) of parenchymal renal arteries. To determine the existence of a link between RI of the main renal arteries (RRI) and diastolic dysfunction, a group of 127 hypertensive patients, with glomerular filtration rates >50 mL/min (mean estimated glomerular filtration rate: 88.6 ± 15.2 mL/min) and no comorbidities, was studied. RRI and transmitral flow were evaluated using the deceleration time (DT) and E/A ratio. A statistically significant correlation between RRI and DT (>240 ms) was noted (p < 0.001). The RRI cutoff that best discriminated patients with DT >240 ms was 0.675. For each unitary increment of 10 mm in DT, the log-transformed RRI significantly increased by a mean of 0.006 point (p < 0.001). This study revealed the importance of the link between RRI and transmitral DT in addition to the renowned significance of the increase in RI as a cardiovascular risk factor in hypertensive patients without comorbidities.
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Affiliation(s)
- Michele Antonio Prencipe
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Di Giorgio
- Press Office, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Angela Maria Pellegrino
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Mangiacotti
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimiliano Coppetti
- Unit of Biostatistics, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Filippo Aucella
- Department of Medical Sciences, Division of Nephrology and Dialysis, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
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El Aggan H, Mahmoud S, El Shair H, Elabd H. Increased macrophage activation marker soluble CD163 is associated with graft dysfunction and metabolic derangements in renal transplant recipients. Biomed J 2020; 44:S179-S189. [PMID: 35300946 PMCID: PMC9068521 DOI: 10.1016/j.bj.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/28/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hayam El Aggan
- Department of Internal Medicine (Nephrology and Transplantation Unit), University of Alexandria, Alexandria, Egypt.
| | - Sabah Mahmoud
- Department of Medical Biochemistry, University of Alexandria, Alexandria, Egypt
| | - Heba El Shair
- Department of Internal Medicine (Nephrology and Transplantation Unit), University of Alexandria, Alexandria, Egypt
| | - Hazem Elabd
- Department of Internal Medicine (Nephrology and Transplantation Unit), University of Alexandria, Alexandria, Egypt
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Abstract
CONTEXT Doppler sonography is a noninvasive method to evaluate the hemodynamic status of the kidney, and its parameters are used as direct and indirect predictors of certain parenchyma and renovascular diseases. However, the effect of hydration on kidney hemodynamics has not been explored via Doppler sonography. OBJECTIVE To examine differences in arterial Doppler velocities of normal adult kidney before and after hydration. METHODS A total of 60 native kidneys in 30 normal adult participants (mean age, 26 years) were assessed using Doppler sonography. Quantitative ultrasound Doppler parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) of the main renal artery and the intrarenal (interlobar) arteries were measured immediately before and 1 hour after ingestion of 500 mL of water. We tested differences in Doppler parameters before and after hydration using a paired t test, analyzed the correlation of the increase in PSV to the increase in EDV after hydration using Pearson correlation coefficient (PCC), and examined intraobserver reliability using intraclass correlation coefficient (ICC). RESULTS Statistical analyses revealed that the differences in PSV and EDV values before and after hydration at the main renal artery and interlobar arteries of the kidney were significant (P<.001), whereas the RI at the main renal artery and interlobar arteries were not (P>.05). PCC for the correlation of the increase in PSV to the increase in EDV was greater than 0.80. ICC for intraobserver repeatability in performing kidney Doppler sonography was 0.92. CONCLUSION Our results suggest that Doppler sonography is able to demonstrate changes in kidney hemodynamics within 1 hour after hydration. The normal kidney reflects proportional increases in PSV and EDV at the main renal artery and interlobar arteries, while maintaining vascular resistance. Doppler flow velocities of renal arteries can be considered as noninvasive quantitative markers for evaluating the response of kidney hemodynamics to hydration.
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Akaishi T, Abe M, Miki T, Miki M, Funamizu Y, Ito S, Abe T, Ishii T. Ratio of diastolic to systolic blood pressure represents renal resistive index. J Hum Hypertens 2020; 34:512-519. [PMID: 31586124 PMCID: PMC7367813 DOI: 10.1038/s41371-019-0264-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022]
Abstract
Increased intrarenal vascular resistance is suggested to accompany chronic kidney diseases (CKD), which is known to be closely associated with hypertension. However, there are few studies that have examined the relationship between blood pressure and intrarenal vascular resistance. Renal color Doppler ultrasonography is one method that can non-invasively evaluate intrarenal vascular resistance. In this study, we comprehensively studied the correlations between ultrasonic parameters and blood pressure indices to elucidate their relationships. In total, 162 patients with suspected CKD were enrolled for this study. Demographics, blood pressure, blood test, urine test, and renal color Doppler ultrasonography data were obtained. The ratio of diastolic to systolic blood pressure (D/S ratio) and pulse pressure were calculated. Our results indicated strong negative correlations between the renal resistive index (RI) values in all four of the studied kidney regions and the D/S ratio. The RI values also showed significant correlations with diastolic pressure and pulse pressure, but they were weaker. Partial correlation coefficients between pulse pressure, mean arterial pressure, D/S ratio, and RI showed that D/S ratio significantly correlated with RI, but pulse pressure or mean arterial pressure did not. Systolic blood pressure did not correlate with any of the studied ultrasonic values. The negative correlation between RI values and the D/S ratio was still observed in subjects without renal dysfunction or any medications. In conclusion, D/S ratio, rather than pulse pressure or mean arterial pressure, would be the most appropriate index to estimate/calculate/judge intrarenal vascular resistance.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan.
| | - Takashi Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Mika Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Yasuharu Funamizu
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Sadayoshi Ito
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan
| | - Takaaki Abe
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
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Bădulescu MR, Socaciu MA, Moisoiu T, Andries A, Iacob G, Badea R. Current status of imaging diagnosis in the transplanted kidney. A review of the literature with a special focus on contrast-enhanced ultrasonography. Med Pharm Rep 2020; 93:133-144. [PMID: 32478319 PMCID: PMC7243885 DOI: 10.15386/mpr-1536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Ultrasonographic scanning is currently the most widespread imaging diagnostic procedure. The method provides real-time morphological, vascular and elastographic information in a non-invasive manner. In recent years, harmonic vascular examination has become accessible using intravenous contrast agents. In urological pathology, this procedure is used in the detection and evaluation of vascular and ischemic complications, in the classification of complex cysts according to the Bosniak system, also in the renal lesions with uncertain etiology and in acute pyelonephritis for the detection of abscesses. The contrast agent (SonoVue) is angiospecific and can be used in patients transplanted immediately after surgery without adverse effects or impaired renal function. Thus, it is desirable to be used in the nephrological pathology of the renal graft and to develop diagnostic models based on the evaluation of renal microvascularization, as well as the quantitative data resulting from the graphical representation of the specific parameters. The purpose of this review is to evaluate the current state of the literature regarding the place and role of contrast substance ultrasound in the early diagnosis of acute renal graft dysfunction and to make a differential diagnosis of this pathological entity. Method This review quantifies the role of contrast ultrasound in the diagnosis of acute complications of the renal graft. The research was conducted based on the databases PubMed, MedScape, Cochrane, according to the search criteria such as contrast-enhanced ultrasound + kidney transplant, “time intensity curves” + “kidney transplant”, filtered for the period 2004–2018. Results In the nephrological pathology of the renal graft, contrast-enhanced ultrasound is a valuable tool, superior to Doppler ultrasound in predicting the evolution of the renal graft, identifying very small early defects in renal microvascularization. A number of studies succeeded in identifying acute graft dysfunction, some of which establish its etiology - humoral rejection versus acute tubular necrosis. On the other hand, the contrast-enhanced ultrasound parameters do not have the ability to distinguish between cellular and humoral rejection. Conclusions If, at present, the histopathological examination is the only one that can differentiate with certainty the cause of acute renal graft dysfunction, we consider that contrast-enhanced ultrasound, as a non-invasive imaging technique, opens a favorable perspective for increasing the survival of the renal graft and decreasing the complications in the renal transplant. The combination of other ultrasound techniques, together with contrast-enhanced ultrasound, could lead to the development of new diagnostic models.
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Affiliation(s)
- Maria Ramona Bădulescu
- Hemodialysis Department, 5 Medical Clinic and Urology Department. Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Adrian Socaciu
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Urology Department, Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Andries
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medical Imaging Department, "Prof dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Gheorghiţă Iacob
- Morphology Department, Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca. Romania
| | - Radu Badea
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Bhattad PB, Jain V. Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management. Cureus 2020; 12:e7609. [PMID: 32399343 PMCID: PMC7213650 DOI: 10.7759/cureus.7609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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Simeoni M, Borrelli S, Garofalo C, Fuiano G, Esposito C, Comi A, Provenzano M. Atherosclerotic-nephropathy: an updated narrative review. J Nephrol 2020; 34:125-136. [PMID: 32270411 DOI: 10.1007/s40620-020-00733-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Abstract
The increased prevalence of chronic kidney disease (CKD) in elderly patients recognizes, as main cause, the long-term exposure to atherosclerosis and hypertension. Chronic ischemic damage due to critical renal arterial stenosis induces oxidative stress and intra-renal inflammation, resulting in fibrosis and microvascular remodelling, that is the histological picture of atherosclerotic renal vascular disease (ARVD). The concomitant presence of a long history of hypertension may generate intimal thickening and luminal narrowing of renal arteries and arterioles, glomerulosclerosis, interstitial fibrosis and tubular atrophy, more typically expression of hypertensive nephropathy. These complex mechanisms contribute to the development of CKD and the progression to End Stage Kidney Disease. In elderly CKD patients, the distinction among these nephropathies may be problematic; therefore, ischemic and hypertensive nephropathies can be joined in a unique clinical syndrome defined as atherosclerotic nephropathy. The availability of novel diagnostic procedures, such as intra-vascular ultrasound and BOLD-MRI, in addition to traditional imaging, have opened new scenarios, because these tools allow to identify ischemic lesions responsive to renal revascularization. Indeed, although trials have deflated the role of renal revascularization on the renal outcomes, it should be still used to avoid dialysis initiation and/or to reduce blood pressure in selected elderly patients at high risk. Nonetheless, lifestyle modifications (smoking cessation, increased physical activity), statins and antiplatelet use, as well as cautious use of renin-angiotensin system inhibitors, remain the main therapeutic approach aimed at slowing the renal damage progression. Mesenchymal stem cells and Micro-RNA are promising target of anti-fibrotic therapy, which might provide potential benefit in ARVD patients, though safety and efficacy profile in humans is unknown too.
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Affiliation(s)
| | - Silvio Borrelli
- Nephrology and Dialysis Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Garofalo
- Nephrology and Dialysis Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giorgio Fuiano
- Nephrology Units at University "Magna Graecia", Catanzaro, Italy
| | | | - Alessandro Comi
- Nephrology Units at University "Magna Graecia", Catanzaro, Italy
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Provenzano M, Rivoli L, Garofalo C, Faga T, Pelagi E, Perticone M, Serra R, Michael A, Comi N, Andreucci M. Renal resistive index in chronic kidney disease patients: Possible determinants and risk profile. PLoS One 2020; 15:e0230020. [PMID: 32236125 PMCID: PMC7112174 DOI: 10.1371/journal.pone.0230020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians. METHODS Consecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable. RESULTS We studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (p<0.001), diabetes (p = 0.042), CVD (p = 0.009), smoking habit (p = 0.021) and higher serum phosphorus levels (p = 0.001) were associated with higher continuous RI. Serum phosphorus showed Area Under the Curves (AUC) values of 0.714 and 0.664 for discriminating RI cut-offs of 0.70 and 0.65. CONCLUSIONS This analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function.
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Affiliation(s)
- Michele Provenzano
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Laura Rivoli
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Carlo Garofalo
- Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Teresa Faga
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Elena Pelagi
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters: Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ashour Michael
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Nicolino Comi
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
| | - Michele Andreucci
- Nephrology Unit of Magna Graecia University in Catanzaro, Catanzaro, Italy
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Hitsumoto T. Correlation Between the Cardio-Ankle Vascular Index and Renal Resistive Index in Patients With Essential Hypertension. Cardiol Res 2020; 11:106-112. [PMID: 32256917 PMCID: PMC7092774 DOI: 10.14740/cr1026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/17/2020] [Indexed: 01/18/2023] Open
Abstract
Background Renal resistive index (RRI) is a parameter determined by Doppler sonography that reflects renal hemodynamics. Significant relationships connecting increases in the RRI with cardiovascular risk factors and the incidence of cardiovascular disease in hypertensive patients have been reported. This cross-sectional study aimed to clarify the relationship between cardio-ankle vascular index (CAVI), a novel marker of arterial stiffness, and the RRI in patients with essential hypertension with the goal of primary prevention of cardiovascular disease. Methods The study included 245 patients undergoing treatment for essential hypertension (95 men and 150 women; mean age ± standard deviation, 65 ± 13 years) with no history of cardiovascular disease. The CAVI and RRI were measured using commercial devices, and their relationships to various clinical parameters were examined. Results A significant positive correlation was observed between the CAVI and RRI (r = 0.43, P < 0.001). Multiple regression analyses revealed a value of β of 0.28 (P < 0.001) when CAVI was evaluated as the independent and RRI as the dependent variable. Receiver-operating characteristic curve analysis indicated that the CAVI cutoff point for high RRI (> 0.70) was 9.0 with area under the curve of 0.700 (P < 0.001). Conclusion The results from this study indicate that the CAVI varies directly with measures of renal vascular hemodynamics (RRI) in patients with essential hypertension. These findings identified a cardiovascular risk value of the CAVI from the perspective of renal hemodynamics as 9.0 in this patient population.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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Acharya R, Ellenwood S, Upadhyay K. Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature. MEDICINES 2020; 7:medicines7020009. [PMID: 32093171 PMCID: PMC7168152 DOI: 10.3390/medicines7020009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 12/23/2022]
Abstract
Background: Fibromuscular dysplasia (FMD) is one of the important etiologies of renovascular hypertension in children. It is usually resistant to multiple antihypertensive agents and can cause extreme elevation in blood pressures, which can lead to end organ damage if not promptly diagnosed and treated. Treatment options include medical management with antihypertensive agents, balloon or stent angioplasties, surgical revascularization, and nephrectomy. The aim of the study was to review the efficacy of antihypertensive therapy only in the management of FMD in a very young child. Methods: This is a retrospective chart study with review of literature. Results: Here, we report a 22-month-old toddler who presented with severe resistant hypertension and cardiomyopathy who was found to have focal FMD of the right renal artery. She also presented with proteinuria, hyponatremia that was probably secondary to pressure natriuresis, hypokalemia, hyperaldosteronism, and elevated plasma renin activity. The stabilization of blood pressures was done medically with the usage of antihypertensive medications only, without the need for angioplasty or surgical revascularization. Conclusions: We demonstrate that surgical intervention may not always be necessary in the treatment of all cases of FMD, especially in a small child where such intervention may be technically challenging and lead to potential complications. Hence, medical management alone may be sufficient, at least for the short-term, in small children with controlled hypertension and normal renal function, with surgical intervention reserved for FMD with medication-refractory hypertension and/or compromised renal function.
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Affiliation(s)
- Ratna Acharya
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
| | - Savannah Ellenwood
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
| | - Kiran Upadhyay
- Department of Pediatrics, Division of Pediatric Nephrology, University of Florida, Gainesville, FL 32610, USA
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Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection? J Hum Hypertens 2020; 34:420-431. [DOI: 10.1038/s41371-020-0307-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/04/2020] [Accepted: 01/27/2020] [Indexed: 01/16/2023]
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Freccero F, Petrucelli M, Cipone M, Nocera I, Sgorbini M. Doppler evaluation of renal resistivity index in healthy conscious horses and donkeys. PLoS One 2020; 15:e0228741. [PMID: 32027703 PMCID: PMC7004319 DOI: 10.1371/journal.pone.0228741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/21/2020] [Indexed: 01/08/2023] Open
Abstract
The renal resistive index (RRI) is used as a measurement of downstream resistance in arteries. The aim of this study was to assess the RRI of the arcuate arteries by pulsed-wave Doppler ultrasonography in healthy conscious horses and donkeys, and to verify any differences related to age, breed, bodyweight (BW) or body condition (BCS). Thirty-three healthy conscious horses and nine donkeys had their systolic and diastolic flow velocities at the level of the arcuate arteries estimated by pulsed-wave Doppler ultrasound, and the RRI was calculated. The relationship of RRI with age, breed (Trotters vs. other breeds), bodyweight (BW), and body condition score (BCS) were evaluated. PW Doppler evaluation of RRI was successfully applied in most of the horses, but to date not in the donkeys. In horses, median RRI values for the right kidney (0.58±0.006) were statistically higher than for the left (0.51±0.006). For the donkeys the values were comparable. There was no significant difference in RRI between horses younger or older than 15 years, and between breeds in horses. No correlation with age, BW or BCS was found in either horses or donkeys.
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Affiliation(s)
- Francesca Freccero
- Department of Veterinary Medical Sciences, Ozzano dell’Emilia, Bologna, Italy
| | - Marina Petrucelli
- School of Biosciences and Veterinary Medicine, Veterinary Teaching Hospital, Matelica, MC, Italy
| | - Mario Cipone
- Department of Veterinary Medical Sciences, Ozzano dell’Emilia, Bologna, Italy
| | - Irene Nocera
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, San Piero a Grado, PI, Italy
| | - Micaela Sgorbini
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, San Piero a Grado, PI, Italy
- * E-mail:
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Kopitkó C, Gondos T, Fülöp T, Medve L. Reinterpreting Renal Hemodynamics: The Importance of Venous Congestion and Effective Organ Perfusion in Acute Kidney Injury. Am J Med Sci 2020; 359:193-205. [PMID: 32089228 DOI: 10.1016/j.amjms.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/07/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
The significance of effective renal perfusion is relatively underemphasized in the current literature. From a renal standpoint, besides optimizing cardiac output, renal perfusion should be maximized as well. Among the several additional variables of the critically ill, such as intra-abdominal pressure, the presence of venous congestion and elevated central venous pressures, airway pressures generated by mechanical ventilation do affect net renal perfusion. These forces represent both a potential danger and an ongoing opportunity to improve renal outcomes in the critically ill and an opportunity to move beyond the simplified viewpoint of optimizing volume status. Therefore, to optimize nephron-protective therapies, nephrologists and intensive care physicians should be familiar with the concept of net renal perfusion pressure. This review appraises the background literature on renal perfusion pressure, including the initial animal data and historical human studies up to the most current developments in the field, exploring potential avenues to assess and improve renal blood supply.
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Affiliation(s)
- Csaba Kopitkó
- Intensive Care Unit, Uzsoki Teaching Hospital, Budapest, Hungary.
| | - Tibor Gondos
- Department of Oxyology and Emergency Care, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - László Medve
- Intensive Care Unit, Markhot Ferenc Hospital, Eger, Hungary
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Bolboacă SD, Elec FI, Elec AD, Muntean AM, Socaciu MA, Iacob G, Zaro R, Andrieș AI, Bădulescu RM, Ignat RM, Iancu M, Badea RI. Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study. Diagnostics (Basel) 2020; 10:E41. [PMID: 31941112 PMCID: PMC7169400 DOI: 10.3390/diagnostics10010041] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients' characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young's modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68-31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08-27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (-0.44, p-value < 0.0001 for allograft cortex and -0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed.
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Affiliation(s)
- Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania;
| | - Florin Ioan Elec
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania;
- Department of Renal Transplantation, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania; (A.D.E.); (A.M.M.); (G.I.)
| | - Alina Daciana Elec
- Department of Renal Transplantation, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania; (A.D.E.); (A.M.M.); (G.I.)
| | - Adriana Milena Muntean
- Department of Renal Transplantation, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania; (A.D.E.); (A.M.M.); (G.I.)
| | - Mihai Adrian Socaciu
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Str., no. 19-23, 400162 Cluj-Napoca, Romania; (M.A.S.); (R.Z.)
- Department of Medical Imaging, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Constanța Str., no. 5, 400162 Cluj-Napoca, Romania
| | - Gheorghita Iacob
- Department of Renal Transplantation, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania; (A.D.E.); (A.M.M.); (G.I.)
| | - Răzvan Zaro
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Str., no. 19-23, 400162 Cluj-Napoca, Romania; (M.A.S.); (R.Z.)
- Department of Medical Imaging, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Constanța Str., no. 5, 400162 Cluj-Napoca, Romania
| | - Alexandra-Ioana Andrieș
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Str., no. 19-23, 400162 Cluj-Napoca, Romania; (M.A.S.); (R.Z.)
- Department of Medical Imaging, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Constanța Str., no. 5, 400162 Cluj-Napoca, Romania
| | - Ramona Maria Bădulescu
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4-6, 400006 Cluj-Napoca, Romania;
| | - Radu Mihai Ignat
- Department of Anatomy, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 3-5, 400006 Cluj-Napoca, Romania;
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania;
| | - Radu Ion Badea
- Department of Medical Imaging, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Str., no. 19-23, 400162 Cluj-Napoca, Romania; (M.A.S.); (R.Z.)
- Department of Medical Imaging, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Constanța Str., no. 5, 400162 Cluj-Napoca, Romania
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Watanabe I, Shintani Y, Terada S, Fujii T, Kiuchi S, Nakanishi R, Katayanagi T, Kawasaki M, Tokuhiro K, Ohsawa H, Ikeda T. A Clinical Association between an Increasing Renal Resistive Index and the Atherosclerotic Burden in Patients with a Preserved Renal Function. Intern Med 2020; 59:909-916. [PMID: 32238661 PMCID: PMC7184073 DOI: 10.2169/internalmedicine.3232-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective A positive correlation is observed between the progression of renal impairment and the increasing risk of cardiovascular disease. Our aim was to examine the relationship between the renal resistive index (RRI) assessed by duplex sonography and the extent of atherosclerosis in patients without renal impairment undergoing vascular imaging studies. Methods The RRI was evaluated pre-procedurally among 106 outpatients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 undergoing clinically-driven coronary computed tomography angiography (CCTA). In those subjects, a carotid artery ultrasound scan was also performed to evaluate carotid artery disease. We investigated the association between the RRI and the atherosclerotic extent, defined by the presence of coronary artery calcium (CAC) >0 and carotid intima-media thickness (cIMT) ≥1.0 mm. Results Multi-site atherosclerosis (CAC>0 and cIMT≥1.0 mm) was found in 31 patients. The RRI was significantly increased with an increasing number of atherosclerotic vessels (absence of atherosclerosis: 0.65±0.04 vs. single-site atherosclerosis: 0.67±0.06 vs. multi-site atherosclerosis: 0.71±0.05, p<0.001). A multivariate logistic regression analysis showed that RRI>0.70 [odds ratio (OR): 4.05, 95% confidence interval (CI), 1.37-12.0, p=0.01], cardio ankle vascular index (CAVI) ≥9.0 (OR: 8.18, 95% CI: 2.47-27.1, p<0.01), diabetes (OR: 4.34, 95% CI: 1.37-13.7, p=0.01) and an eGFR>90 mL/min/1.73 m2 (OR: 5.89, 95% CI: 1.39-25.1, p=0.01) were associated with multi-site atherosclerosis. Conclusion The RRI, a sub-clinical renal parameter is an atherosclerotic marker in patients without renal impairment.
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Affiliation(s)
- Ippei Watanabe
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Yodo Shintani
- Cardiovascular Centre of Misato Central General Hospital, Japan
| | | | - Takahiro Fujii
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
| | | | | | | | - Hidefumi Ohsawa
- Cardiovascular Centre of Misato Central General Hospital, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University School of Medicine, Japan
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An assessment of the utility and repeatability of the renal resistive index in horses. PLoS One 2019; 14:e0226941. [PMID: 31877188 PMCID: PMC6932750 DOI: 10.1371/journal.pone.0226941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to establish the value of the renal resistive index (RI) of intrarenal arteries in healthy warmblood non-racing horses of different ages to assess the influence of physiologic factors and repeatability of measurement. The kidney ultrasonography examination was performed in three age groups: 15 foals, 15 adults and 15 elderly horses. The procedure was performed in unsedated standing animals. RI values were measured using pulsed-wave Doppler at the medial part of each kidney in the intrarenal arteries. To evaluate repeatability, all measurements were repeated two hours after the first examination. Statistical analysis of the relationship between groups was carried out using Fisher’s test. The relationship between the RI value and the physiological parameters was evaluated using linear regression. Repeatability of measurements was determined based on the Bland-Altman plot. The mean RI value in the studied horses was 0.48 ± 0.05 in the left kidney and 0.49 ± 0.05 in the right kidney. There were no statistically significant differences between the RI values in foals and adult horses. The elderly horses had a significantly higher RI value. Pulse pressure was the only physiological parameter affecting the RI value. The repeatability coefficient was 0.089 for the right kidney and 0.09 for the left kidney. The presented result suggest that elderly healthy horses have higher RI values than younger animals, which should be taken into account in clinical practice. The arterial pulse pressure should also be considered when interpreting RI values. The measurements have high repeatability, but in the authors’ opinion, this procedure is time consuming and requires experience.
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Kataoka H, Sawara Y, Kawachi K, Manabe S, Mochizuki T, Nitta K. Impacts of Sex Differences in Pulse Pressure among Patients with Chronic Kidney Disease. J Pers Med 2019; 9:jpm9040052. [PMID: 31835400 PMCID: PMC6963663 DOI: 10.3390/jpm9040052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Though disease-related differences between the sexes have increasingly attracted attention, the renal impact of pulse pressure (PP) in patients with chronic kidney disease (CKD) has never been investigated comprehensively in relation to differences associated with sex. We aimed to examine sex differences in PP as a related factor of CKD progression from the perspective of atherosclerosis. Methods: A total of 156 patients with CKD matched according to age and estimated glomerular filtration rate (eGFR) were separated into sex-based cohorts. Multivariate Cox proportional hazards analyses were performed to identify factors associated with renal outcomes. Kaplan–Meier analyses were performed to assess disease progression, which was defined as a ≥50% estimated glomerular filtration rate (eGFR) decline or end-stage renal disease. Results: The mean age of the study participants was 58.9 ± 13.1 years, and the median follow-up period was 114.0 months. A multivariate Cox regression analysis showed that PP was significantly associated with disease progression among the entire cohort (p = 0.007). In the sex-based sub-cohort analyses, PP was significantly associated with disease progression in men (p = 0.0004) but not in women. Among the entire cohort, PP was correlated positively with age (p = 0.03) and negatively with high-density lipoprotein-cholesterol (HDL-C) level (p = 0.003). PP was significantly correlated with visceral fat area (VFA) (p = 0.04) and hemoglobin level (p = 0.04) in men and with HDL-C level (p = 0.003) in women. Conclusion: A high PP is a significant related factor of CKD progression, especially in men, in whom it is significantly associated with greater VFA and lower hemoglobin level.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women’s Medical University, Tokyo 162-866, Japan
| | - Yukako Sawara
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Keiko Kawachi
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women’s Medical University, Tokyo 162-866, Japan
- Correspondence: ; Tel.: +81-3-3353-8111; Fax: +81-3-3356-0293
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Sistani SS, Alidadi A, Moghadam AA, Mohamadnezhad F, Ghahderijani BH. Comparison of renal arterial resistive index in type 2 diabetic nephropathy stage 0-4. Eur J Transl Myol 2019; 29:8364. [PMID: 31908744 PMCID: PMC6926434 DOI: 10.4081/or.2019.8364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) is one of world health problems and its prevalence and incidence is increasing. Chronic Kidney Failure involves a range of pathophysiologic processes that are associated with impaired renal function, leading to cardiovascular morbidity and mortality. Renal artery resistive index (RI) is indicator of atherosclerotic change in small vessels. The current study was aimed to assess RI in diabetic nephropathy patients at stage 0-4 and to compare RRI with HbA1c, systolic blood pressure, diastolic blood pressure, albuminuria and glomerular filtration rate (GFR). In this cross sectional study,100 diabetic nephropathy patients who attend to nephrology clinic of Ali-ibn Abi Talib Hospital were entered to the study. Ultrasound Doppler renal resistive index was measured and other information was recorded from their last lab data that was recorded in their medical records. Variable included: systolic blood pressure, diastolic blood pressure, albuminuria, GFR, HbA1c. All data was analyzed by Pearson's Correlation Coefficient. The findings indicated a significant correlation of RI with systolic BP (p=0.04 R=0.75), microalbuminuria (P=0.001 R=0.67), and GFR (P=0.001 R=0.76), while diastolic BP (P=0/45 R=0/32), HbA1c (P=0/56 R=0/43) were not found to be associated with RI. The findings indicated that increased systolic blood pressure, albumin excretion (microalbuminuria) and severity of disease were capable of increasing RI values in diabetic nephropathy patients. In addition, decreased GFR.
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Affiliation(s)
- Sharareh Sanei Sistani
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Alidadi
- Department of Nephrology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Fatemeh Mohamadnezhad
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Serum Oxidative Stress Markers are not Associated with Renal and Common Carotid Arteries Arteriosclerotic Vascular Changes in Patients with Gout. ACTA MEDICA BULGARICA 2019. [DOI: 10.2478/amb-2019-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To establish the association between serum levels of reactive oxygen species (ROS) products, nitric oxide (NO) radicals and ascorbate radicals with renal resistive index (RRI), common carotid artery resistive index (CCARI) and intima-media thickness (IMT) in gout patients, and to find out whether the connection is more pronounced when tophi are present.
Methods: A cross-sectional study including 71 consecutive gout patients, divided into two groups according to the presence of subcutaneous tophi. Serum concentrations of ROS products, NO radicals and ascorbate radicals were determined by ex vivo electron paramagnetic resonance (EPR) study. RRI was measured in both kidneys at the level of interlobar arteries with 3.5 MHz transducer. By applying ultrasound of the common carotid arteries, conducted with 10 MHz linear transducer CCARI and IMT were measured.
Results: Gouty arthritis without tophi and gouty tophi subjects were age-matched. Serum uric acid and distribution of conventional cardiovascular risk factors was equal in the groups. However, in tophi patients CRP and the number of individuals who had suffered a cardiovascular event were higher. In the two stages of the disease serum levels of ROS products, NO radicals, ascorbate radicals, as well as RRI and CCARI were comparable but intima-media was thicker in gouty tophi. Serum concentrations of ROS products, NO radicals and ascorbate radicals did not correlate with RRI, CCARI and IMT. Among untreated and treated with Allopurinol or Febuxostat patients the means of ROS products, NO radicals, ascorbate radicals, RRI, CCARI and IMT were similar.
Conclusions: In the earlier and advanced stage of the disease we found no difference in oxidative stress level but the degree of inflammation was higher in tophi subjects. No connection was established between serum ROS products, NO radicals and ascorbate radicals with renal and carotid arteries arteriosclerotic vascular changes. We suggest that in gout individuals intrinsic inflammation has a leading role in the process of atherogenesis.
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Abe M, Akaishi T, Miki T, Miki M, Funamizu Y, Araya K, Ishizawa K, Takayama S, Takase K, Abe T, Ishii T, Ito S. Influence of renal function and demographic data on intrarenal Doppler ultrasonography. PLoS One 2019; 14:e0221244. [PMID: 31454365 PMCID: PMC6711528 DOI: 10.1371/journal.pone.0221244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023] Open
Abstract
Intrarenal Doppler ultrasonography is a non-invasive method to evaluate the renal blood flow in patients with renal arterial stenosis as well as chronic kidney diseases (CKD). Until recently, the relationship between ultrasonography findings and CKD stage has not been fully understood. Overall, 162 patients with CKD without apparent renal arterial stenosis were included in this study, and the pulsed-wave Doppler ultrasonography findings were evaluated in terms of the following parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) at the renal arterial trunk, hilum, segmental, and interlobar regions. Age showed a significant negative correlation with the estimated glomerular filtration rate (eGFR), kidney size, and aortic PSV. Additionally, age showed a significant positive correlation with RI in all 4 regions. The eGFR showed a positive correlation with the aortic PSV and kidney size, but a negative correlation with RI. Both age and eGFR were found to be independently associated with aortic blood flow. On the intrarenal ultrasound, EDV and RI showed stronger correlations with eGFR than PSV, suggesting that the former indices would be better markers of renal function. In particular, the interlobar EDV was found to be the best index that reflects renal function. Although the RI is also a good marker of renal function, it is confounded by age; thus, its utility would be weaker than that of the EDV. In conclusion, intrarenal pulsed-wave Doppler ultrasonography is a useful tool to estimate and evaluate the renal function; the interlobar EDV may be the best index to estimate the effective perfusion and filtration of the kidneys.
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Affiliation(s)
- Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
- * E-mail:
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Takashi Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Mika Miki
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Yasuharu Funamizu
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Kaori Araya
- Clinical Physiology Center, Tohoku University Hospital, Sendai, Japan
| | - Kota Ishizawa
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin Takayama
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Takaaki Abe
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Sadayoshi Ito
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
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