1
|
Lubas A, Zegadło A, Frankowska E, Klimkiewicz J, Jędrych E, Niemczyk S. Ultrasound Doppler Flow Parameters Are Independently Associated with Renal Cortex Contrast-Enhanced Multidetector Computed Tomography Perfusion and Kidney Function. J Clin Med 2023; 12:jcm12062111. [PMID: 36983114 PMCID: PMC10054581 DOI: 10.3390/jcm12062111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The assessment of kidney perfusion has an emerging significance in many diagnostic applications. However, whether and which of the ultrasound Doppler parameters better express renal cortical perfusion (RCP) was not shown. The study aimed to prove the usefulness of Doppler ultrasound parameters in the assessment of RCP regarding low-dose contrast-enhanced multidetector computer tomography (CE-MDCT) blood flow. METHODS Thirty non-stenotic kidneys in twenty-five hypertensive patients (age 58.9 ± 19.0) with mild-to-severe renal dysfunction were included in the study. Resistive index (RI) and end-diastolic velocity (EDV) in segmental arteries, color Doppler dynamic RCP intensity (dRCP), RI (dRI), pulsatility index (dPI), and CE-MDCT blood flow (CBF) in the renal cortex were estimated. RESULTS CBF correlated significantly with age, estimated glomerular filtration rate (eGFR), RI, EDV, dRI, dPI, and dRCP. In separate multivariable backward regression analyses, RI (R2 = 0.290, p = 0.003) and dRCP (R2 = 0.320, p = 0.001) were independently associated with CBF. However, in the common ultrasound model, only dRCP was independently related to CBF (R2 = 0.317, p = 0.001). Only CBF and EDV were independently associated with eGFR (R2 = 0.510, p < 0.001). CONCLUSIONS Renal cortical perfusion intensity is the best ultrasound marker expressing renal cortical perfusion. In patients with hypertension and kidney dysfunction, renal resistive index and end-diastolic velocity express renal cortical perfusion and kidney function, respectively.
Collapse
Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Arkadiusz Zegadło
- Department of Radiology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Jakub Klimkiewicz
- Department of Anesthesiology and Intensive Care, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Ewelina Jędrych
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| |
Collapse
|
2
|
Gregg LP, Van Buren PN, Ramsey DJ, Maydon A, Banerjee S, Walther CP, Virani SS, Winkelmayer WC, Navaneethan SD, Hedayati SS. Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1-3: a pilot study. J Investig Med 2022; 70:jim-2022-002467. [PMID: 35853670 PMCID: PMC10461401 DOI: 10.1136/jim-2022-002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Natriuretic peptide levels are elevated in persons with chronic kidney disease (CKD) stages 1-3, but it remains unclear whether this is associated with extracellular volume excess or early cardiovascular changes. We hypothesized that patients with CKD stages 1-3 would have evidence of cardiovascular changes, which would associate with brain natriuretic peptide (BNP), amino-terminal-pro-BNP (NT-pro-BNP), and patient-reported symptoms.Outpatients with CKD stages 1-3 and non-CKD controls were enrolled. Cardiovascular parameters included extracellular water (ECW) normalized to body weight measured using whole-body multifrequency bioimpedance spectroscopy, and total peripheral resistance index (TPRI) and cardiac index measured by impedance cardiography. Dyspnea, fatigue, depression, and quality of life were quantified using questionnaires.Among 21 participants (13 with CKD), median (IQR) BNP was 47.0 (28.0-302.5) vs 19.0 (12.3-92.3) pg/mL, p=0.07, and NT-pro-BNP was 245.0 (52.0-976.8) vs 26.0 (14.5-225.8) pg/mL, p=0.08, in the CKD and control groups, respectively. Those with CKD had higher pulse pressure (79 (66-87) vs 64 (49-67) mm Hg, p=0.046) and TPRI (3721 (3283-4278) vs 2933 (2745-3198) dyn×s/cm5/m2, p=0.01) and lower cardiac index (2.28 (2.08-2.78) vs 3.08 (2.43-3.37) L/min/m2, p=0.02). In the overall cohort, natriuretic peptides correlated with pulse pressure (BNP r=0.59; NT-pro-BNP r=0.58), cardiac index (BNP r=-0.76; NT-pro-BNP r=-0.62), and TPRI (BNP r=0.48), p<0.05 for each, but not with ECW/weight. TPRI and blood pressure correlated moderately with symptoms.Elevated natriuretic peptides may coincide with low cardiac index and elevated peripheral resistance in patients with CKD stages 1-3. The role of these biomarkers to detect subclinical cardiovascular changes needs to be further explored.
Collapse
Affiliation(s)
- L Parker Gregg
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Medical Care Line, Section of Nephrology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
| | - Peter N Van Buren
- Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Medical Service, Renal Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - David J Ramsey
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
| | - Amaris Maydon
- Mental Health Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Subhash Banerjee
- Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Medical Service, Cardiology Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Salim S Virani
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
- Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
- Internal Medicine, Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Medical Care Line, Section of Nephrology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - S Susan Hedayati
- Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
Lubas A, Grzywacz A, Niemczyk S, Kamiński G, Saracyn M. Renal Cortical Perfusion Estimated in Color Doppler Dynamic Tissue Perfusion Measurement in Patients Treated with Levothyroxine Following Total Thyroidectomy for Resectable Thyroid Cancer Is Independently Associated with Free Thyroxine: A Single-Center Prospective Study. Med Sci Monit 2021; 27:e932096. [PMID: 34383727 PMCID: PMC8369933 DOI: 10.12659/msm.932096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The thyroid state significantly influences renal function. However, a direct link between thyroid and kidney dysfunction has not been identified. Thyroid hormones affect cardiac output and vascular resistance, and thus can modify kidney perfusion. This prospective study aimed to test the association between renal cortical perfusion (RCP) estimated in color Doppler sonographic dynamic tissue perfusion measurement (DTPM) with thyroid hormones in 36 patients treated with levothyroxine following total thyroidectomy for resectable thyroid cancer. Material/Methods Blood tests, blood pressure monitoring, and DTPM of the renal cortex were performed. To exclude possible reading errors, the intrarater reliability of the ultrasound perfusion measurement method was estimated. Results The absolute difference between the 2 ultrasound RCP measurements was 5.2±4.4%. RCP correlated significantly with free thyroxine (FT4) (r=0.46; p=0.006) but not with triiodothyronine and thyroid-stimulating hormone. In the adjusted to age backward stepwise multivariable regression analysis model, including estimated glomerular filtration rate, mean arterial pressure, and FT4, only FT4 was independently associated with RCP (R2=0.21; p=0.006). Conclusions Renal cortical perfusion is independently associated with free thyroxine, which can contribute to renal function abnormalities in the condition of impaired thyroid function. This small prospective study from a single center showed that the renal cortex’s color Doppler sonographic dynamic tissue perfusion measurement had very good intraobserver reproducibility.
Collapse
Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Anna Grzywacz
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
4
|
Szczepankiewicz B, Pasławska U, Siwińska N, Plens K, Pasławski R. Evaluation of the diagnostic value of the renal resistive index as a marker of the subclinical development of cardiorenal syndrome in MMVD dogs. J Renin Angiotensin Aldosterone Syst 2021; 22:1470320321995082. [PMID: 33730896 PMCID: PMC8010829 DOI: 10.1177/1470320321995082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Myxomatous mitral valve disease (MMVD) in dogs inevitably causes renal
dysfunction. These interactions are known as the cardiorenal syndrome (CRS).
The main aims of the study were to evaluate whether renal resistive index
(RRI) may be useful as a non-invasive marker in subclinical stage of kidney
injury in dogs with MMVD and to compare RRI with SDMA and Cyst C. Methods: Forty-four dogs were divided into two groups: control—15 healthy dogs
and the heart group—29 dogs with MMVD (ACVIM class Cc). Study
protocol included: anamnesis, clinical examination, electrocardiography,
echocardiography, chest radiography, abdominal ultrasonography with
measurements of the renal resistive index (RRI), urine, and blood
analysis. Results: The RRI in the heart group was significantly higher
0.725 ± 0.035 versus control group
0.665 ± 0.028
(p < 0.00085). The RRI cut-off
point in dogs with stable chronic heart failure (CHF) under 8 years
is 0.775, in older 0.64. RRI was similar in MMVD dogs treated with
ACE-I + furosemide and dogs treated
ACE-I + torasemide + pimobendan + spironolactone.
There was no correlation between RRI and SDMA or Cyst C. Conclusion: RRI is more sensitive than creatinine, SDMA and Cyst C to reveal kidney
injury in MMVD dogs class Cc younger than 8 years.
Collapse
Affiliation(s)
- Barbara Szczepankiewicz
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | - Urszula Pasławska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland.,Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Natalia Siwińska
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
| | | | - Robert Pasławski
- Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
| |
Collapse
|
5
|
Kylies D, Freitag-Wolf S, Fulisch F, Seoudy H, Kuhn C, Kihm LP, Pühler T, Lutter G, Dempfle A, Frey N, Feldkamp T, Frank D. Improvement of renal function after transcatheter aortic valve replacement and its impact on survival. BMC Nephrol 2021; 22:77. [PMID: 33653283 PMCID: PMC7923662 DOI: 10.1186/s12882-021-02274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. Results Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15–0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05–0.44]) compared to patients without RI. Conclusions We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02274-5.
Collapse
Affiliation(s)
- Dominik Kylies
- Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany.,Present Address: Department of Internal Medicine III, Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg (UKE), Hamburg, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Fulisch
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Lars Philipp Kihm
- Department of Internal Medicine I, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Pühler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Thorsten Feldkamp
- Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany.
| |
Collapse
|
6
|
Saracyn M, Lubas A, Bober B, Kowalski Ł, Kapusta W, Niemczyk S, Wartofsky L, Kamiński G. Recombinant Human Thyrotropin Worsens Renal Cortical Perfusion and Renal Function in Patients After Total Thyroidectomy Due to Differentiated Thyroid Cancer. Thyroid 2020; 30:653-660. [PMID: 31964314 DOI: 10.1089/thy.2019.0372] [Citation(s) in RCA: 4] [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] [Indexed: 12/28/2022]
Abstract
Background: Although thyrotropin (TSH) receptors are found in many nonthyroid tissues, we know little about the direct action of TSH on these receptors. Patients after total thyroidectomy for differentiated thyroid cancer (DTC) provide an interesting model for studying this issue. The administration of exogenous TSH in patients with an established thyroid state on levothyroxine (LT4) treatment allows us to study the effect of elevated TSH concentrations independent of thyroid status on the function of various organs, including the kidneys. The aim of this study was to assess the effects of the administration of recombinant human TSH (rhTSH) on renal perfusion and glomerular filtration in this group of patients. Methods: The study included 24 patients after total thyroidectomy due to DTC, without concomitant diseases, receiving only LT4 who qualified for radioiodine treatment (RIT). For two consecutive days, the patients received rhTSH and subsequently the RIT. Clinical and biochemical evaluation of thyroid and renal function was carried out before and 24 hours after the second dose of rhTSH and before the RIT. On the sixth day of hospitalization, the patients' glomerular filtration rate was re-evaluated. Kidney perfusion was assessed using color Doppler ultrasound imaging before and 24 hours after the second dose of rhTSH and before the RIT. Results: The administration of rhTSH to patients after total thyroidectomy due to DTC caused significant deterioration of renal perfusion after the second dose of rhTSH before the RIT, which was followed by a significant reduction in glomerular filtration. Furthermore, rhTSH did not significantly affect the hemodynamic parameters that could worsen renal function. Conclusions: This study indicates that TSH alone, independent of thyroid hormone concentrations, can influence renal perfusion and renal function.
Collapse
Affiliation(s)
- Marek Saracyn
- Department of Endocrinology and Radioisotope Therapy, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Barbara Bober
- Department of Endocrinology and Radioisotope Therapy, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Łukasz Kowalski
- Department of Endocrinology and Radioisotope Therapy, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Waldemar Kapusta
- Department of Endocrinology and Radioisotope Therapy, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| | - Leonard Wartofsky
- Georgetown University School of Medicine, Washington, District of Columbia, USA
- Thyroid Cancer Research Unit, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Nephrology and Dialysotherapy, Military Medical Institute, Warsaw, Poland
| |
Collapse
|
7
|
Doppler tissue perfusion measurement is a sensitive and specific tool for a differentiation between malignant and inflammatory pancreatic tumors. PLoS One 2019; 14:e0215944. [PMID: 31034484 PMCID: PMC6488051 DOI: 10.1371/journal.pone.0215944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/11/2019] [Indexed: 01/12/2023] Open
Abstract
Differentiation between pancreatic malignant and inflammatory tumors presents an important diagnostic problem. The ability to recognize pancreatic malignant tumors using Doppler evaluation of tissue perfusion has been recently demonstrated. The aim of the study was to assess the diagnostic value of Dynamic Tissue Perfusion Measurement (DTPM) in the differentiation between malignant and inflammatory pancreatic tumors. The study included 60 patients (35M, 25F, age 60.9 ± 2.3 years) with a malignant (Group 1, n = 30) or inflammatory (Group 2, n = 30) pancreatic tumor undergoing endoscopic ultrasound with the evaluation of tissue perfusion by Color Doppler and a simultaneous biopsy of lesions for cytological evaluation. In 20 patients the diagnosis was verified in the postoperative histopathological examination. Flow velocity (FV) and percentiles of the distribution of perfusion intensity (PR) evaluated by DTPM were analyzed with regard to receiver-operator-characteristics. FV as well as PR were significantly higher in Group 2 compared to Group 1. A threshold of 2.0 cm/sec for FV identified patients with malignancies with a sensitivity of 83% and specificity of 86%. In multivariable regression analysis, the best PR parameter for differentiating between malignant and inflammatory tumors was 97.5% percentile, whose value of 0.922 allowed for the recognition of pancreatic malignant tumors with a sensitivity of 62% and specificity of 83% (p < 0.001). In conclusion, Color Doppler ultrasound tissue perfusion parameters are a sensitive and specific tool in the differentiation between malignant and inflammatory pancreatic tumors.
Collapse
|
8
|
Laranjinha I, Matias P, Oliveira R, Casqueiro A, Bento MT, Carvalho AP, Adragão T, Jorge C, Bruges M, Birne R, Machado D, Weigert A. The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study. J Vasc Access 2018; 20:482-487. [DOI: 10.1177/1129729818817248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion. Methods: We conducted a study in 17 kidney-transplanted patients with a functioning arteriovenous access. We evaluated, at baseline and 30 s after compression of the arteriovenous access (access flow occlusion), the hemodynamic parameters and the renal resistive index of the graft by Doppler ultrasound. Results: After arteriovenous access occlusion 82.4% (n = 14) of the patients had a decrease in resistive index. All patients had a decrease in heart rate (67 vs 58 bpm, p < 0.001) and 14 (82.4%) had an increase in mean blood pressure (98.3 vs 101.7 mm Hg, p = 0.044). There was a significant decrease in the resistive index (ΔRI) after the access occlusion (0.68 vs 0.64, p = 0.030). We found a negative correlation in Qa (r2 = −0.55, p = 0.022) with the ΔRI, and Qa was an independent predictor of ΔRI in a model adjusted to pre-occlusion resistive index. Conclusion: Our results showed that temporary occlusion of an arteriovenous access causes a significant decline in renal graft resistive index and this decline is higher with the occlusion of accesses with higher Qa. These results suggest that the maintenance of arteriovenous accesses, mainly those with higher Qa, can decrease renal graft perfusion.
Collapse
Affiliation(s)
- Ivo Laranjinha
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Patricia Matias
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School – Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Regina Oliveira
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Casqueiro
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Maria Teresa Bento
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Paula Carvalho
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Teresa Adragão
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School – Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Cristina Jorge
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Margarida Bruges
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rita Birne
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Domingos Machado
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - André Weigert
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
9
|
Lubas A, Kade G, Saracyn M, Niemczyk S, Dyrla P. Dynamic tissue perfusion assessment reflects associations between antihypertensive treatment and renal cortical perfusion in patients with chronic kidney disease and hypertension. Int Urol Nephrol 2018; 50:509-516. [PMID: 29374813 PMCID: PMC5845077 DOI: 10.1007/s11255-018-1798-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Renal cortical perfusion measured in noninvasive, dynamic ultrasonic method is connected with the hemodynamic cardiac properties and renal function. Antihypertensive drugs affect the functioning of the heart and kidneys. The aim of the study was to evaluate the effect of a chronic use of antihypertensive drugs on ultrasound parameters of renal cortical perfusion. METHODS The study included 56 consecutive patients (49 M + 7 F, age 54.0 ± 13.3) with stable chronic kidney disease and hypertension. Color Doppler dynamic tissue perfusion measurement was used to assess renal cortical perfusion. RESULTS Patients were treated with a mean of 2.7 ± 1.4 antihypertensive drugs, of which diuretics accounted for 25%, angiotensin-converting enzyme inhibitors (ACE-I) together with angiotensin receptor blockers (ARB) 24%, beta-blockers (BB) 23%, calcium channel blockers 16%, alpha-1 blockers (α1B) 9% and centrally acting drugs 3%. All investigated groups of drugs correlated significantly with parameters of renal perfusion. In multivariable regression analyses adjusted to age, diuretics were connected with the decrease (r = - 0.473) and ACE-I + ARB (r = 0.390) with the improvement of proximal and whole renal cortex perfusion (R2 = 0.28; p < 0.001), whereas BB (r = - 0.372) and α1B (r = - 0.280) independently correlated with worsened perfusion of renal distal cortex (R2 = 0.21, p < 0.01). CONCLUSIONS The type of antihypertensive therapy had a significant influence on the ultrasound parameters of renal cortical perfusion. Noninvasive, ultrasonic dynamic tissue perfusion measurement method appears to be an adequate tool to assess the impact of drugs on renal cortical perfusion.
Collapse
Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów str. 128, 04-141, Warsaw, Poland.
| | - Grzegorz Kade
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów str. 128, 04-141, Warsaw, Poland
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Szaserów str. 128, 04-141, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów str. 128, 04-141, Warsaw, Poland
| | - Przemysław Dyrla
- Department of Gastroenterology, Military Institute of Medicine, Szaserów str. 128, 04-141, Warsaw, Poland
| |
Collapse
|
10
|
Left Ventricular Strain and Relaxation Are Independently Associated with Renal Cortical Perfusion in Hypertensive Patients. ADVANCES IN MEDICINE AND MEDICAL RESEARCH 2018; 1133:1-8. [DOI: 10.1007/5584_2018_304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
11
|
Lubas A, Kade G, Ryczek R, Banasiak P, Dyrla P, Szamotulska K, Schneditz D, Niemczyk S. Ultrasonic evaluation of renal cortex arterial area enables differentiation between hypertensive and glomerulonephritis-related chronic kidney disease. Int Urol Nephrol 2017; 49:1627-1635. [PMID: 28573489 PMCID: PMC5556137 DOI: 10.1007/s11255-017-1634-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/27/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE Identifying the primary etiology of cardio-renal syndrome in a timely manner remains an ongoing challenge in nephrology. We hypothesized that hypertensive kidney damage can be distinguished from chronic glomerulonephritis at an early stage of chronic kidney disease (CKD) using ultrasound (US) Doppler sonography. METHODS Fifty-six males (age 54 ± 15, BMI 28.3 ± 3.5 kg/m2) with hypertension and stable CKD at stages 2-4 [38 with essential hypertension (HT-CKD); 18 with glomerulonephritis (GN-CKD)] were studied. Blood tests, UACR, echocardiography, ABPM, carotid IMT, and an ultrasound dynamic tissue perfusion measurement (DTPM) of the renal cortex were performed. RESULTS HT-CKD patients had reduced proximal renal cortex perfusion as well as reduced total and proximal renal cortex arterial area. Proximal renal cortex arterial area ≤0.149 cm2 identified hypertension-related CKD with a sensitivity of 71% and a specificity of 78% (AUC 0.753, p < 0.001). CONCLUSIONS Evidence of diminished arterial vascularity or perfusion of renal proximal cortex, both derived from US Doppler, could be helpful in differentiating hypertensive nephropathy from glomerulonephritis-related CKD.
Collapse
Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland.
| | - Grzegorz Kade
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland
| | - Robert Ryczek
- Department of Cardiology, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland
| | - Piotr Banasiak
- Health Center Karczew, Otwocka 28, 05-480, Karczew, Poland
| | - Przemysław Dyrla
- Department of Gastroenterology, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology, Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland
| | - Daniel Schneditz
- Institute of Physiology, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland
| |
Collapse
|
12
|
Dyrla P, Lubas A, Gil J, Niemczyk S. Doppler tissue perfusion parameters in recognizing pancreatic malignant tumors. J Gastroenterol Hepatol 2016; 31:691-5. [PMID: 26455432 DOI: 10.1111/jgh.13193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Histopathology, radiological imaging methods with the administration of contrast agents are efficient to differentiate focal lesions of the pancreas. Invasiveness, contrast toxicity, and limited accessibility ameliorate their application. Noninvasive and contrast-agent-free method could improve diagnostics and accelerate treatment. AIMS The aim of the study is to evaluate the diagnostic properties of ultrasound parameters of organ perfusion in the detection of malignant tumors of the pancreas. METHODS Thirty-six patients with a focal lesion of the pancreas underwent endosonography with color flow imaging and biopsy for histological evaluation. Five patients were excluded because of the absence of the Doppler signal in pancreatic lesion. In the dynamic tissue perfusion measurement (DTPM) means of flow velocity (FV), resistive index, pulsatility index, and perfusion relief intensity (PR) were estimated. RESULTS In the group with malignant tumors FV was significantly lower compared with the group with inflammatory changes. In receiver operating characteristic (ROC) analysis FV below the optimal cut-off point of 2.382 cm/s identified patients with malignant lesions with a sensitivity of 92% and specificity of 90%. In the group with malignant tumors significantly lower values of PR in all considered percentiles were observed. Based on the ROC analysis in the group with solid tumors, it was found that PR25 ≤ 0.057 allowed to recognize malignancies with a sensitivity of 100% and specificity of 80%, and in the groups with solid and cystic tumors with a sensitivity of 100% and specificity of 79%. CONCLUSIONS FV and PR intensity derived from DTPM are reliable markers in recognition of pancreatic malignant masses.
Collapse
Affiliation(s)
- Przemysław Dyrla
- Department of Gastroenterology, Military Institute of Medicine, Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Gil
- Department of Gastroenterology, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|