Duplex Sonography of Normal Renal Allografts

Severely elevated intrarenal arterial impedance and abnormal venous flow pattern in a normal functioning kidney graft

Serial Doppler sonographic impedance measurements represent the most common diagnostic method for noninvasive monitoring of kidney grafts. Severely elevated arterial impedance is almost always associated with graft dysfunction. However, we describe in the present work a renal transplant recipient with optimal graft function despite permanently elevated arterial impedance (pulsatility index (PI) ranging from 2.9-3.0, and resistive index (RI) = 1.0 as well as an abnormal venous flow pattern. In contrast, the contralateral graft from the same cadaver donors transplanted into a 17-year-old female patient displayed normal range PI and RI values in conjunction with a normal serum creatinine. Known causes of arterial impedance elevation such as rejection, cyclosporine, urinary obstruction, and external graft compression were excluded. Other extrarenal causes of high impedance, such as aortic insufficiency and reduced aortic compliance, were also excluded. No evidence of impaired venous outflow at the site of the anastomosis of the main renal vein to the iliac vein was found. Those findings support the view that impedance indexes are hemodynamic rather than functional parameters.

Short- and long-term repeatability of intrarenal resistive index in the pig

RATIONALE AND OBJECTIVES

To evaluate the short- and long-term repeatability (intraobserver variation) of the renal resistive index (RI) in a pig model.

METHODS

Under standardized ambient conditions, short- and long-term repeatabilities were assessed by measuring the RI three consecutive times at 30-minute intervals in 14 pigs and twice 4 weeks apart in 6 pigs, respectively. Repeatability was judged according to predefined criteria, which included calculation of coefficients of variation (CVs) and repeatability coefficients combined with visual assessment and estimation of bias.

RESULTS

Short-term repeatability was acceptable, having an average CV of 4.9% +/- 2.9% and of 6.1% +/- 4.7% in two comparisons, findings that were reiterated in the visual assessment. Long-term results were, however, less consistent, having an average CV of 8.1% +/- 6.1% and prominent scatter on the visual assessment graphs.

CONCLUSIONS

In this study, RI measurements showed an acceptable short-term repeatability, whereas long-term results were less consistent. The components of error contributing to the modest long-term repeatability need to be investigated in studies of larger populations.