1
|
Darabont R, Mihalcea D, Vinereanu D. Current Insights into the Significance of the Renal Resistive Index in Kidney and Cardiovascular Disease. Diagnostics (Basel) 2023; 13:diagnostics13101687. [PMID: 37238172 DOI: 10.3390/diagnostics13101687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Initially, the renal resistive index (RRI) was investigated with the aim of improving diagnosis in kidney diseases, but this goal was not met. Recently, many papers have highlighted the prognostic significance of the RRI in chronic kidney disease: specifically, in estimating the revascularization success of renal artery stenoses or the evolution of the graft and the recipients in renal transplantation. Moreover, the RRI has become significant in the prediction of acute kidney injury in critically ill patients. Studies in renal pathology have revealed correlations of this index with parameters of systemic circulation. The theoretical and experimental premises of this connection were then reconsidered, and studies analyzing the link between RRI and arterial stiffness, central and peripheral pressure, and left ventricular flow were conducted with this purpose. Many data currently indicate that RRI is influenced more by pulse pressure and vascular compliance than by renal vascular resistance-assuming that RRI reflects the complex interplay between systemic circulation and renal microcirculation and should be considered a marker of systemic cardiovascular risk beyond its prognostic relevance for kidney disease. In this review, we overview the clinical research that reveals the implications of RRI in renal and cardiovascular disease.
Collapse
Affiliation(s)
- Roxana Darabont
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Diana Mihalcea
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Dragos Vinereanu
- Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, 050098 Bucharest, Romania
- Cardiology Department, University and Emergency Hospital, 050098 Bucharest, Romania
| |
Collapse
|
2
|
Zhu L, Huang R, Zhou Z, Fan Q, Yan J, Wan X, Zhao X, He Y, Dong F. Prediction of Renal Function 1 Year After Transplantation Using Machine Learning Methods Based on Ultrasound Radiomics Combined With Clinical and Imaging Features. ULTRASONIC IMAGING 2023; 45:85-96. [PMID: 36932907 DOI: 10.1177/01617346231162910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Kidney transplantation is the most effective treatment for advanced chronic kidney disease (CKD). If the prognosis of transplantation can be predicted early after transplantation, it might improve the long-term survival of patients with transplanted kidneys. Currently, studies on the assessment and prediction of renal function by radiomics are limited. Therefore, the present study aimed to explore the value of ultrasound (US)-based imaging and radiomics features, combined with clinical features to develop and validate the models for predicting transplanted kidney function after 1 year (TKF-1Y) using different machine learning algorithms. A total of 189 patients were included and classified into the abnormal TKF-1Y group, and the normal TKF-1Y group based on their estimated glomerular filtration rate (eGFR) levels 1 year after transplantation. The radiomics features were derived from the US images of each case. Three machine learning methods were employed to establish different models for predicting TKF-1Y using selected clinical and US imaging as well as radiomics features from the training set. Two US imaging, four clinical, and six radiomics features were selected. Then, the clinical (including clinical and US image features), radiomics, and combined models were developed. The area under the curves (AUCs) of the models was 0.62 to 0.82 within the test set. Combined models showed statistically higher AUCs than the radiomics models (all p-values <.05). The prediction performance of different models was not significantly affected by the different machine learning algorithms (all p-values >.05). In conclusion, US imaging features combined with clinical features could predict TKF-1Y and yield an incremental value over radiomics features. A model integrating all available features may further improve the predictive efficacy. Different machine learning algorithms may not have a significant impact on the predictive performance of the model.
Collapse
Affiliation(s)
- Lili Zhu
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Renjun Huang
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou City, Jiangsu Province, P.R. China
| | - Qingmin Fan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Junchen Yan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Xiaojing Wan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Xiaojun Zhao
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Yao He
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Fenglin Dong
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| |
Collapse
|
3
|
Goyal A, Hemachandran N, Kumar A, Sharma R, Shamim SA, Bansal VK, Das CJ, Kandasamy D, Agarwal SK, Dinda AK, Seenu V. Evaluation of the Graft Kidney in the Early Postoperative Period: Performance of Contrast-Enhanced Ultrasound and Additional Ultrasound Parameters. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1771-1783. [PMID: 33184930 DOI: 10.1002/jum.15557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the various quantitative parameters of Doppler ultrasound, contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) of graft kidneys in the early postoperative period and to explore their utility in the diagnosis of parenchymal causes of graft dysfunction. METHODS In this ethically approved study, consecutive patients who underwent renal transplantation from March 2017 to August 2018 were recruited, and those with urologic or vascular complications and those who denied consent were excluded. All patients underwent ultrasound with Doppler, SWE, CEUS (using sulfur hexafluoride), and renal scintigraphic examinations 3 to 10 days after transplantation. A composite reference standard was used, including the clinical course, renal function test results, urine output, and histopathologic results for graft dysfunction. Cortical SWE values, quantitative CEUS parameters (generated from a time-intensity curve), and their ratios were analyzed to identify graft dysfunction and differentiate acute tubular necrosis (ATN) from acute rejection (AR). RESULTS Of the 105 patients included, 19 developed graft dysfunction (18.1%; 12 ATN, 5 AR, and 2 drug toxicity) in the early postoperative period. The peak systolic velocity in the interpolar artery showed a significant difference between control and graft dysfunction groups (P < .001) as well as between ATN and AR (P = .019). Resistive indices and SWE did not show significant differences. Ratios of the time to peak showed a significant difference between control and graft dysfunction groups (P < .05). The rise time and fall time of the large subcapsular region of interest and the rise time ratio were significantly different between ATN and AR (P = .03). CONCLUSIONS Contrast-enhanced ultrasound can be used to diagnose parenchymal causes of early graft dysfunction with reasonable diagnostic accuracy.
Collapse
Affiliation(s)
- Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Naren Hemachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V Seenu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Päivärinta J, Oikonen V, Räisänen-Sokolowski A, Tolvanen T, Löyttyniemi E, Iida H, Nuutila P, Metsärinne K, Koivuviita N. Renal vascular resistance is increased in patients with kidney transplant. BMC Nephrol 2019; 20:437. [PMID: 31775670 PMCID: PMC6882025 DOI: 10.1186/s12882-019-1617-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite improvement in short-term outcome of kidney transplants, the long-term survival of kidney transplants has not changed over past decades. Kidney biopsy is the gold standard of transplant pathology but it’s invasive. Quantification of transplant blood flow could provide a novel non-invasive method to evaluate transplant pathology. The aim of this retrospective cross-sectional pilot study was to evaluate positron emission tomography (PET) as a method to measure kidney transplant perfusion and find out if there is correlation between transplant perfusion and histopathology. Methods Renal cortical perfusion of 19 kidney transplantation patients [average time from transplantation 33 (17–54) months; eGFR 55 (47–69) ml/min] and 10 healthy controls were studied by [15 O]H2O PET. Perfusion and Doppler resistance index (RI) of transplants were compared with histology of one-year protocol transplant biopsy. Results Renal cortical perfusion of healthy control subjects and transplant patients were 2.7 (2.4–4.0) ml min− 1 g− 1 and 2.2 (2.0–3.0) ml min− 1 g− 1, respectively (p = 0.1). Renal vascular resistance (RVR) of the patients was 47.0 (36.7–51.4) mmHg mL− 1min− 1g− 1 and that of the healthy 32.4 (24.6–39.6) mmHg mL− 1min−1g−1 (p = 0.01). There was a statistically significant correlation between Doppler RI and perfusion of transplants (r = − 0.51, p = 0.026). Transplant Doppler RI of the group of mild fibrotic changes [0.73 (0.70–0.76)] and the group of no fibrotic changes [0.66 (0.61–0.72)] differed statistically significantly (p = 0.03). No statistically significant correlation was found between cortical perfusion and fibrosis of transplants (p = 0.56). Conclusions [15 O]H2O PET showed its capability as a method in measuring perfusion of kidney transplants. RVR of transplant patients with stage 2–3 chronic kidney disease was higher than that of the healthy, although kidney perfusion values didn’t differ between the groups. Doppler based RI correlated with perfusion and fibrosis of transplants.
Collapse
Affiliation(s)
- Johanna Päivärinta
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland. .,Department of Medicine, University of Turku, Turku, Finland.
| | - Vesa Oikonen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Anne Räisänen-Sokolowski
- Department of Pathology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | | | - Hidehiro Iida
- Turku PET Centre, University of Turku, Turku, Finland
| | - Pirjo Nuutila
- Department of Medicine, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland
| | - Niina Koivuviita
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
5
|
Preuss S, Rother C, Renders L, Wagenpfeil S, Büttner-Herold M, Slotta-Huspenina J, Holtzmann C, Kuechle C, Heemann U, Stock KF. Sonography of the renal allograft: Correlation between doppler sonographic resistance index (RI) and histopathology. Clin Hemorheol Microcirc 2019; 70:413-422. [PMID: 30562894 DOI: 10.3233/ch-189306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Allograft rejection (AR), chronic allograft injury (CAI) and acute tubular necrosis (ATN) can lead to renal allograft dysfunction after kidney transplantation. Interstitial fibrosis/tubular atrophy (Banff classification 2005) describes chronic allograft injury with no specific etiology, thus explaining the common final endpoint of various (immunologic and non immunologic) etiologies. The aim of this study was to evaluate correlations between the Doppler sonographic RI-values and histopathological changes of renal allografts biopsies during rejection, acute tubular necrosis and chronic allograft injury as well as the influence of donor and recipient features on the intrarenal RI-values. METHODS 102 allograft biopsies and ultrasound reports of 69 patients with kidney transplantation performed at the hospital Klinikum rechts der Isar (Technische Universität München, Germany) between 2009 and 2013 were analyzed retrospectively (41 biopsies of living donors, 61 biopsies of deceased donors). Chronic allograft injury was described using the IFTA (interstitial fibrosis and tubular atrophy) or the ECAI score (extended chronic allograft injury score). The ECAI score was built out of the chronic histological lesions glomerulopathy, interstitial fibrosis, tubular atrophy and fibrous intimal thickening (cg + ci + ct + cv) of the BANFF scoring. RESULTS Intrarenal RI-values were significantly higher in patients with allograft rejection than without rejection (median 0,79 vs. 0,73; inter quartile range: 0,20 vs. 0,13; p = 0,018). The same was found for T-and non-T cell mediated rejection (median 0,78 vs. 0,73; inter quartile range 0,20 vs. 0,13; p = 0,039). There were no significant differences in the RI-values between the subtypes of T-cell mediated rejection (type IA-IIB). Furthermore, there were no significant differences of RI-values regarding antibody-mediated rejection (present vs. not present) or type of rejection (T-cell- vs. antibody mediated rejection). Patients with rejection and simultaneously chronic allograft injury showed significantly higher RI-values than patients with only chronic allograft injury. Analyses using the IFTA or the ECAI score showed comparable results (IFTA p = 0,043; Score p = 0,021). The intrarenal RI-value was neither able to detect chronic allograft injury nor to distinguish between acute tubular necrosis and rejection. The intrarenal RI-value showed a significant correlation with recipient age (p < 0,001) but not with donor features. CONCLUSION In summary, the intrarenal RI-value can indicate a rejection but gives no clear hint to acute tubular necrosis and cannot differentiate from it. Since patients with rejection can have normal RI-values, a biopsy should always be performed in case of suspected rejection. The intrarenal RI-value has no unambiguous validity to determine intrinsic values of the renal allograft, but should rather be understood and interpreted as a systemic parameter influenced by multiple factors.
Collapse
Affiliation(s)
- Stephanie Preuss
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Charlotte Rother
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Stefan Wagenpfeil
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (IMBEI), Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland, Germany
| | | | | | - Christopher Holtzmann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Claudius Kuechle
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Konrad Friedrich Stock
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| |
Collapse
|
6
|
P16 INK4a Deletion Ameliorated Renal Tubulointerstitial Injury in a Stress-induced Premature Senescence Model of Bmi-1 Deficiency. Sci Rep 2017; 7:7502. [PMID: 28790310 PMCID: PMC5548892 DOI: 10.1038/s41598-017-06868-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
To determine whether p16 INK4a deletion ameliorated renal tubulointerstitial injury by inhibiting a senescence-associated secretory phenotype (SASP) in Bmi-1-deficient (Bmi-1 -/-) mice, renal phenotypes were compared among 5-week-old Bmi-1 and p16 INK4a double-knockout, and Bmi-1 -/- and wild-type mice. Fifth-passage renal interstitial fibroblasts (RIFs) from the three groups were analyzed for senescence and proliferation. The effect of Bmi-1 deficiency on epithelial-to-mesenchymal transition (EMT) was examined in Bmi-1-knockdown human renal proximal tubular epithelial (HK2) cells, which were treated with concentrated conditioned medium (CM) from the fifth-passage renal interstitial fibroblasts (RIFs) of above three group mice or with exogenous TGF-β1. Our results demonstrated that p16 INK4a deletion largely rescued renal aging phenotypes caused by Bmi-1 deficiency, including impaired renal structure and function, decreased proliferation, increased apoptosis, senescence and SASP, DNA damage, NF-κB and TGF-β1/Smad signal activation, inflammatory cell infiltration, and tubulointerstitial fibrosis and tubular atrophy. P16 INK4a deletion also promoted proliferation, reduced senescence and SASP of RIFs and subsequently inhibited EMT of Bmi-1-knockdown HK2 cells. TGF-β1 further induced the EMT of Bmi-1-knockdown HK2 cells. Thus, p16 INK4a positive senescent cells would be a therapeutic target for preventing renal tubulointerstitial injury.
Collapse
|
7
|
Sung CK, Han BS, Kim SH. Factors influencing the renal arterial Doppler waveform: a simulation study using an electrical circuit model (secondary publication). Ultrasonography 2016; 35:69-77. [PMID: 26732576 PMCID: PMC4701363 DOI: 10.14366/usg.15056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose: The goal of this study was to evaluate the effect of vascular compliance, resistance, and pulse rate on the resistive index (RI) by using an electrical circuit model to simulate renal blood flow. Methods: In order to analyze the renal arterial Doppler waveform, we modeled the renal blood-flow circuit with an equivalent simple electrical circuit containing resistance, inductance, and capacitance. The relationships among the impedance, resistance, and compliance of the circuit were derived from well-known equations, including Kirchhoff’s current law for alternating current circuits. Simulated velocity-time profiles for pulsatile flow were generated using Mathematica (Wolfram Research) and the influence of resistance, compliance, and pulse rate on waveforms and the RI was evaluated. Results: Resistance and compliance were found to alter the waveforms independently. The impedance of the circuit increased with increasing proximal compliance, proximal resistance, and distal resistance. The impedance decreased with increasing distal compliance. The RI of the circuit decreased with increasing proximal compliance and resistance. The RI increased with increasing distal compliance and resistance. No positive correlation between impedance and the RI was found. Pulse rate was found to be an extrinsic factor that also influenced the RI. Conclusion: This simulation study using an electrical circuit model led to a better understanding of the renal arterial Doppler waveform and the RI, which may be useful for interpreting Doppler findings in various clinical settings.
Collapse
Affiliation(s)
- Chang Kyu Sung
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Bong Soo Han
- Department of Radiological Science, College of Health Science, Yonsei University, Wonju, Korea
| | - Seung Hyup Kim
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Gao J, Rubin JM, Weitzel W, Lee J, Dadhania D, Kapur S, Min R. Comparison of Ultrasound Corticomedullary Strain with Doppler Parameters in Assessment of Renal Allograft Interstitial Fibrosis/Tubular Atrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2631-2639. [PMID: 26219696 DOI: 10.1016/j.ultrasmedbio.2015.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 05/28/2023]
Abstract
To compare the capability of ultrasound strain and Doppler parameters in the assessment of renal allograft interstitial fibrosis/tubular atrophy (IF/TA), we prospectively measured ultrasound corticomedullary strain (strain) and intra-renal artery Doppler end-diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI) in 45 renal transplant recipients before their kidney biopsies. We used 2-D speckle tracking to estimate strain, the deformation ratio of renal cortex to medulla produced by external compression using the ultrasound transducer. We also measured Doppler EDV, PSV and RI at the renal allograft inter-lobar artery. Using the Banff scoring system for renal allograft IF/TA, 45 patients were divided into the following groups: group 1 with ≤5% (n = 12) cortical IF/TA; group 2 with 6%-25% (n = 12); group 3 with 26%-50% (n = 11); and group 4 with >50% (n = 10). We performed receiver operating characteristic curve analysis to test the accuracy of these ultrasound parameters and duration of transplantation in determining >26% cortical IF/TA. In our results, strain was statistically significant in all paired groups (all p < 0.005) and inversely correlated with the grade of cortical IF/TA (p < 0.001). However, the difference in PSV and EDV was significant only between high-grade (>26%, including 26%-50% and >50%) and low-grade (≤25%, including <5% and 6%-25%) cortical IF/TA (p < 0.001). RI did not significantly differ in any paired group (all p > 0.05). The areas under the receiver operating characteristic curve for strain, EDV, PSV, RI and duration of transplantation in determining >26% cortical IF/TA were 0.99, 0.94, 0.88, 0.52 and 0.92, respectively. Our results suggest that corticomedullary strain seems to be superior to Doppler parameters and duration of transplantation in assessment of renal allograft cortical IF/TA.
Collapse
Affiliation(s)
- Jing Gao
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.
| | - Jonathan M Rubin
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - William Weitzel
- University of Michigan Hospitals, VA Medical Center, Ann Arbor, Michigan, USA
| | - Jun Lee
- Rogosin Institute, Weill Cornell Medical College, New York, New York, USA
| | - Darshana Dadhania
- Rogosin Institute, Weill Cornell Medical College, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Robert Min
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
9
|
Jin J, Lv X, Chen L, Zhang W, Li J, Wang Q, Wang R, Lu X, Miao D. Bmi-1 plays a critical role in protection from renal tubulointerstitial injury by maintaining redox balance. Aging Cell 2014; 13:797-809. [PMID: 24915841 PMCID: PMC4331754 DOI: 10.1111/acel.12236] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 12/18/2022] Open
Abstract
To determine whether Bmi-1 deficiency could lead to renal tubulointerstitial injury by mitochondrial dysfunction and increased oxidative stress in the kidney, 3-week-old Bmi-1-/- mice were treated with the antioxidant N-acetylcysteine (NAC, 1 mg mL−1) in their drinking water, or pyrro-quinoline quinone (PQQ, 4 mg kg−1 diet) in their diet for 2 weeks, and their renal phenotypes were compared with vehicle-treated Bmi1-/- and wild-type mice. Bmi-1 was knocked down in human renal proximal tubular epithelial (HK2) cells which were treated with 1 mm NAC for 72 or 96 h, and their phenotypes were compared with control cells. Five-week-old vehicle-treated Bmi-1-/- mice displayed renal interstitial fibrosis, tubular atrophy, and severe renal function impairment with decreased renal cell proliferation, increased renal cell apoptosis and senescence, and inflammatory cell infiltration. Impaired mitochondrial structure, decreased mitochondrial numbers, and increased oxidative stress occurred in Bmi-1-/- mice; subsequently, this caused DNA damage, the activation of TGF-β1/Smad signaling, and the imbalance between extracellular matrix synthesis and degradation. Oxidative stress-induced epithelial-to-mesenchymal transition of renal tubular epithelial cells was enhanced in Bmi-1 knocked down HK2 cells. All phenotypic alterations caused by Bmi-1 deficiency were ameliorated by antioxidant treatment. These findings indicate that Bmi-1 plays a critical role in protection from renal tubulointerstitial injury by maintaining redox balance and will be a novel therapeutic target for preventing renal tubulointerstitial injury.
Collapse
Affiliation(s)
- Jianliang Jin
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Xianhui Lv
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Lulu Chen
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Wei Zhang
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Jinbo Li
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Qian Wang
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Rong Wang
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
| | - Xiang Lu
- Department of Gerontology The Second Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Dengshun Miao
- The State Key Laboratory of Reproductive Medicine Department of Anatomy Histology and Embryology Nanjing Medical University Nanjing China
- Department of Gerontology The Second Affiliated Hospital of Nanjing Medical University Nanjing China
| |
Collapse
|
10
|
Bezerra DDO, Feitosa MLT, Almeida HMD, Costa FAL, Braga JFV, Souza FDAL, Alves FR, Pessoa GT, Carvalho MAMD. Collared Pecary (tayassu tajacu) as a new model of renal ischemic injury induced by clamping the renal artery. Acta Cir Bras 2014; 29:560-72. [DOI: 10.1590/s0102-8650201400150003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/22/2014] [Indexed: 11/22/2022] Open
|
11
|
Granata A, Zanoli L, Clementi S, Fatuzzo P, Di Nicolò P, Fiorini F. Resistive intrarenal index: myth or reality? Br J Radiol 2014; 87:20140004. [PMID: 24734937 DOI: 10.1259/bjr.20140004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In renal diagnosis, the B-mode ultrasound is used to provide an accurate study of the renal morphology, whereas the colour and power Doppler are of strategic importance in providing qualitative and quantitative information about the renal vasculature, which can also be obtained through the assessment of the resistive index (RI). To date, this is one of the most sensitive parameters in the study of kidney diseases and allows us to quantify the changes in renal plasma flow. If a proper Doppler ultrasound examination is carried out and a critical analysis of the values obtained is performed, the RI measurement at the interlobar artery level has been suggested in the differential diagnosis between nephropathies. The aim of this review is to highlight the pathological conditions in which the study of intrarenal RI provides useful information about the pathophysiology of renal diseases in both the native and the transplanted kidneys.
Collapse
Affiliation(s)
- A Granata
- 1 Nephrology and Dialysis Unit, "St Giovanni di Dio" Hospital, Agrigento, Italy
| | | | | | | | | | | |
Collapse
|
12
|
Gao J, Min R, Hamilton J, Weitzel W, Chen J, Juluru K, Rubin JM. Corticomedullary strain ratio: a quantitative marker for assessment of renal allograft cortical fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1769-1775. [PMID: 24065258 DOI: 10.7863/ultra.32.10.1769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To quantitatively assess the correlation between the corticomedullary strain ratio and cortical fibrosis in renal transplants. METHODS Using quasistatic ultrasound elasticity imaging, we prospectively assessed the corticomedullary strain ratio in renal allografts of 33 patients who underwent renal transplant sonography and biopsy. Based on Banff score criteria for renal cortical fibrosis, 33 allografts were divided into 2 groups: group 1 (n = 19), with mild (<25%) fibrosis; and group 2 (n = 14), with moderate (>26%) fibrosis. We used 2-dimensional speckle-tracking software to perform offline analysis of cortical and medullary strain induced by external compression by the ultrasound transducer. We then calculated the corticomedullary strain ratio (cortical normalized strain/medullary normalized strain; normalized strain = developed strain/applied strain [deformation from the abdominal wall to the pelvic muscles]). An unpaired 2-tailed t test was used to determine differences in normalized strain and the strain ratio between the groups. Receiver operating characteristic curve analysis was performed to determine the best strain ratio cutoff value for identifying moderate fibrosis. RESULTS Normalized strain differed between the cortex and medulla (mean ± SD: group 1, 4.58 ± 2.02 versus 2.58 ± 1.38; P = .002; group 2, 1.71 ± 0.42 versus 2.60 ± 0.87; P = .0011). The strain ratio in group 1 was higher than in group 2 (2.06 ± 1.33 versus 0.70 ± 0.20; P = .0007). The area under the receiver operating characteristic curve was 0.964. The sensitivity and specificity of a strain ratio cutoff value of 0.975 for determining moderate fibrosis were 92.9% and 94.7%, respectively. CONCLUSIONS Strain values vary in different compartments of the kidney. The corticomedullary strain ratio on ultrasound elasticity imaging decreases with increasing renal cortical fibrosis, which makes it potentially useful as a noninvasive quantitative marker for monitoring the progression of fibrosis in renal transplants.
Collapse
Affiliation(s)
- Jing Gao
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 E 68th St, Suite 8A-37, New York, NY 10065 USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Gao J, Chevalier J, Auh YH, Rubin JM, Wang H, Sun LN, Seshan S, Min R. Correlation between Doppler parameters and renal cortical fibrosis in lupus nephritis: a preliminary observation. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:275-282. [PMID: 23245821 DOI: 10.1016/j.ultrasmedbio.2012.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/11/2012] [Accepted: 10/08/2012] [Indexed: 06/01/2023]
Abstract
To assess the relationship between renal Doppler parameters and renal cortical fibrosis in lupus nephritis (LN), we retrospectively reviewed 24 patients with LN underwent both renal color Doppler sonography and renal biopsy. The angle-corrected Doppler parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) at the main and interlobar renal arteries were measured. The Doppler parameters and PSV and EDV ratios of the interlobar artery to main renal artery were compared with histopathologic analysis of the kidney biopsy specimen. On the basis of renal cortical fibrosis, the 24 cases of LN were divided into two groups: mild (6%-25%) renal cortex fibrosis (n = 13) and moderate (26%-50%) renal cortex fibrosis (n = 11). An independent-samples two tailed t test was used to statistically analyze the differences in PSV, EDV and RI between the two groups. Receiver operating characteristic was analyzed for assessing the accuracy of interlobar artery PSV and EDV in predicting moderate renal cortical fibrosis. In our result, both PSV and EDV in moderate renal cortex fibrosis were lower than that in mild renal cortex fibrosis. There were statistically significant differences in PSV and EDV at the interlobar artery, EDV and RI at the main renal artery, and PSV and EDV ratios of the interlobar artery to main renal artery between the two groups (all p < 0.05). The area under receiver operating characteristic curves of PSV and EDV for predicting >26% renal cortical fibrosis was 0.96 and 0.90, respectively. The optimal cutoff values for differentiating >26% renal cortical fibrosis from those <25% were PSV 30 cm/s (sensitivity = 0.92; specificity = 1) and EDV 13 cm/s (sensitivity = 0.77; specificity = 1). Therefore, the values of PSV and EDV at the interlobar artery can potentially be used as hemodynamic indicators of renal cortical fibrosis, which may non-invasively assist in monitoring the progression of renal cortical fibrosis in LN, especially in patients with contraindications to renal biopsy.
Collapse
Affiliation(s)
- Jing Gao
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Ozkan F, Yavuz YC, Inci MF, Altunoluk B, Ozcan N, Yuksel M, Sayarlioglu H, Dogan E. Interobserver variability of ultrasound elastography in transplant kidneys: correlations with clinical-Doppler parameters. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:4-9. [PMID: 23103325 DOI: 10.1016/j.ultrasmedbio.2012.09.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 08/01/2012] [Accepted: 09/18/2012] [Indexed: 06/01/2023]
Abstract
Real-time sonoelastography (RSE) is a relatively new imaging technique that visualizes relative difference in tissue hardness by evaluating changes in local strain in response to external stress. Our aim was to evaluate the ability of investigators to use sonoelastography to detect differences in renal cortical stiffness and assess the relationship between stiffness and clinical-Doppler parameters. In 42 adult renal transplant recipients, sonoelastography of kidney was performed to calculate the strain ratio (SR) of the central echo complex to the renal parenchyma. Resistive index (RI) and pulsatility index (PI) were also measured. Estimated glomerular filtration rate (eGFR) was calculated. Parenchymal stiffness showed significant positive correlation with RI and PI (r: 0.41 p = 0.007 and r: 0.48 p = 0.001, respectively). Parenchymal stiffness and eGFR did not have a significant correlation (p = 0.42). Interobserver agreement, expressed as intraclass correlation coeffiicient was 0.47 (95% CI: 0.05-0.70). Parenchymal stiffness (SR) showed significant positive correlation with RI and PI but sonoelastography has also wide range intra- and low interobserver agreement in renal transplants. Further studies are warranted in larger patient groups to determine the reliability of sonoelastography in renal transplants.
Collapse
Affiliation(s)
- Fuat Ozkan
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Wang HK, Chiou SY, Lai YC, Cheng HY, Lin NC, Loong CC, Chiou HJ, Chou YH, Chang CY. Early Postoperative Spectral Doppler Parameters of Renal Transplants: The Effect of Donor and Recipient Factors. Transplant Proc 2012; 44:226-9. [DOI: 10.1016/j.transproceed.2011.12.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
16
|
Chetboul V, Daste T, Gouni V, Concordet D, Trehiou-Sechi E, Serres F, Pouchelon J, Germain C, Layssol-Lamour C, Lefebvre H. Renal Resistive Index in 55 Dogs with Degenerative Mitral Valve Disease. J Vet Intern Med 2011; 26:101-8. [DOI: 10.1111/j.1939-1676.2011.00840.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/23/2011] [Accepted: 10/14/2011] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - V. Gouni
- Unité de Cardiologie d'Alfort and Centre Hospitalier Universitaire Vétérinaire d'Alfort; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort
| | - D. Concordet
- Université de Toulouse; INPT; Ecole Nationale Vétérinaire de Toulouse; F-31076 Toulouse & INRA; Toulouse
| | - E. Trehiou-Sechi
- Unité de Cardiologie d'Alfort and Centre Hospitalier Universitaire Vétérinaire d'Alfort; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort
| | - F. Serres
- Unité de Cardiologie d'Alfort and Centre Hospitalier Universitaire Vétérinaire d'Alfort; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort
| | - J.L. Pouchelon
- UMR INSERM U955; Ecole Nationale Vétérinaire d'Alfort; Maisons-Alfort
| | | | | | | |
Collapse
|