Association between early resistive index measurement and. Colourcoded duplex sonography is the accepted firstline imaging tool after kidney transplantation which enables the detection of morphological pathologies as well as alterations in perfusion. The intrarenal resistive index is routinely measured in many renaltransplantation centers for assessment of renalallograft status, although the value of the resistive index remains unclear. Sir, complete renal vein thrombosis rvt after renal transplantation has an incidence of 0. A noninvasive predictor of kidney dysfunction and hepatorenal failure in liver disease joel f. Doppler intrarenal arteries had a high resistance index, some more preserved. The role of the intrarenal resistive index in kidney. High rri can be caused by vasoconstriction, decreased vascular compliance, or capillary rarefaction, and is associated with renal arterial disease 4. To determine the relationship between resistive index ri measured by doppler ultrasound, serum creatinine scr, and histopathological changes on biopsy during kidney trans plant dysfunction in early postoperative period, we studied 47 kidney transplant patients.
The renal doppler resistive index renal ri is a noninvasive tool that has been used to assess renal perfusion in the intensive care unit icu setting. Nutritional status and intrarenal resistive indices after. The aim of this study was to analyze the influence of nutritional status on intrarenal resistive parameters as measured in the early period after successful kidney transplantation by. The mean value of three measurements at each kidney is usually. Platt jf, ellis jh, rubin jm, dipietro ma, sedman ab. Comparison between doppler ultrasound resistive index. The inability of an early posttransplantation intrarenal. Research article open access intrarenal resistance index. Interestingly, ri shows direct linear correlation with serum. The inability of an early posttransplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults. Resistive index measurements after kidney transplantation. In a large series, 73% were detected with a median delay of 8 days 2 suggesting that rvt develops gradually, presumably beginning as partial vein thrombosis.
Intrarenal ri was unable to assess renal function in a rat liver transplantation model. There may thus be a narrow but important window for early. Determinants and prognostic significance of the renal resistive index. However, limited data are available concerning changes of renal ri and the development of aki early after reperfusion. Intrarenal resistive index after renal transplantation nejm. Systemic arterial hemodynamics and the renal resistive. Resistive index as a predictor of early failure of kidney transplantation. Renal arterial resistive index radiology reference. Intrarenal resistive index after renal transplantation core. Intrarenal resistive index after renal transplantation request pdf. Fasting plasma total homocysteine levels and mortality and allograft loss in kidney transplant recipients. Previous studies have demonstrated the usefulness of the ri as a predictor of allograft outcomes based on ri measurement in the later stages after transplantation. In renal diagnosis, the bmode 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.
Renal resistive index reflects fontan pathophysiology and. Both pulsatility index pi and resistance index ri in the kidney graft were measured by doppler sonography twice. Factors associated with renal doppler resistive index in. Renal resistive index rri is a sonographic index assessing the resistance to flow in intrarenal arcuate or interlobar arteries. Intrarenal arterial doppler sonography in patients with nonobstructive renal disease. Renal resistive index is associated with inactive matrix. Six additional transplants performed all failed a successful kidney transplant would require. Spectral doppler ultrasonography provides the evaluation of renal resistive index rri, a noninvasive and reproducible measure to investigate arterial compliance andor resistance. Renal resistive index in hypertensive patients andrikou. Rapid adaptation of the intrarenal resistance index after. The renal arterial resistive index ri is a sonographic index to assess for renal arterial disease.
The use of renal resistive indices rris for the study of renal microcirculation has in the past been proposed for the identification of renal organ damage or even to specifically identify injury to some areas of the renal parenchyma. Indeed, in many papers, the terms resistive index and renal vascular resistance are used interchangeably. Nevertheless, according to the most recent evidences from literature this organbased conception of rris has been proven to be partial and unable to explain the. Elevated values are associated with poorer prognosis in various renal disorders and renal transplant. The intrarenal ri increased significantly during the anhepatic stage, and decreased significantly early after the reperfusion. Granata a, fiorini f, andrulli s, logias f, gallieni m, romano g, sicurezza. Parolini c, noce a, staffolani e, giarrizzo gf, costanzi s, splendiani g.
Renal vein thrombosis after renal transplantation early. Pdf intrarenal resistance index for the assessment of. Ultrasound renal resistive index is not an organspecific predictor of allograft outcome. Doppler us assessment of the renal transplantation epos. The potential role of doppler sonography in the evaluation of renal colic has been particularly controversial. Increased renal resistive index in atherosclerosis and. Prognostic significance of renal arterial resistance index in living. Why does renal resistive index predict mortality in. The value of intrarenal resistive index after renal transplantation maarten naesens in memoriam of prof. Ri after renal transplantation may lead to a more aggressive management of high risk patients, and. The renal arterial resistive index ri is a sonographic index of intrarenal arteries defined as peak systolic velocity end diastolic velocity peak systolic velocity. The arterial resistive index, also referred to as the resistive index ri or pourcelot index, is a measure of pulsatile blood flow. The renal resistive index rri, derived from the doppler flowvelocity. Resistive index predicts renal prognosis in chronic kidney disease.
Request pdf the role of the intrarenal resistive index in kidney transplantation the evaluation of renal allografts has progressed little over the past 20 years. In this study, the ri was calculated using doppler ultrasonography on postoperative day 7 in patients undergoing renal transplantation. Imagination to reality early 20th century 1902 prof. The rri is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. In a singlecenter, prospective study involving 321 renalallograft recipients, we measured the resistive index at baseline, at the time of protocolspecified renalallograft biopsies 3, 12, and 24 months after transplantation, and at the time of biopsies performed because of graft dysfunction. Shakeri bavil a, mirfakhraei a, tayebi khosroshahi h, chokhachizadeh moghadam r, fouladi df. Intrarenal resistance index for the assessment of acute. Metaanalysis of observational studies in epidemiology moose group. Diagnostic of renal resistive index for the assessment of. In a singlecenter, prospective study involving 321 renalallograft recipients. Renal transplantation is one of the most important therapeutic alternatives for patients. The dopplerderived renal resistive index has been used for years in a variety of clinical settings such as the assessment of chronic renal allograft rejection, detection and management of renal artery stenosis, evaluation of progression risk in chronic kidney disease, differential diagnosis in acute and chronic obstructive renal disease, and more recently as a predictor of renal and global. Early assessment of renal resistance index after kidney transplant.
The inability of an early posttransplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults abolhassan shakeri bavil, alirezal mirfakhraei, hamid tayebi khosroshahi, reihaneh chokhachizadeh. Kidney transplantation has become the optimal treatment for endstage renal disease. Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites 18 september 2008 intensive care medicine, vol. Acute kidney injury aki is a common complication after liver transplantation lt and. The purpose of this study is to evaluate the prognostic performance of intrarenal resistive index in the first years after kidney transplantation on graft function and on patient and graft survival. This study was conducted to clarify the clinical significance of the rri in fontan pathophysiology. Color doppler ultrasonography of intrarenal arterial resistance index ri, performed early after kidney transplant, has proven to reliab. Reference values and factors associated with renal resistive index in a familybased population study. Methods we measured the rri in 280 consecutive fontan patients and 36 healthy controls. Intrarenal resistive index in renal transplantation n engl j med 369. Seiler s, colbus sm, lucisano g, rogacev ks, gerhart mk, ziegler m, fliser d, heine gh.
Request pdf intrarenal resistive index after renal transplantation the intrarenal resistive index is routinely measured in many renaltransplantation centers. Objective the renal resistive index ri and pulsatility index pi, measured using doppler ultrasonography, reflect intrarenal vascular resistance. Objectives the renal resistive index rri reflects nonrenal pathophysiology, such as great artery stiffness, haemodynamics and even endorgan damage in patients with hypertension. Yves vanrenterghem eurotransplant winter meeting 2014 2. Ri peak systolic velocity end diastolic velocity peak systolic velocity. We evaluated the relationship between these indices and pulse wave velocity pwv, a measure of arterial stiffness, which reflects atherosclerosis, and determined whether renal ri and pi differ depending on the underlying renal disease. In two initial series, either an ri greater than 0.
Currently, several transplantation centers use the intrarenal resistive index ri, which is calculated using doppler ultrasonography, to evaluate renal allografts. Any information contained in this pdf file is automatically generated from digital material. Renal transplantation is the therapy of choice in patients with established renal failure, resulting in improved survival and quality of life while proving more costeffective than dialysis. Liver transplantation, doppler sonography, renal function, resistive index, cys, ngal background. Acute kidney injury aki is a common complication after liver transplantation lt and associated with a high mortality. In the united kingdom, the 1 and 5year graft survival rate for a renal transplant is now 93% and 83%, respectively, for deceaseddonor organs both heartbeating donors and nonheart. It may also be present after removing the double j stent.
Point of care renal ultrasonography for the busy nephrologist. Background acute kidney injury aki is a common complication after liver transplantation lt and associated with a high mortality. An important and widely used variable to assess the overall perfusion of the renal. Metaanalysis of observational studies in epidemiology. However, the influence of obesity has not been established on parameters of renal vascular resistance variation. With regard to the protocolspecified measurements, higher resistive indexes were not. Intrarenal resistive index after renal transplantation. The aim of this study was to investigate the value of renal resistive index ri for the assessment of renal colic and to determine whether it is predictive of renal stone disease.
In addition, the determinants of the intrarenal resistive index, including a detailed analysis of the relation between graft histology and the. Early measurement of pulsatility and resistive indexes. In cases of ras, the increase in ri is associated with a reduced likelihood of improved renal function after pta and is a predictor of poor allograft survival after kidney transplantation. However, many parameters have been described as influential on the values of renal ri. The intrarenal resistive index is routinely measured in many renal transplantation centers for assessment of renal allograft status, although the value of the resistive index remains unclear. Lucey,3 department of radiology, department of surgery and 3department of internal medicine, university michigan medical center, ann arbor, michigan 481090030. Renal duplex doppler ultrasonography a noninvasive. The renal resistive index rri is measured by doppler sonography in an intrarenal artery, and is the difference between the peak systolic and enddiastolic blood velocities divided by the peak systolic velocity. Renal resistive index and longterm outcome in chronic.