Relationship Between Renal Resistive Index and Increased Renal Cortical Stiffness in Patients with Preserved Renal Function


Abstract views: 41 / PDF downloads: 27

Authors

DOI:

https://doi.org/10.5152/EurJTher.2018.817

Keywords:

Conventional ultrasonography, cortical stiffnes, renal resistive index

Abstract

Objective: We aimed to investigate the relationship between cortical stiffness (CS) determined by shear wave elastography (SWE) and conventional ultrasonography (USG) parameters, and identify the determining parameters that increased CS.

Methods: In this study, 229 patients who underwent renal USG were included. In addition to conventional renal USG, SWE was performed. Patients were divided into two groups: with increased CS and without increased CS.

Results: The median CS value of the patients included in the study was 4.92 kPa. The increased CS value was taken as the limit value of 5.0 kPa. The age, creatinine and estimated glomerular filtration rate levels, and presence of diabetes and hypertension were significantly higher in the increased CS group (p<0.05). It was found that the cortical echogenicity increase (stage I-II), renal resistance index (RRI), and acceleration time values were significantly higher in patients with increased CS (p<0.05). When logistic regression analysis was performed to identify patients with increased CS, we found that RRI, diabetes presence, and cortical echogenicity stages I and II independently predicted an increase in CS (p<0.05). According to this analysis, RRI (every-0.1), diabetes, and cortical echogenicity stages I and II increased the risk of increased CS by 2.3 times, 14%, 10.5% and 18.2%, respectively. In ROC analysis for RRI, the area under the curve was 0.719. When the cut-off value for RRI was taken as 0.70, it was found to be 71.1% sensitive and 64.3% specific for increased CS.

Conclusion: The increase in renal echogenicity and RRI obtained by conventional USG studies independently identifies patients with increased CS.

Metrics

Metrics Loading ...

References

Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 2005; 28: 164-76.

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis 2007; 49(2 Suppl 2): S12-S154.

Sicari R, Gargani L, Wiecek A, Covic A, Goldsmith D, Suleymanlar G, et al. The use of echocardiography in observational clinical trials: the EURECA-m registry. Nephrol Dial Transplant 2013; 28: 19-23.

Zaffanello M, Piacentini G, Bruno C, Brugnara M, Fanos V. Renal elasticity quantifcation by acoustic radiation force impulse applied to the evaluation of kidney diseases: a review. J Investig Med 2015; 63: 605-12.

Samir AE, Allegretti AS, Zhu Q, Dhyani M, Anvari A, Sullivan DA, et al. Shear wave elastography in chronic kidney disease: a pilot experience in native kidneys. BMC Nephrol 2015; 116: 119.

Goya C, Kilinc F, Hamidi C, Yavuz A, Yildirim Y, Cetincakmak MG, et al. Acoustic radiation force impulse imaging for evaluation of renal parenchyma elasticity in diabetic nephropathy. Am J Roentgenol 2015; 204: 324-9.

Hassan K, Loberant N, Abbas N, Fadi H, Shadia H, Khazim K. Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease. Ther Clin Risk Manag 2016; 12: 1615-22.

Stegall MD, Park WD, Larson TS, Gloor JM, Cornell LD, Sethi S, et al. The histology of solitary renal allografts at 1 and 5 years after transplantation. Am J Transplant 2010; 11: 698-707.

Clevert DA, Stock K, Klein B, Slotta-Huspenina J, Prantl L, Heemann U, et al. Evaluation of Acoustic Radiation Force Impulse (ARFI) imaging and contrast-enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings. Clin Hemorheol Microcirc 2009; 43: 95-107.

Ozkan F, Yavuz YC, Inci MF, Altunoluk B, Ozcan N, Yuksel M, et al. Interobserver variability of ultrasound elastography in transplant kidneys: correlations with clinical-Doppler parameters. Ultrasound Med Biol 2013; 39: 4-9.

Wang HK, Lai YC, Lin YH, Chiou HJ, Chou YH. Acoustic Radiation Force Impulse Imaging of the Transplant Kidney: Correlation Between Cortical Stiffness and Arterial Resistance in Early Post-transplant Period. Transplant Proc 2017; 49: 1001-4.

Arndt R, Schmidt S, Loddenkemper C, Grünbaum M, Zidek W, van der Giet M, et al. Noninvasive evaluation of renal allograft fibrosis by transient elastographyda pilot study. Transpl Int 2010; 23: 871-7.

Stock KF, Klein BS, Vo Cong MT, Sarkar O, Römisch M, Regenbogen C, et al. ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis. Clin Hemorheol Microcirc 2010; 46: 139-48.

Guo LH, Xu HX, Fu HJ, Peng A, Zhang YF, Liu LN. Acoustic radiation force impulse imaging for noninvasive evaluation of renal parenchyma elasticity: preliminary findings. PLoS One 2013; 8: e68925.

He WY, Jin YJ, Wang WP, Li CL, Ji ZB, Yang C. Tissue elasticity quantification by acoustic radiation force impulse for the assessment of renal allograft function. Ultrasound Med Biol 2014; 40: 322-9.

Bob F, Grosu I, Sporea I, Bota S, Popescu A, Sirli R, et al. Is there a correlation between kidney shear wave velocity measured with VTQ and histological parameters in patients with chronic glomerulonephritis? A pilot study. Med Ultrason 2018; 1: 27-31.

Stock KF, Klein BS, Cong MT, Regenbogen C, Kemmner S, Büttner M, et al. ARFI-based tissue elasticity quantifcation and kidney graft dysfunction: frst clinical experiences. Clin Hemorheol Microcirc 2011; 49: 527-35.

Cui G, Yang Z, Zhang W, Li B, Sun F, Xu C, et al. Evaluation of acoustic radiation force impulse imaging for the clinicopathological typing of renal fbrosis. Exp Ther Med 2014; 7: 233-5.

Singh H, Panta OB, Khanal U, Ghimire RK. Renal Cortical Elastography: Normal Values and Variations. J Med Ultrasound 2017; 25: 215- 20.

Neıman HL. The urinary system. In: Textbook of abdominal ultrasound, p. 330. Edited by B. B. Goldberg. Williams & Wilkins, Baltimore 1993.

Platt JF, Rubin JM, Bowerman RA, Marn CS. The inability to detect kidney disease on the basis of echogenicity. Am J Roentgenol 1988; 151: 317-9.

Soldo D, Brkljacic B, Bozikov V, Drinkovic I, Hauser M. Diabetic nephropathy. Comparison of conventional and duplex Doppler ultrasonographic findings. Acta Radiol 1997; 38: 296-302.

Moghazi S, Jones E, Schroepple J, Arya K, McClellan W, Hennigar RA, et al. Correlation of renal histopathology with sonographic findings. Kidney Int 2005; 67: 1515-20.

Lee YS, Lee MJ, Kim MJ, Im YJ, Kim SW, Lim NL, et al. Is Increased Echogenicity Related to a Decrease in Glomerular Filtration Rate? Objective Measurements in Pediatric Solitary Kidney Patients--A Retrospective Analysis. PLoS One 2015; 10: e0133577.

Bude RO, Rubin JM. Effect of downstream cross-sectional area of an arterial bed on the resistive index and the early systolic acceleration. Radiology 1999; 212: 732-8.

Brkljacić B, Mrzljak V, Drinković I, Soldo D, Sabljar-Matovinović M, Hebrang A. Renal vascular resistance in diabetic nephropathy: duplex Doppler US evaluation. Radiology 1994; 192: 549-54.

Kim SH, Kim SM, Lee HK, Kim S, Lee JS, Han MC. Diabetic nephropathy: duplex Doppler ultrasound findings. Diabetes Res Clin Pract 1992; 18: 75-81.

Radermacher J, Ellis S, Haller H. Renal resistance index and progression of renal disease. Hypertension 2002; 39: 699-703.

Bruno RM, Daghini E, Versari D, Sgrò M, Sanna M, Venturini L, et al. Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis: a monocentric observational study. Cardiovasc Ultrasound 2014; 20: 12-9.

Doi Y, Iwashima Y, Yoshihara F, Kamide K, Hayashi S, Kubota Y, et al. Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension 2012; 60: 770-7.

Mogensen CE, Schmitz O. The diabetic kidney: from hyperfiltration and microalbuminuria to end-stage renal failure. Med Clin North Am 1988; 72: 1465-92.

Schmitz A, Vaeth M, Mogensen CE. Systolic blood pressure relates to the rate of progression of albuminuria in NIDDM. Diabetologia 1994; 37: 1251-8.

Downloads

Published

2023-04-19

How to Cite

Koç, A. S., & Sümbül, H. E. (2023). Relationship Between Renal Resistive Index and Increased Renal Cortical Stiffness in Patients with Preserved Renal Function. European Journal of Therapeutics, 24(4), 255–261. https://doi.org/10.5152/EurJTher.2018.817

Issue

Section

Original Articles