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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 11/2012

01.11.2012 | Review

Renal Doppler to assess renal perfusion in the critically ill: a reappraisal

verfasst von: David Schnell, Michael Darmon

Erschienen in: Intensive Care Medicine | Ausgabe 11/2012

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Abstract

Purpose

To describe the method and significance of Doppler-based resistive index (RI) and to provide an updated description of its interest with a special focus on the critically ill.

Methods

Review of selected studies on RI found in the PubMed, Ovid and Cochrane databases. Additional references were retrieved from the selected studies.

Results

An increasing body of evidence suggests that renal Doppler may help to assess perfusion of native or transplanted kidneys. In addition, recent studies suggest that it may be useful in critically ill patients. The RI is a parameter derived from Doppler examination that is calculated as follows: \( {\text{RI}} = \left[ {\text{peak systolic shift}}\,-\,{\text{minimum diastolic shift}} \right]/{\text{peak systolic shift}} \). Renal Doppler has proven to be valuable for assessing large arterial or venous abnormalities and has been suggested to assess renal perfusion and to predict acute kidney injury (AKI) in critically ill patients. However, numerous factors have been shown to influence renal Doppler and may constitute potential confounding factors. Moreover, experience with critically ill patients is scant and our understanding of factors influencing RI in this setting is limited.

Conclusion

Doppler-based RI seems to be a promising tool in the critically ill to assess the risk of AKI, help in differentiating persistent from transient AKI, or assess changes in renal perfusion as consequences of therapeutic intervention. However, we still lack large, adequately powered studies in non-selected populations of patients before implementing this technique in clinical practice. In addition, the impact of several factors that may influence this parameter remains to be evaluated.
Literatur
1.
Barozzi L, Valentino M, Santoro A, Mancini E, Pavlica P (2007) Renal ultrasonography in critically ill patients. Crit Care Med 35:S198–S205PubMedCrossRef
2.
3.
Krumme B, Blum U, Schwertfeger E, Flugel P, Hollstin F, Schollmeyer P, Rump LC (1996) Diagnosis of renovascular disease by intra- and extrarenal Doppler scanning. Kidney Int 50:1288–1292PubMedCrossRef
4.
Allen KS, Jorkasky DK, Arger PH, Velchik MG, Grumbach K, Coleman BG, Mintz MC, Betsch SE, Perloff LJ (1988) Renal allografts: prospective analysis of Doppler sonography. Radiology 169:371–376PubMed
5.
Buckley AR, Cooperberg PL, Reeve CE, Magil AB (1987) The distinction between acute renal transplant rejection and cyclosporine nephrotoxicity: value of duplex sonography. AJR Am J Roentgenol 149:521–525PubMed
6.
Patriquin HB, O’Regan S, Robitaille P, Paltiel H (1989) Hemolytic-uremic syndrome: intrarenal arterial Doppler patterns as a useful guide to therapy. Radiology 172:625–628PubMed
7.
Platt JF, Rubin JM, Ellis JH, DiPietro MA (1989) Duplex Doppler US of the kidney: differentiation of obstructive from nonobstructive dilatation. Radiology 171:515–517PubMed
8.
Platt JF (1992) Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol 158:1035–1042PubMed
9.
Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J (2007) Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med 33:1557–1562PubMedCrossRef
10.
Duranteau J, Deruddre S, Vigue B, Chemla D (2008) Doppler monitoring of renal hemodynamics: why the best is yet to come. Intensive Care Med 34:1360–1361PubMedCrossRef
11.
Lauschke A, Teichgraber UK, Frei U, Eckardt KU (2006) ‘Low-dose’ dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int 69:1669–1674PubMedCrossRef
12.
Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY (2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 32:1553–1559PubMedCrossRef
13.
Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C, Brochard L (2011) Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med 37:68–76PubMedCrossRef
14.
Murphy ME, Tublin ME (2000) Understanding the Doppler RI: impact of renal arterial distensibility on the RI in a hydronephrotic ex vivo rabbit kidney model. J Ultrasound Med 19:303–314PubMed
15.
Le Dorze M, Bougle A, Deruddre S, Duranteau J (2012) Renal Doppler ultrasound: a new tool to assess renal perfusion in critical illness. Shock 37:360–365PubMedCrossRef
16.
Schneider A, Johnson L, Goodwin M, Schelleman A, Bellomo R (2011) Bench-to-bedside review: contrast enhanced ultrasonography–a promising technique to assess renal perfusion in the ICU. Crit Care 15:157PubMedCrossRef
17.
Knapp R, Plotzeneder A, Frauscher F, Helweg G, Judmaier W, zur Nedden D, Recheis W, Bartsch G (1995) Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation. J Ultrasound Med 14:427–429PubMed
18.
Keogan MT, Kliewer MA, Hertzberg BS, DeLong DM, Tupler RH, Carroll BA (1996) Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology 199:165–169PubMed
19.
Norris CS, Pfeiffer JS, Rittgers SE, Barnes RW (1984) Noninvasive evaluation of renal artery stenosis and renovascular resistance. Experimental and clinical studies. J Vasc Surg 1:192–201PubMedCrossRef
20.
Bude RO, DiPietro MA, Platt JF, Rubin JM, Miesowicz S, Lundquist C (1992) Age dependency of the renal resistive index in healthy children. Radiology 184:469–473PubMed
21.
Terry JD, Rysavy JA, Frick MP (1992) Intrarenal Doppler: characteristics of aging kidneys. J Ultrasound Med 11:647–651PubMed
22.
el Helou N, Helenon O, Augusti M, Correas JM, el Rody F, Souissi M, Moreau JF (1993) Renal Doppler ultrasonography in the diagnosis of acute obstructions of the upper urinary tract. J Radiol 74:499–507PubMed
23.
Mostbeck GH, Gossinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D (1990) Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology 175:511–513PubMed
24.
Tublin ME, Tessler FN, Murphy ME (1999) Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology 213:258–264PubMed
25.
Vade A, Dudiak C, McCarthy P, Hatch DA, Subbaiah P (1999) Resistive indices in the evaluation of infants with obstructive and nonobstructive pyelocaliectasis. J Ultrasound Med 18:357–361PubMed
26.
Mastorakou I, Lindsell DR, Piepoli M, Adamopoulos S, Ledingham JG (1994) Pulsatility and resistance indices in intrarenal arteries of normal adults. Abdom Imaging 19:369–373PubMedCrossRef
27.
Raisinghani A, Rafter P, Phillips P, Vannan MA, DeMaria AN (2004) Microbubble contrast agents for echocardiography: rationale, composition, ultrasound interactions, and safety. Cardiol Clin 22:171–180, v
28.
Vogel R, Indermuhle A, Reinhardt J, Meier P, Siegrist PT, Namdar M, Kaufmann PA, Seiler C (2005) The quantification of absolute myocardial perfusion in humans by contrast echocardiography: algorithm and validation. J Am Coll Cardiol 45:754–762PubMedCrossRef
29.
Dolan MS, Gala SS, Dodla S, Abdelmoneim SS, Xie F, Cloutier D, Bierig M, Mulvagh SL, Porter TR, Labovitz AJ (2009) Safety and efficacy of commercially available ultrasound contrast agents for rest and stress echocardiography a multicenter experience. J Am Coll Cardiol 53:32–38PubMedCrossRef
30.
Mostbeck GH, Kain R, Mallek R, Derfler K, Walter R, Havelec L, Tscholakoff D (1991) Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation. J Ultrasound Med 10:189–194PubMed
31.
Jensen G, Bardelli M, Volkmann R, Caidahl K, Rose G, Aurell M (1994) Renovascular resistance in primary hypertension: experimental variations detected by means of Doppler ultrasound. J Hypertens 12:959–964PubMedCrossRef
32.
Wan L, Yang N, Hiew CY, Schelleman A, Johnson L, May C, Bellomo R (2008) An assessment of the accuracy of renal blood flow estimation by Doppler ultrasound. Intensive Care Med 34:1503–1510PubMedCrossRef
33.
Raff U, Schwarz TK, Schmidt BM, Schneider MP, Schmieder RE (2010) Renal resistive index–a valid tool to assess renal endothelial function in humans? Nephrol Dial Transplant 25:1869–1874PubMedCrossRef
34.
Bude RO, Rubin JM (1999) Stenosis of the main artery supplying an organ: effect of end-organ vascular compliance on the poststenotic peak systolic velocity. J Ultrasound Med 18:603–613PubMed
35.
Darmon M, Schortgen F, Leon R, Moutereau S, Mayaux J, Di Marco F, Devaquet J, Brun-Buisson C, Brochard L (2009) Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensive Care Med 35:1031–1038PubMedCrossRef
36.
Sharkey RA, Mulloy EM, O’Neill SJ (1998) Acute effects of hypoxaemia, hyperoxaemia and hypercapnia on renal blood flow in normal and renal transplant subjects. Eur Respir J 12:653–657PubMedCrossRef
37.
Sharkey RA, Mulloy EM, O’Neill SJ (1999) The acute effects of oxygen and carbon dioxide on renal vascular resistance in patients with an acute exacerbation of COPD. Chest 115:1588–1592PubMedCrossRef
38.
Sharkey RA, Mulloy EM, Long M, O’Neill SJ (1999) The effect of continuous positive airway pressure (CPAP) on renal vascular resistance: the influence of renal denervation. Crit Care 3:33–37PubMedCrossRef
39.
Mitchell GF (2008) Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol 105:1652–1660PubMedCrossRef
40.
Derchi LE, Leoncini G, Parodi D, Viazzi F, Martinoli C, Ratto E, Vettoretti S, Vaccaro V, Falqui V, Tomolillo C, Deferrari G, Pontremoli R (2005) Mild renal dysfunction and renal vascular resistance in primary hypertension. Am J Hypertens 18:966–971PubMedCrossRef
41.
Ohta Y, Fujii K, Arima H, Matsumura K, Tsuchihashi T, Tokumoto M, Tsuruya K, Kanai H, Iwase M, Hirakata H, Iida M (2005) Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography. J Hypertens 23:1905–1911PubMedCrossRef
42.
Williams GJ, Macaskill P, Chan SF, Karplus TE, Yung W, Hodson EM, Craig JC (2007) Comparative accuracy of renal duplex sonographic parameters in the diagnosis of renal artery stenosis: paired and unpaired analysis. AJR Am J Roentgenol 188:798–811PubMedCrossRef
43.
Kirkpatrick AW, Colistro R, Laupland KB, Fox DL, Konkin DE, Kock V, Mayo JR, Nicolaou S (2007) Renal arterial resistive index response to intraabdominal hypertension in a porcine model. Crit Care Med 35:207–213PubMedCrossRef
44.
Umgelter A, Reindl W, Franzen M, Lenhardt C, Huber W, Schmid RM (2009) Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites. Intensive Care Med 35:152–156PubMedCrossRef
45.
Platt JF, Ellis JH, Rubin JM, DiPietro MA, Sedman AB (1990) Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. AJR Am J Roentgenol 154:1223–1227PubMed
46.
Ikee R, Kobayashi S, Hemmi N, Imakiire T, Kikuchi Y, Moriya H, Suzuki S, Miura S (2005) Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis 46:603–609PubMedCrossRef
47.
Aikimbaev KS, Canataroglu A, Ozbek S, Usal A (2001) Renal vascular resistance in progressive systemic sclerosis: evaluation with duplex Doppler ultrasound. Angiology 52:697–701PubMedCrossRef
48.
Platt JF, Rubin JM, Ellis JH (1997) Lupus nephritis: predictive value of conventional and Doppler US and comparison with serologic and biopsy parameters. Radiology 203:82–86PubMed
49.
Sari A, Dinc H, Zibandeh A, Telatar M, Gumele HR (1999) Value of resistive index in patients with clinical diabetic nephropathy. Invest Radiol 34:718–721PubMedCrossRef
50.
Frauchiger B, Nussbaumer P, Hugentobler M, Staub D (2000) Duplex sonographic registration of age and diabetes-related loss of renal vasodilatory response to nitroglycerine. Nephrol Dial Transplant 15:827–832PubMedCrossRef
51.
Petersen LJ, Petersen JR, Talleruphuus U, Ladefoged SD, Mehlsen J, Jensen HA (1997) The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure. Nephrol Dial Transplant 12:1376–1380PubMedCrossRef
52.
Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A, Eisenberger U, Burg M, Luft FC, Gwinner W, Haller H (2003) The renal arterial resistance index and renal allograft survival. N Engl J Med 349:115–124PubMedCrossRef
53.
Don S, Kopecky KK, Filo RS, Leapman SB, Thomalla JV, Jones JA, Klatte EC (1989) Duplex Doppler US of renal allografts: causes of elevated resistive index. Radiology 171:709–712PubMed
54.
Rifkin MD, Needleman L, Pasto ME, Kurtz AB, Foy PM, McGlynn E, Canino C, Baltarowich OH, Pennell RG, Goldberg BB (1987) Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index. AJR Am J Roentgenol 148:759–762PubMed
55.
Perrella RR, Duerinckx AJ, Tessler FN, Danovitch GM, Wilkinson A, Gonzalez S, Cohen AH, Grant EG (1990) Evaluation of renal transplant dysfunction by duplex Doppler sonography: a prospective study and review of the literature. Am J Kidney Dis 15:544–550PubMed
56.
Kelcz F, Pozniak MA, Pirsch JD, Oberly TD (1990) Pyramidal appearance and resistive index: insensitive and nonspecific sonographic indicators of renal transplant rejection. AJR Am J Roentgenol 155:531–535PubMed
57.
Genkins SM, Sanfilippo FP, Carroll BA (1989) Duplex Doppler sonography of renal transplants: lack of sensitivity and specificity in establishing pathologic diagnosis. AJR Am J Roentgenol 152:535–539PubMed
58.
Trillaud H, Merville P, Tran Le Linh P, Palussiere J, Potaux L, Grenier N (1998) Color Doppler sonography in early renal transplantation follow-up: resistive index measurements versus power Doppler sonography. AJR Am J Roentgenol 171:1611–1615PubMed
59.
Lebkowska U, Malyszko J, Lebkowski W, Brzosko S, Kowalewski R, Lebkowski T, Janica J, Michalak P, Gacko M, Mysliwiec M, Walecki J (2007) The predictive value of arterial renal blood flow parameters in renal graft survival. Transplant Proc 39:2727–2729PubMedCrossRef
60.
Radmehr A, Jandaghi AB, Hashemi Taheri AP, Shakiba M (2008) Serial resistive index and pulsatility index for diagnosing renal complications in the early posttransplant phase: improving diagnostic efficacy by considering maximum values. Exp Clin Transplant 6:161–167PubMed
61.
Nezami N, Tarzamni MK, Argani H, Nourifar M (2008) Doppler ultrasonographic indices after renal transplantation as renal function predictors. Transplant Proc 40:94–99PubMedCrossRef
62.
Schwenger V, Korosoglou G, Hinkel UP, Morath C, Hansen A, Sommerer C, Dikow R, Hardt S, Schmidt J, Kucherer H, Katus HA, Zeier M (2006) Real-time contrast-enhanced sonography of renal transplant recipients predicts chronic allograft nephropathy. Am J Transplant 6:609–615PubMedCrossRef
63.
Amis ES Jr, Cronan JJ, Pfister RC, Yoder IC (1982) Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 19:101–105PubMedCrossRef
64.
Platt JF, Rubin JM, Ellis JH (1989) Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. AJR Am J Roentgenol 153:997–1000PubMed
65.
Gottlieb RH, Kt Luhmann, Oates RP (1989) Duplex ultrasound evaluation of normal native kidneys and native kidneys with urinary tract obstruction. J Ultrasound Med 8:609–611PubMed
66.
Onur MR, Cubuk M, Andic C, Kartal M, Arslan G (2007) Role of resistive index in renal colic. Urol Res 35:307–312PubMedCrossRef
67.
Tublin ME, Dodd GD 3rd, Verdile VP (1994) Acute renal colic: diagnosis with duplex Doppler US. Radiology 193:697–701PubMed
68.
Gurel S, Akata D, Gurel K, Ozmen MN, Akhan O (2006) Correlation between the renal resistive index (RI) and nonenhanced computed tomography in acute renal colic: how reliable is the RI in distinguishing obstruction? J Ultrasound Med 25:1113–1120 (quiz 1121–1113)PubMed
69.
Platt JF (1994) Looking for renal obstruction: the view from renal Doppler US. Radiology 193:610–612PubMed
70.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212PubMedCrossRef
71.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31PubMedCrossRef
72.
Lameire N, Hoste E (2004) Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr Opin Crit Care 10:468–475PubMedCrossRef
73.
Waikar SS, Bonventre JV (2009) Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 20:672–679PubMedCrossRef
74.
Lameire N, Van Biesen W, Vanholder R (2005) Acute renal failure. Lancet 365:417–430PubMed
75.
American Society of Nephrology (2005) American Society of Nephrology renal research report. J Am Soc Nephrol 16:1886–1903
76.
Bossard G, Bourgoin P, Corbeau JJ, Huntzinger J, Beydon L (2011) Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass. Br J Anaesth 107:891–898PubMedCrossRef
77.
Stevens PE, Gwyther SJ, Hanson ME, Boultbee JE, Kox WJ, Phillips ME (1990) Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man. Intensive Care Med 16:153–158PubMedCrossRef
78.
Izumi M, Sugiura T, Nakamura H, Nagatoya K, Imai E, Hori M (2000) Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound. Am J Kidney Dis 35:713–719PubMedCrossRef
79.
Platt JF, Rubin JM, Ellis JH (1991) Acute renal failure: possible role of duplex Doppler US in distinction between acute prerenal failure and acute tubular necrosis. Radiology 179:419–423PubMed
80.
Corradi F, Brusasco C, Vezzani A, Palermo S, Altomonte F, Moscatelli P, Pelosi P (2011) Hemorrhagic shock in polytrauma patients: early detection with renal Doppler resistive index measurements. Radiology 260:112–118PubMedCrossRef
81.
Mimura I, Nangaku M (2010) The suffocating kidney: tubulointerstitial hypoxia in end-stage renal disease. Nat Rev Nephrol 6:667–678PubMedCrossRef
Metadaten
Titel
Renal Doppler to assess renal perfusion in the critically ill: a reappraisal
verfasst von
David Schnell
Michael Darmon
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 11/2012
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2692-z

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