Doppler Spectrum Analysis to Diagnose Rejection During Posttransplant Acute Renal Failure

Jw, Merkus; Aj, Hoitsma; Wn, van Asten; Ra, Koene; Sh, Skotnicki

doi:10.1097/00007890-199409150-00008

Cited by 23 publications

(5 citation statements)

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“…Mercus et al reported that Doppler spectrum analysis enables the detection of AR as early as 5 days after transplantation [5]. Using serial Doppler ultrasonography, we observed that it is possible to detect an increase in intra-renal indices well in advance (0.95 days before the commencement of anti-rejection treatment).…”

Section: Discussionmentioning

confidence: 59%

“…Tranquart et al [7] observed that RI at 30 min after transplantation was significantly higher in patients who developed ATN (n=8, mean RI 0.80+0.09) than in those who did not develop ATN (n = 9, mean RI 0.66 + 0.12). Needleman and Kurtz [5] reported that duplex ultrasonography could not distinguish between ATN and AR and concluded that biopsy remained the procedure of choice. By raising the cut-off line from of PI from 1.4 to 1.8 and that of RI from 0.7 to 0.8, a marked improvement was noted in specificity and positive predictability reciprocal to, and thereby at the cost of, reduced sensitivity, Tables 3 and 4.…”

Section: Discussionmentioning

confidence: 99%

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Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Sharma

Rustom

Evans

et al. 2004

Transplant International

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This study aims to explore the utility of serial duplex scanning and to compare its results with those of single time-point scans of renal allografts in the diagnosis of acute rejection (AR). A retrospective analysis of 60 17 serial duplex scans (mean: 9.8 scans per patient, 5.7 of which were done during the first 10 days) was performed in 614 patients with 462 episodes of AR from 1992-2000. Even in the absence of AR (n = 278), there were day-to-day fluctuations in pulsatility index (PI) and resistive index (RI). An increase of > 10% in intra-renal indices was noted 0.95 days (mean) before the commencement of treatment for AR (SD 1.3, range 1-6 days). In patients with acute tubular necrosis (ATN), who have high base line indices, sensitivity of single value of PI and RI was 58% (cut-off level 1.8) and 68% (cut-off level 0.8), with specificity of 66% and 56%, respectively. By contrast, a > 10% increase over the previous 'best' in PI and RI had a sensitivity of 78% and 60% respectively, and a specificity of 78% and go%, respectively. Reversal of flow during diastole (n = 50) was found to be associated with 22% graft loss within 3 months of transplantation. We can conclude that a considerable overlap between the indices of patients with AR and those with ATN greatly limits the diagnostic yield of duplex scanning. Nonetheless, serial scanning of renal allografts is more likely to herald the need for biopsy in the diagnosis of AR than one-time scanning.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Sharma

Rustom

Evans

et al. 2004

Transplant International

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“…Color Doppler ultrasound is widely used to detect graft dysfunction [ 10 , 11 ]. Early research [ 12 ] showed that it is possible to detect acute rejection 5 days after transplantation. Sharma et al [ 11 ] analyzed 6017 ultrasonic scans performed in 614 patients with 462 episodes of acute rejection from 1992 to 2000, and reported that a >10% increase over the previous ‘best’ RI had a sensitivity of 60% and a specificity of 90% for the diagnosis of acute rejection.…”

Section: Discussionmentioning

confidence: 99%

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

et al. 2021

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Background The aim of this study was to investigate the diagnostic and prognostic utility of color Doppler ultrasound for graft dysfunction in recurrent immunoglobulin A nephropathy (IgAN). Material/Methods We selected a series of 78 biopsies diagnostic of recurrent IgAN following living-donor transplantation from July 2004 to January 2019. Based on Lee’s classification, Doppler parameters in different degrees of histopathological injury were retrospectively analyzed. Results The 4-year cumulative graft survival rate after biopsy was 66.3%, and the difference among the Kaplan-Meier curves of Lee’s classification ( P <0.01) was significant. Doppler parameters showed that echo enhancement, decreasing blood flow distribution, decreasing end-diastolic velocity (EDV) of the main renal artery (MRA), segmental renal atery (SRA) and interlobar renal artery (IRA), and an elevated resistance index (RI) of the arcuate renal artery (ARA) were significantly different among grades I-V of Lee’s classification ( P <0.05). Logistic multivariate analysis indicated that echo enhancement (HR 13.6, 95% CI 2.7–68.4) and decreasing EDV of the SRA (HR 1.1 for a 1-cm/s, 95% CI 1.0–1.2) were independent predictors of severe injury (IV–V). The ROC curve fitted by echo enhancement and decreasing EDV of the SRA had an area under the curve of 0.87. The cutoff was 17.5 cm/s (decreasing EDV of the SRA) without echo enhancement. The sensitivity and specificity were 72.2% and 91.7%, respectively. Conclusions Color Doppler ultrasound successfully evaluated the graft dysfunction in recurrent IgAN; a decreasing EDV of the SRA indicated severe histopathological injury and poor prognosis.

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“…In clinical renal vascular studies, the pulsatility index (PI) (Gosling and King 1974) and the resistive index (RI) are both calculated from the averaged blood pressure and flow values obtained from a Doppler sonograph. These indices have proved to be helpful in many clinical situations (Handa et al 1986, Veglio et al 1995, Karadeniz et al 1996 but they have their limitations (Merkus et al 1994, Salgado et al 1997, Pozniak et al 1988, Warshauer et al 1988. It is expected that a complete renal impedance spectrum with frequency dependency ought to provide a good deal more information about the physical properties of the renal vascular bed and hence offer greater diagnostic power than both the PI and RI.…”

Section: Motivation For Studying the Complete Renal Impedance Spectrummentioning

confidence: 99%

Three-block electrical model of renal impedance

et al. 2005

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In this study, we measured the characteristic renal impedance profiles of Wistar rats and simulated the profiles using an electrical model with three series connected Windkessel blocks containing inductance. It is expected that a complete renal impedance profile ought to provide better physical properties information and have more diagnostic power than the pulsatility (PI) and resistive indices (RI) as a result of frequency dependency. A characteristic peak value at the third harmonic on the renal impedance amplitude curve was observed and the phase curve decreased with increasing harmonic numbers. From least mean square fitted parameters, the three blocks were given distinct physical properties and identified as: (1) the renal artery, (2) the small arteries plus the afferent arteriole and (3) the residual kidney (i.e., the efferent arteriole plus the post glomerular capillary structures). These allocations were made according to respective physical properties reported in previous research. These classifications were further confirmed when we compressed the kidney or infused Ang II. Variations in electrical parameters concurred with the likely affected blood vessels reported. This model describes renal impedance characteristics well; and it provides useful hints on the physical properties of the renal vascular system as well as allows for distinctions in possible physiologically affected locations during functional disturbance. It has potential for development as a clinical non-invasive diagnostic tool.

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Doppler Spectrum Analysis to Diagnose Rejection During Posttransplant Acute Renal Failure

Cited by 23 publications

References 0 publications

Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy

Three-block electrical model of renal impedance

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