Importance of the Renal Resistive Index in Children Suffering from Vesicoureteral Reflux

Radmayr, Christian; Klauser, Andrea; Maneschg, Christoph; Bartsch, Georg; Frauscher, Ferdinand

doi:10.1159/000019931

Cited by 14 publications

(2 citation statements)

References 17 publications

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“…It is well recognized that RI values may be high with VUR in children [28]. In another study, mean RI values were 0.77 in children with VUR grade 4-5 and were less than 0.7 in children with VUR grade 1-3 [30]. In our study, the mean RI value was not different in children with VUR grade 4-5 or in those with VUR grade 1-3.…”

Section: Discussioncontrasting

confidence: 44%

Resistive index in febrile urinary tract infections: predictive value of renal outcome

Özçelik¹,

Polat

Aktas

et al. 2004

Pediatric Nephrology

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In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the Sişli Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4-6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744+/-0.06 in infants, 0.745+/-0.03 in preschool children, and 0.733+/-0.09 in patients of school age with upper UTI. However, the mean RI was 0.703+/-0.06 in infants, 0.696+/-0.1 in preschool children, and 0.671+/-0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI ( P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy ( P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the view that the children with high RI values are at a high risk of reflux, scarring, or both, which was frequently observed in febrile UTI. This might allow identification of patients at risk for severe renal lesions that require more aggressive therapy, investigation, and follow-up than those with lower UTI.

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Section: Discussioncontrasting

confidence: 44%

Resistive index in febrile urinary tract infections: predictive value of renal outcome

Özçelik¹,

Polat

Aktas

et al. 2004

Pediatric Nephrology

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“…The results obtained in our study are similar to those published by Frauscher et al . and Radmayr et al ., where the authors measuring renal resistive index (RI) at the level of the interlobar/arcuate arteries using color Doppler demonstrated that children with VUR grade I–III showed RI values less than the normal physiological upper limit, whereas patients with VUR grade IV–V demonstrated a significant increase of RI value [ 16 , 17 ]. Apart from these single publications found in the literature, no other reports describing renal parenchymal perfusion measurements in children with UTIs and/or VUR seem to have been published.…”

Section: Discussionmentioning

confidence: 99%

Color Doppler dynamic tissue perfusion measurement: a novel tool in the assessment of renal parenchymal perfusion in children with vesicoureteral reflux

Woźniak¹,

Scholbach²,

Scholbach³

et al. 2016

aoms

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IntroductionVesicoureteral reflux (VUR) occurs in 20–50% of children suffering from recurrent urinary tract infections (UTIs) and is associated with an increased risk of renal scarring and impaired renal function. Early detection of renal perfusion deterioration would allow for the implementation of more aggressive treatment and potentially prevent further damage to the renal parenchyma. The aim of the study was to assess renal parenchymal perfusions in children with recurrent UTIs with and without coexisting VUR, and compare the findings with the results of healthy patients.Material and methodsColor Doppler sonographic dynamic renal parenchymal perfusion measurements were performed with PixelFlux (Chameleon-Software, Germany) software in 77 children with recurrent UTIs and coexisting VUR and in 30 children with UTIs without VUR. The findings were compared with the results of 53 healthy children.ResultsCortical parenchymal perfusion of children suffering from UTIs and VUR was significantly reduced when compared to the control group. Statistically significant differences (p < 0.05) were found in all perfusion parameters (i.e. mean velocity (vmix), mean perfused area (Amix), mean perfusion intensity (Imix), tissue pulsatility index (TPI), and tissue resistance index (TRI)) between the control group and children suffering from UTIs and VUR, particularly VUR grades III and IV. There were no significant differences between the UTI group and the control group. No differences were found between the controls and VUR grade II.ConclusionsRenal parenchymal perfusion decreases significantly with higher grades of VUR.

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Vesicoureteral Reflux in Children

Mattoo

Gupta²

2022

Pediatric Nephrology

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Importance of the Renal Resistive Index in Children Suffering from Vesicoureteral Reflux

Cited by 14 publications

References 17 publications

Resistive index in febrile urinary tract infections: predictive value of renal outcome

Resistive index in febrile urinary tract infections: predictive value of renal outcome

Color Doppler dynamic tissue perfusion measurement: a novel tool in the assessment of renal parenchymal perfusion in children with vesicoureteral reflux

Vesicoureteral Reflux in Children

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