O papel da ultra-sonografia vascular com Doppler colorido na avaliação da hipertensão reno-vascular: acurácia da técnica direta de avaliação das artérias renais

Abstract

477The early diagnosis of patients suspected of having renovascular hypertension is important because of the risk of progression to renal insufficiency due to the nephropathic ischemia caused by lesions limiting the renal artery flow.The diagnosis of arterial hypertension resulting from renal artery stenosis may be established with the following different complementary examinations: determination of selective renin in the renal vein; functional study with radioisotopes; excretory urography; determination of the peripheral renin stimulated with captopril; magnetic angioresonance; angiography; and, more recently, vascular color Doppler ultrasound.Arteriography is the most precise method for diagnosing renal artery stenosis, but it has some limitations, such as allergic reaction and the risk of nephrotoxicity due to the contrast medium, in addition to complications inherent to the procedure and its high cost. Another important factor is that arteriography is an anatomic study, and, therefore, does not provide hemodynamic information about the renal lesions.This study aimed at assessing the accuracy of vascular color Doppler ultrasound as compared with that of arteriography in identifying hemodynamically significant renal artery stenoses. MethodsWe carried out a prospective double-blind study at the Noninvasive Vascular Laboratory of the Hospital de Caridade of the Santa Casa de Misericórdia de Curitiba/PUCPR, to assess the accuracy of vascular color Doppler ultrasound in the diagnosis of stenotic or obstructive lesions in the renal arteries as compared with that of arteriography, which is considered the gold standard.One hundred and thirty-seven renal arteries from 69 adult patients (30 men and 39 women) suspected of having renovascular arterial hypertension, with no distinction of complexion or biotype, and a mean age of 54 years were studied. One of the patients had undergone nephrectomy prior to the study.The following patients with arterial hypertension of recent onset were included in the study: young individuals with no familial history of hypertension; individuals > 55 years with arterial hypertension of recent onset or abrupt lack of control; hypertensive individuals refractory to treatment; hypertensive individuals with an abdominal murmur; and individuals with predominantly diastolic arterial hypertension (> 120 mmHg). Patients with the following characteristics were excluded from the study: previous diagnosis of renal artery lesion; history of allergy to iodinated contrast me- ObjectiveTo assess the accuracy of vascular color Doppler ultrasound as compared with digital subtraction arteriography for identifying hemodynamically significant renal artery stenoses. MethodsOne hundred and thirty-seven renal arteries from 69 adult patients suspected of having renovascular arterial hypertension were prospectively studied with ultrasound. The results obtained were compared in a double-blind manner with those obtained on digital subtraction arteriography, and the following parameters were calculated according to ...

Parâmetros diretos do duplex scan no diagnóstico da estenose da artéria renal: estudo de validação e otimização dos pontos de corte

“…These findings also concur with the study conducted by House and associates, who obtained better results using a combination of PSV of 180 cm/sec and RAR of 3.0 27 . Although Engelhorn and associates had obtained high sensitivity rates using the cut-off points recommended by medical literature, they emphasized that in the cases of false-negatives results, the PSV was approximately 200 cm/sec and the RAR was lower than 3.5 29 .…”

Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis

“…Doença aterosclerótica multiarterial em pacientes hipertensos diAgnóstico de hipertensão ArteriAl com estenose de ArtériA renAl e AvAliAção dA função renAl O diagnóstico de hipertensão arterial com estenose de artéria renal foi considerado observando-se a presença de hipertensão arterial, caracterizada como PAS ≥ 140 mmHg ou PAD ≥ 90 mmHg 9 , associada à estenose luminal superior a 70% da artéria renal, realizado no nosso serviço por meio de ultrassonografia doppler colorido ou arteriografia, sendo comprovada a etiologia aterosclerótica pelas características da estenose. 10 A função renal foi avaliada pela dosagem de creatinina sérica, sendo considerados alterados valores acima de 1,3 mg/dL para o sexo masculino e 1,2 mg/dL para o sexo feminino. De posse do peso (kg), gênero, idade (anos), e creatinina sérica (mg/dL), foi calculada a taxa estimada de filtração glomerular (ml/min) por Cockcroft-Gault 11 e os pacientes estratificados quanto ao grau de insuficiência renal crônica, de acordo com suas taxas de filtração glomerular (ml/min) em: 0: > 90 (grupos de risco para doença renal crônica, porém, com ausência de lesão renal); 1: > 90 (lesão renal com função renal normal); 2: 60-89 (insuficiência renal leve); 3: 30-59 (insuficiência renal moderada); 4: 15-29 (insuficiência renal grave); 5: < 15 (insuficiência renal terminal ou dialítica).…”

Avaliação da técnica de arteriografia renal guiada por fluoroscopia em suínos

“…Nos casos de nefropatia vascular humana, o diagnóstico pode ser feito por diferentes exames complementares caros e complexos como: determinação da renina seletiva na veia renal, estudo funcional com radioisótopos, urografia excretora, determinação de renina periférica estimulada com captopril, angiorressonância magnética e ultrassom vascular com Doppler colorido (Engelhorn et al, 2004), porém estes exames não fazem parte da rotina da medicina veterinária.…”

“…De acordo com Engelhorn et al (2004), sempre que for possível utilizar métodos menos invasivos, tais como a ultrassonografia com Doppler colorido antes da avaliação angiográfica, a arteriografia é indicada.…”