Prognostic impact of renal arterial resistance index upon renal allograft survival: the time point matters

Kramann, Rafael; Frank, Dario; Brandenburg, Vincent; Heussen, Nicole; Takahama, Julia; Krüger, Thilo; Riehl, J; Floege, Jürgen

doi:10.1093/ndt/gfr772

Cited by 35 publications

(47 citation statements)

References 11 publications

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“…For this reason, the measure of RRI in the late period of posttransplant follow-up, as it is the case in many patients of Radermarcher study, can give a major prognostic role. This point was stressed by the study of Kramann et al [37]: this author clearly showed that measure of RRI within 6 month after transplantation fail to predict renal allograft failure or death in patient with stable renal function (serum creatinine 1.7 ± 0.9 mg/dL) while measuring RRI later, 12-18 months after transplantation, is useful as a prognostic marker of long-term clinical outcomes (renal allograft failure or death), mainly when RRI [0.75.…”

Section: Rri and Renal Allograft Survivalmentioning

confidence: 97%

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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Doppler ultrasound has been extensively used in detecting reno-vascular diseases, showing to be a noninvasive, safe, low cost and repeatable tool. The Renal Resistive Index (RRI) [(peak systolic velocity -end diastolic velocity)/peak systolic velocity] is a semi-quantitative index derived by Doppler evaluation of renal vascular bed. Normally RRI is in the range of 0.47-0.70, it increases with aging and, usually, it shows a difference between the two kidneys less than 5-8 %. RRI is an important prognostic marker in chronic kidney diseases (CKD), both in diabetic and non-diabetic kidney diseases, because, in longitudinal prospective studies, it significantly correlated with hemodynamic (ABPM, SBP, DBP, pulse pressure) and histopathological parameters (glomerular sclerosis, arteriolosclerosis, interstitial fibrosis/tubular atrophy, interstitial infiltration). In acute kidney injury (AKI) RI is a valid tool in differentiating between pre-renal and renal failure and in predicting renal response to vasoactive agents. In addition a RRI[0.74 can predict the onset of AKI in septic patients. Renal Resistive Index is a useful marker in allograft diseases because it has been widely showed a correlation with histological lesions during worsening of renal function, both in acute rejection and in chronic allograft nephropathy. Recent studies suggest its role in the risk of new onset diabetes after transplantation and it could be one of the parameters to evaluate to shift or withdrawal immunological and/or hypertensive therapy.Keywords Renal resistive index Á Diabetic nephropathy Á Acute kidney injury Á Renal transplantation Á Chronic kidney diseaseRiassunto La Metodica Color Doppler è stata diffusamente utilizzata per evidenziare patologie nefrovascolari in relazione alle caratteristiche di non invasività, sicurezza, basso costo e ripetibilità della stessa. L'indice di resistenza renale (RRI) [(Picco di velocità sistolica -Velocità telediastolica)/ Picco di velocità sistolica] è un indice semiquantitativo derivato dalla valutazione Doppler del letto vascolare renale. Normalmente il valore del RRI è nel range di 0,47-0,70, aumentando con l'età, e usualmente, è presente una differenza tra i due reni inferiore al 5-8%. RRI è un importante marker prognostico nelle patologie renali croniche (CKD), sia diabetiche che non-diabetiche, poichè, in studi prospettici longitudinali, esso correla significativamente con parametri emodinamici (ABPM, Pressione Sistolica, pressione Diastolica, Pressione di Polso) e istopatologici (glomerulosclerosi, arteriolosclerosi, fibrosi interstiziale/ atrofia tubulare e infiltrato interstiziale). Nel Danno Renale Acuto (AKI) RI è un valido strumento nel distinguere l'insufficienza acuta pre-renale da quella renale e nel predire la risposta renale agli agenti vasoattivi. Inoltre un valore di RRI [0,74 può predire la comparsa di AKI nei pazienti affetti da sepsi. RRI è un marker utile nelle patologie del rene trapiantato, perchè è stata ampiamente dimostrata una correlazione con lesioni istologiche...

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Section: Rri and Renal Allograft Survivalmentioning

confidence: 97%

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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“…from a deceased or living donor) is a crucial factor that could potentially confound studies attempting to define a prognostic role for the RI in kidney-graft recipients (19). This is because kidneys harvested from cadaveric donors usually undergo a substantially long period of cold ischemia that could affect the RI after transplantation (8). Although numerous studies have investigated the usefulness of Doppler US examination of the intrarenal arteries in renal transplant patients, to the best of our knowledge, the optimal artery for examination has not been identified.…”

Section: Discussionmentioning

confidence: 99%

The inability of an early post-transplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults

et al. 2016

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Background The intrarenal resistive index (RI) is a promising tool for predicting renal graft outcomes. Due to the complexity of graft function and the presence of diverse contributing factors, however, the available data are inconclusive. Purpose To examine the performance of the RI 1 week after transplant in predicting allograft function at week 12, with an emphasis on the type of intrarenal artery used in the examination. Material and Methods A total of 58 first-time living-donor kidney-allograft-transplantation patients aged less than 50 years underwent Doppler ultrasonography (US) of the intrarenal arteries 1 week after engraftment. The RI was calculated for both the segmental (RI-C) and interlobar-arcuate (RI-P) arteries. Serum creatinine level and the creatinine reduction ratio (CRR) were determined at weeks 1 and 12 post transplantation. Results While the RI did not correlate with serum creatinine level and CRR at week 1, significant correlations were present between the RI and serum creatinine level (r = 0.28, P = 0.03 for both RI-C and RI-P) and CRR (r = -0.25, P = 0.05 for both RI-C and RI-P) at week 12. The sensitivity, specificity, positive predictive value, and negative predictive value of using RI-C in predicting abnormal 12-week serum creatinine level were 51.2%, 52.9%, 72.4%, and 31.3%, respectively; and 53.7%, 47.1%, 70.9%, and 29.6% for RI-P, respectively ( P > 0.99 for all comparisons). Conclusion Early post-transplantation RI correlates significantly with both serum creatinine level and creatinine reduction ratio 12 weeks after engraftment with intermediate predictive accuracy.

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“…They assessed the RI performed 1 day after transplantation in 343 patients and found that graft survival was significantly lower in patients with RI greater than 0.70. Recently, Kramann et al 29 showed that the RI obtained within 6 months after transplantation failed to predict graft survival, whereas the 12-to 18-month posttransplant RI was significant predictor.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Renal Transplant Scintigraphy and Resistance Index Performed Within 2 Days After Transplantation in Predicting Long-Term Graft Function

Yazıcı

Oral

Gokalp³

et al. 2015

Clinical Nuclear Medicine

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Prognostic impact of renal arterial resistance index upon renal allograft survival: the time point matters

Abstract: In our hands, the RI obtained during the first 6 months after transplantation failed to predict renal allograft failure or death, whereas the RI measured 12-18 months after transplantation appeared useful to predict long-term allograft outcomes.

Cited by 35 publications

References 11 publications

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

The inability of an early post-transplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults

Evaluation of Renal Transplant Scintigraphy and Resistance Index Performed Within 2 Days After Transplantation in Predicting Long-Term Graft Function

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