Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography

Deruddre, Stéphane; Cheisson, Gaëlle; Mazoit, Jean‐Xavier; Vicaut, Éric; Benhamou, Dan; Duranteau, Jacques

doi:10.1007/s00134-007-0665-4

Cited by 191 publications

(126 citation statements)

References 27 publications

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“…Several authors have assessed resistive index variation in response to increasing doses of noradrenaline or "renal low" dose dopamine. Results suggest that the resistive index might be a guided goal measurement allowing the optimization of catecholamine doses in order to potentially improve renal perfusion [41,42]. Finally, a further study did not find any variation in the resistive index following an intravascular load, regardless of pre-existing renal function and the response to this load as assessed by a variation in the systolic ejection volume [43].…”

Section: (Grade 2−) Strong Agreementmentioning

confidence: 85%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall.

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Section: (Grade 2−) Strong Agreementmentioning

confidence: 85%

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Ichai

Vinsonneau

Souweine

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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“…Color Doppler identifies vessels localization and allows to [27,28]. In acute renal injury AKIN stage 3 or RIFLE class F, RRI usually exceed 0.7, and a threshold of 0.75 is reported as optimal in recognizing between renal and prerenal disease.…”

Section: Rri and Akimentioning

confidence: 99%

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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“…25 A threshold of RI has been proposed to detect the risk of acute kidney injury 29 and may help to adjust therapeutic modalities for perfusion at the bedside. 30 The RBF increase during infusion of a "renal dopamine dose" at day 6 is associated with vasodilatation reflected by RI decrease. Because RI is a ratio, it cannot analyze the diastolic and systolic flow phases separately and does not take into account the mean flow value.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Bataille

Payen²,

Villiers³

et al. 2016

Exp Clin Transplant

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Objectives: The relation between dopamine infusion and renal hemodynamics and function has not been studied in renal allografts during early recovery. We analyzed the dose response of dopamine infusion on renal blood flow and function in human kidney transplant recipients at reperfusion and during early graft recovery. Conclusions: Immediately after transplant, kidney grafts with ischemic-reperfusion injury are fully dilated and do not respond to dopamine. The specific renal effects observed are due to systemic hemodynamic status. Vascular responsiveness to a "renal dopamine dose" returns on graft recovery.

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Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography

Abstract: Doppler ultrasonography and resistive index measurements may help determine in each patient the optimal MAP for renal blood flow and may be a relevant end-point to titrate the hemodynamic treatment in septic shock.

Cited by 191 publications

References 27 publications

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

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

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