The Renal Resistive Index in systemic sclerosis: Determinants, prognostic implication and proposal for specific age-adjusted cut-offs

Bruni, Cosimo; Rosato, Edoardo; Maestripieri, Vanessa; Gigante, Antonietta; Tesei, Giulia; Bellando-Randone, Silvia; Guiducci, Serena; Chiostri, Marco; Aoufy, Khadija El; Blagojević, Jelena; Moggi-Pignone, Alberto; Paulis, Amato de; Fürst, Daniel E.; Boddi, Maria; Matucci‐Cerinic, Marco

doi:10.1016/j.ejim.2019.09.001

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…In our study, ΔRRI changes were more evident in SSc patients with a nonpathological value of RRI than with pathological RRI at baseline. It may be hypothesized that SSc renal vasculopathy may determine an independent chronic and slow process increasing intrarenal resistances, as previously suggested (13).…”

Section: Discussionmentioning

confidence: 67%

The Renal Resistive Index: A New Biomarker for the Follow-up of Vascular Modifications in Systemic Sclerosis

Gigante¹,

Bruni

Lepri

et al. 2020

J Rheumatol

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Objective The aim of the present retrospective observational study was to evaluate in SSc patients the change of renal resistive index (RRI) over the time (ΔRRI) and under treatment as well as to correlate these changes with disease complications. Methods 230 patients [29 male, median age 57 (48-67) years] were enrolled. At baseline and follow-up [3.43 (2.81-4.45) years] we collected following data: disease variables, nailfold videocapilloscopy (NVC) pattern, FVC (Forced vital capacity), carbon oxide diffusing capacity (DLCO), systolic pulmonary arterial pressure (sPAP), presence of interstitial lung disease, RRI, evaluation of glomerular filtration rate (eGFR), new onset of pulmonary arterial hypertension (PAH). Results RRI value is high in SSc patients with digital ulcers and ACA antibodies, active and late NVC patterns, lcSSc. A significant correlation was observed between ΔRRI and ΔsPAP (r=0.17, p=0.02), with statistically higher ΔRRI (0.08 ± 0.02 versus 0.03 ± 0.05, p=0.04) in patients complicated by PAH onset. No other new onset complication was associated with ΔRRI. The ROC curve analysis confirmed the predictive role of ΔRRI in development of new PAH (AUC 0.84; 95% CI 0.75-0.93, p=0.02). In SSc patients never exposed to sildenafil, ΔRRI was higher (0.04 ± 0.05) compared to both patients exposed to sildenafil during the study period (0.01±0.05, p=0.03) or in those exposed at the time of baseline evaluation (0.00 ± 0.05, p=0.01). Conclusion RRI and its variation in time are a reliable marker of SSc related vasculopathy, both in renal and extra-renal compartments.

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Section: Discussionmentioning

confidence: 67%

The Renal Resistive Index: A New Biomarker for the Follow-up of Vascular Modifications in Systemic Sclerosis

Gigante¹,

Bruni

Lepri

et al. 2020

J Rheumatol

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“…US and Doppler US are the gold standard noninvasive tests for analyzing the kidney as well as the urinary tract. Especially Doppler US is used for measuring renal resistive index, pulsative index, and systolic‐diastolic blood flow 108,111 . It is so beneficial in assessing parenchymal fibrosis, renal vascular resistances or compliance studies, arterial hypertension and sclerosis, and inflammatory changes 106 .…”

Section: Discussionmentioning

confidence: 99%

Neurological, cardiac, musculoskeletal, and renal manifestations of scleroderma along with insights into its genetics, pathophysiology, diagnostic, and therapeutic updates

Prajjwal,

Marsool,

Yadav

et al. 2024

Health Science Reports

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BackgroundScleroderma, also referred to as systemic sclerosis, is a multifaceted autoimmune condition characterized by abnormal fibrosis and impaired vascular function. Pathologically, it encompasses the persistent presence of inflammation, abnormal collagen buildup, and restructuring of blood vessels in various organs, resulting in a wide range of clinical symptoms. This review incorporates the most recent scientific literature on scleroderma, with a particular emphasis on its pathophysiology, clinical manifestations, diagnostic approaches, and treatment options.MethodologyA comprehensive investigation was carried out on numerous databases, such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar, to collect pertinent studies covering diverse facets of scleroderma research.ResultsScleroderma presents with a range of systemic manifestations, such as interstitial lung disease, gastrointestinal dysmotility, Raynaud's phenomenon, pulmonary arterial hypertension, renal complications, neurological symptoms, and cardiac abnormalities. Serological markers, such as antinuclear antibodies, anti‐centromere antibodies, and anti‐topoisomerase antibodies, are important for classifying diseases and predicting their outcomes.DiscussionThe precise identification of scleroderma is crucial for promptly and correctly implementing effective treatment plans. Treatment approaches aim to improve symptoms, reduce complications, and slow down the progression of the disease. An integrated approach that combines pharmacological agents, including immunosuppressants, endothelin receptor antagonists, and prostanoids, with nonpharmacological interventions such as physical and occupational therapy is essential for maximizing patient care.ConclusionThrough the clarification of existing gaps in knowledge and identification of emerging trends, our goal is to improve the accuracy of diagnosis, enhance the effectiveness of therapeutic interventions, and ultimately enhance the overall quality of life for individuals suffering from scleroderma. Ongoing cooperation and creative research are necessary to advance the field and achieve improved patient outcomes and new therapeutic discoveries.

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“…For the purposes of this study, the RRI value considered for each patient was the average of the RRI of the right and left kidneys. According to previous studies, a value greater than 0.70 can be considered high and pathological [13,23]. Patients' blood pressure was measured in accordance with the European Society of Hypertension and European Society of Cardiology Guidelines for the Management of Arterial Hypertension [24].…”

Section: Methodsmentioning

confidence: 99%

Bosentan Does Not Affect Renal Resistive Index in Scleroderma/Systemic Sclerosis Patients

Di Poi,

Colussi,

Bertoni

et al. 2023

Kidney Blood Press Res

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Introduction: If properly evaluated, chronic kidney disease can be found in up to 50% of patients with systemic sclerosis (SSc). The renal resistive index (RRI) is a marker of intrarenal vascular resistance and can predict SSc-associated vasculopathy. This study aimed to determine the impact of bosentan, a nonselective endothelin-1 receptor antagonist, on RRI and kidney function in SSc patients with recurrent digital ulcers. Methods: Twenty-one patients (age 57 ± 9 years, 19 females) were recruited in a 16-week prospective open-label uncontrolled study. Standardized procedures were used to measure general clinical and laboratory characteristics, systolic, diastolic, and mean arterial pressure (MAP), pulse pressure (PP), diastolic to systolic blood pressure (D/S) ratio, and urinary endothelin-1 levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate kidney function as an estimated glomerular filtration rate (eGFR). RRI was measured by Doppler ultrasound as the average of three samplings of intrarenal blood flow in different kidney regions of both kidneys. Patients with secondary causes of kidney disease or kidney diseases associated with albuminuria were excluded. Results: Bosentan treatment for 16 weeks did not change RRI (0.731 ± 0.049–0.730 ± 0.054, p = 0.925), but increased urine endothelin-1 to creatinine ratio (0.27 ± 0.15–0.49 ± 0.57 pg/mg, p = 0.032) and reduced MAP (123 ± 10–101 ± 11 mm Hg, p < 0.001), PP (76 ± 11–68 ± 10 mm Hg, p = 0.003), D/S ratio (0.563 ± 0.044–0.538 ± 0.031, p = 0.006), and eGFR (92 ± 20–84 ± 24 mL/min/1.73 m2, p = 0.003). Discussion/Conclusion: In conclusion, in patients with SSc complicated by digital ulcers and normal to mildly diminished kidney function, bosentan had no effect on intrarenal hemodynamics, but reduced blood pressure levels and kidney function.

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The Renal Resistive Index in systemic sclerosis: Determinants, prognostic implication and proposal for specific age-adjusted cut-offs

Cited by 13 publications

References 35 publications

The Renal Resistive Index: A New Biomarker for the Follow-up of Vascular Modifications in Systemic Sclerosis

The Renal Resistive Index: A New Biomarker for the Follow-up of Vascular Modifications in Systemic Sclerosis

Neurological, cardiac, musculoskeletal, and renal manifestations of scleroderma along with insights into its genetics, pathophysiology, diagnostic, and therapeutic updates

Bosentan Does Not Affect Renal Resistive Index in Scleroderma/Systemic Sclerosis Patients

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