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MINERVA UROLOGICA E NEFROLOGICA

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Minerva Urologica e Nefrologica 2004 December;56(4):343-52

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

The US Color Doppler in acute renal failure

Nori G. 1, Granata A. 2, Leonardi G. 3, Sicurezza E. 2, Spata C. 2

1 Unit of Nephrology and Dialysis “S. ­Maria” General Hospital, Ter­ni, Italy
2 Unit of Nephrology and Dialysis “Vit­to­rio Ema­nuele II, Fer­ra­rot­to, S. Bam­bi­no”, General Hospital, Cata­nia, Italy
3 Unit of Cardiology, “Vit­to­rio Ema­nuele II, Fer­ra­rot­to, S. Bam­bi­no”, General Hospital, Cata­nia, Italy


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Imag­ing tech­niques, espe­cial­ly ultra­so­nog­ra­phy and Dop­pler, can ­give an effec­tive assis­tance in the dif­fe­ren­tial diag­no­sis of ­acute ­renal fail­ure (ARF). An resistence Index (RI) val­ue >0.75 is report­ed as opti­mal in attempt­ing dif­fe­ren­tial diag­no­sis ­between acute tubular necrosis (ANT) and pre­ren­al ARF. In hepatorenal syndrome (HRS) RIs is ­very ­increased. In ­some ­renal vas­cu­litis, as nodose panarteritis (PN), hemolytic-uremic syndrome (HUS), thrombotic thrombocytopenic purpure (TTP), paren­chi­mal per­fu­sion is ­reduced and RI ­increased. In ­lupus neph­ritis the RI val­ues are cor­re­lat­ed ­with crea­ti­nine lev­el and nor­mal RI are con­sid­ered as a ­good prog­nos­tic ­tool. In ­acute prim­i­tive or sec­on­dary glom­e­ru­lo­neph­ritis (GN), RI val­ue is nor­mal, ­with dif­fuse paren­chy­mal hyper­vas­cu­lar­iza­tion. In ­acute cres­cen­tic and pro­life­ra­tive GN and tubu­lo-inter­sti­tial dis­ease, color Doppler (CD) and power Doppler (PD) ­reveal a ­decreased ­renal paren­chy­mal per­fu­sion, ­which cor­re­lates ­with ­increased RI val­ues. In ­acute throm­bo­sis of ­renal ­artery, US color Doppler (DUS) ­reveals ­either an ­absence of Dop­pler sig­nal or a tar­dus-par­vus ­pulse dis­tal to the vas­cu­lar obstruc­tion. In ­this sit­u­a­tion it is pos­sible to vis­u­al­ize hyper­throp­ic per­fo­rat­ing ves­sels ­that redi­rect ­their ­flow ­from the cap­su­lar plex­us to the ­renal paren­chy­ma. In ­acute throm­bo­sis of the ­renal ­vein Dop­pler anal­y­sis of paren­chy­mal ves­sels ­reveals remark­able RI val­ues, some­times ­with ­reversed dia­stol­ic ­flow. In post­ren­al ARF an ­adjunct to the dif­fe­ren­ti­a­tion ­between obstruc­tion and non obstruc­tive dil­a­ta­tion can be ­found ­through RIs. Diag­nos­tic cri­te­ria of obstruc­tion as report­ed by lit­er­a­ture are: RI>0.70 in the obstruct­ed kid­ney and, most­ly, a dif­fer­ence in RI ­between the 2 kid­neys >0.06-0.1.

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