Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney diseaseReportar como inadecuado

Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Nephrology

, 13:139

First Online: 25 October 2012Received: 25 April 2012Accepted: 25 September 2012


BackgroundChronic kidney disease CKD is a growing public health problem and end stage renal disease ESRD represents a large human and economic burden. It is important to identify patients at high risk of ESRD. In order to determine whether renal Doppler resistive index RI may discriminate those patients, we analyzed whether RI was associated with identified prognosis factors of CKD, in particular histological findings, and with renal outcome.

MethodsRI was measured in the 48 hours before renal biopsy in 58 CKD patients. Clinical and biological data were collected prospectively at inclusion. Arteriosclerosis, interstitial fibrosis and glomerulosclerosis were quantitatively assessed on renal biopsy in a blinded fashion. MDRD eGFR at 18 months was collected for 35 60% patients. Renal function decline was defined as a decrease in eGFR from baseline of at least 5 mL-min- 1.73 m-year or need for chronic renal replacement therapy. Pearson’s correlation, Mann–Whitney and Chi-square tests were used for analysis of quantitative and qualitative variables respectively. Kaplan Meier analysis was realized to determine renal survival according to RI value using the log-rank test. Multiple logistic regression was performed including variables with p < 0.20 in univariate analysis.

ResultsMost patients had glomerulonephritis 82%. Median age was 46 years 21–87, eGFR 59 mL-min- 1.73m 5–130, percentage of interstitial fibrosis 10% 0–90, glomerulosclerosis 13% 0–96 and RI 0.63 0.31-1.00. RI increased with age r = 0.435, p = 0.0063, pulse pressure r = 0.303, p = 0.022, renal atrophy r = −0.275, p = 0.038 and renal dysfunction r = −0.402, p = 0.0018. Patients with arterial intima-media ratio ≥ 1 p = 0.032, interstitial fibrosis > 20% p = 0.014 and renal function decline p = 0.0023 had higher RI. Patients with baseline RI ≥ 0.65 had a poorer renal outcome than those with baseline RI < 0.65 p = 0.0005. In multiple logistic regression, RI≥0.65 was associated with accelerated renal function decline independently of baseline eGFR and proteinuria-creatininuria ratio OR=13.04 1.984-85.727, p = 0.0075. Sensitivity, specificity, predictive positive and predictive negative values of RI ≥ 0.65 for renal function decline at 18 months were respectively 77%, 86%, 71% and 82%.

ConclusionsOur results suggest that RI ≥ 0.65 is associated with severe interstitial fibrosis and arteriosclerosis and renal function decline. Thus, RI may contribute to identify patients at high risk of ESRD who may benefit from nephroprotective treatments.

KeywordsChronic kidney disease Arteriosclerosis Fibrosis Renal doppler AbbreviationsCKDChronic kidney disease

DBPDiastolic blood pressure

eGFREstimated glomerular filtration rate

ESRDEnd stage renal disease

FSGNFocal segmental glomerulonephritis

HIVANHIV-associated nephropathy

RIRenal doppler resistive index

RRTRenal replacement therapy

SBPSystolic blood pressure.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-13-139 contains supplementary material, which is available to authorized users.

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Autor: Naïke Bigé - Pierre Patrick Lévy - Patrice Callard - Jean-Manuel Faintuch - Valérie Chigot - Virginie Jousselin - Pierr


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