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

BACKGROUND: Chronic 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 th...

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Autores principales: Bigé, Naïke, Lévy, Pierre Patrick, Callard, Patrice, Faintuch, Jean-Manuel, Chigot, Valérie, Jousselin, Virginie, Ronco, Pierre, Boffa, Jean-Jacques
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531254/
https://www.ncbi.nlm.nih.gov/pubmed/23098365
http://dx.doi.org/10.1186/1471-2369-13-139
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author Bigé, Naïke
Lévy, Pierre Patrick
Callard, Patrice
Faintuch, Jean-Manuel
Chigot, Valérie
Jousselin, Virginie
Ronco, Pierre
Boffa, Jean-Jacques
author_facet Bigé, Naïke
Lévy, Pierre Patrick
Callard, Patrice
Faintuch, Jean-Manuel
Chigot, Valérie
Jousselin, Virginie
Ronco, Pierre
Boffa, Jean-Jacques
author_sort Bigé, Naïke
collection PubMed
description BACKGROUND: Chronic 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. METHODS: RI 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(2)/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. RESULTS: Most patients had glomerulonephritis (82%). Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m(2) [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%. CONCLUSIONS: Our 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.
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spelling pubmed-35312542013-01-10 Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease Bigé, Naïke Lévy, Pierre Patrick Callard, Patrice Faintuch, Jean-Manuel Chigot, Valérie Jousselin, Virginie Ronco, Pierre Boffa, Jean-Jacques BMC Nephrol Research Article BACKGROUND: Chronic 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. METHODS: RI 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(2)/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. RESULTS: Most patients had glomerulonephritis (82%). Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m(2) [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%. CONCLUSIONS: Our 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. BioMed Central 2012-10-25 /pmc/articles/PMC3531254/ /pubmed/23098365 http://dx.doi.org/10.1186/1471-2369-13-139 Text en Copyright ©2012 Bigé et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Bigé, Naïke
Lévy, Pierre Patrick
Callard, Patrice
Faintuch, Jean-Manuel
Chigot, Valérie
Jousselin, Virginie
Ronco, Pierre
Boffa, Jean-Jacques
Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title_full Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title_fullStr Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title_full_unstemmed Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title_short Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
title_sort renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531254/
https://www.ncbi.nlm.nih.gov/pubmed/23098365
http://dx.doi.org/10.1186/1471-2369-13-139
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