Nephrology Dialysis Transplantation, Vol 12, Issue 8 1608-1614, Copyright © 1997 by Oxford University Press
J Riehl, H Schmitt, D Bongartz, D Bergmann and H Sieberth
Background: Detection of renal artery stenoses (RAS)
by means of duplex Doppler ultrasound with direct scanning of the main
renal arteries is subject to numerous limitations. Using semiquantitative
analysis of the Doppler curve, which can be recorded from intrarenal
arteries, it is possible to detect RAs unaffected by the problems of direct
Doppler scanning of the renal arteries. Method: Both
angiography of the renal arteries and colour duplex ultrasonography (US) of
the intrarenal vessels (interlobar arteries) were performed in 214 patients
(53.2±15.1 years) with severe arterial hypertension. Angiography
was used as 'gold standard' in the diagnosis of RAS and the Doppler results
were compared with the subsequent findings on angiography. At angiography,
the reduction of diameter >70% was assessed as haemodynamically
effective RAS. For the duplex Doppler diagnosis of RAS the following
parameters were calculated: (a) resistive index (RI) of each kidney, and
(b) side-to-side differences of the resistive indices (&Dgr;RI) between
the right and left kidney. Results: Angiography
demonstrated 59 RAS (>70%) in 53 patients, including six with
bilateral RAS. By means of duplex US we found a significant difference of
RI between kidneys with RAS (0.48±0.11) and without RAS
(0.63±0.08; P<0.001). In addition, a significant
difference of the &Dgr;RI was noted in patients with RAS
(24.4%±12.5%) and the controls without RAS
(3.6%±2.7%). Using a combination of both RI and &Dgr;RI,
threshold values of RI=0.45 resp. &Dgr;RI=8% yields a sensitivity of
92.5% and a specificity of 95.7% in the detection of haemodynamically
effective RAS. Conclusion: Colour duplex US with
calculation of the RI and &Dgr;RI of intrarenal arteries is a valuable
non-invasive test assessing the haemodynamic effects of RAS. Low costs and
safety support the use of the Doppler technique in screening for
renovascular disease. Keywords: colour duplex
ultrasonography; renal artery stenosis; renovascular hypertension;
resistive index
ORIGINAL ARTICLES
Renal artery stenosis: evaluation with colour duplex ultrasonography
Medizinische Klinik II, Universitatsklinik der TWTH Aachen, Pauwelsstr. 30, 52057 Aachen, Germany; Corresponding author
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