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Renal Resistive İndeks’in Hafif Orta Böbrek Yetersizliği Olan Koroner Arter Hastalarında Hastalık Şiddetini Belirlemedeki Yeri

Yıl 2016, Cilt: 16 Sayı: 2, 0 - 0, 20.05.2016

Bircan Alan Adem Aktan Abdurrahim Dusak

https://doi.org/10.17098/amj.75211

Öz

Amaç: Çalışmamızda hafif orta renal yetersizliği olan hastalarda renal resistive indeksini (RRİ)saptayarak bunun renal fonksiyonlar ve koroner arter hastalığının (KAH) şiddetiyle ilişkisini araştırdık.

Materyal ve Metot: Çalışmaya koroner angiografisi yapılarak KAH  tanısı konmuş 41 erkek,35 kadın toplam 76  hasta alındı. Tüm hastalarda renal doppler ultrasonografi (US) ile RRİ’ leri ölçüldü. Renal parankim kalınlığı, böbrek uzunluk ve genişlikleri ölçüldü.  Gensini risk skorlama sistemiyle KAH şiddeti skorlanarak hastalar hafif-KAH (Gensini skoru ≤ 20)  ve şiddetli-KAH (Gensini skoru > 20) olmak üzere iki guruba ayrılarak karşılaştırıldı. Ayrıca tüm hastalarda glomerular filtrasyon  hızı (eGFR) hesaplanarak 3 ayrı sub gruba ayrıldı ve RRI ile ilişkisi araştırıldı.  

Bulgular: Gensini skoruna göre şiddetli KAH olanlarda hafif KAH olanlara göre anlamlı derecede yüksek RRİ değerleri saptandı [0.62 (0.58-0.71)] karşı [0.71 (0.63-0.78)], p < 0.01]. Böbrek uzunluğu, böbrek genişliği, böbrek parankim kalınlıkları arasında anlamlı fark saptanmadı. eGFR, şiddetli KAH’lı hastalarda hafif KAH grubuna göre anlamlı derecede düşüktü(p= 0.02).

eGFR değerlerine göre evrelendirilen KAH’lı hastalarda ,renal yetersizlik evresi ile RRİ arasında anlamlı ilişki saptanmıştır. Evre 1 (GFR≥90) olanlarda RI  [0.63(0.59-0.68)], evre 2( GFR 60-59) olanlarda RI [0.77(0.71-0.84)],evre 3(GFR 30-59)  olanlarda ise RI [0.81(0.73-0.85)]idi, (p<0.01).

RRİ değerinin hafif ciddi koroner arter hastalığı tanısında, sensivite % 77, spesifite % 66 bulundu.

Sonuç: RRI değerleri KAH’ lı hastalarda hastalık şiddetine paralel şekilde artış göstermektedir. İlaveten renal yetersizlik derecesi artıkça RRİ değerleri artmaktadır. Doppler US ile RRİ ölçümü KAH şiddetini saptamada aynı zamanda böbrek fonksiyon ve mikrosirkülasyonu hakkında noninvaziv bir yöntem olarak ilave bilgiler sağlayabilir.

Anahtar Kelimeler

Renal resistive indeks renal parankim kalınlığı koroner arter hastalığı Gensini skoru eGFR kronik böbrek hastalığı

Kaynakça

  • Komuro K. Evaluation of kidney circulation using duplex Doppler ultrasonography. Rinsho Byori 2010;58(8):816-22.
  • Edwards MS, Craven TE, Burke GL, Dean RH, Hansen KJ. Renovascular disease and the risk of adverse coronary events in the elderly: a prospective, population-based study. Arch Intern Med 2005;165(2):207-13.
  • Edwards MS, Hansen KJ, Craven TE, et al. Relationships between renovascular disease, blood pressure, and renal function in the elderly: a population-based study. Am J Kidney Dis 2003;41(5):990-6.
  • Hansen KJ, Tribble RW, Reavis SW, et al. Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990;12(3):227-36.
  • Crutchley TA, Pearce JD, Craven TE, Stafford JM, Edwards MS, Hansen KJ. Clinical utility of the resistive index in atherosclerotic renovascular disease. J Vasc Surg 2009;49(1):148-55.
  • Veglio F, Provera E, Pinna G, et al. Renal resistive index after captopril test by echo-Doppler in essential hypertension. Am J Hypertens 1992;5(7):431-6.
  • Tedesco MA, Natale F, Mocerino R, Tassinario G, Calabrò R. Renal resistive index and cardiovascular organ damage in a large population of hypertensive patients. J Hum Hypertens 2007;21(4):291-6.
  • Pearce JD, Craven TE, Edwards MS, et al. Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study. Am J Kidney Dis 2010;55(2):281-90.
  • Sugiura T, Nakamori A, Wada A, et al. Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol 2004;61:119-26.
  • Bashore TM, Balter S, Barac A, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012;59:2221-305.
  • Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988;78:486-502.
  • Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • Oishi Y, Wakatsuki T, Nishikado A, et al. Circulating adhesion molecules and severity of coronary atherosclerosis. Coron Artery Dis 2000;11:77-81.
  • Kaya H, Ertaş F, İslamoğlu, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost 2014;20:50-4.
  • Radermacher J, Ellis S, Haller H. Renal resistance index and progression of renal disease. Hypertension 2002;39(2 Pt 2):699-703.
  • Splendiani G, Parolini C, Fortunato L, Sturniolo A, Costanzi S. Resistive index in chronic nephropathies: predictive value of renal outcome. Clin Nephrol 2002;57(1):45-50.
  • Chonchol MB, Aboyans V, Lacroix P, Smits G, Berl T, Laskar M. Long-term outcomes after coronary artery bypass grafting: preoperative kidney function is prognostic. J Thorac Cardiovasc Surg 2007;134(3):683-9.
  • Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004 23;351(13):1296-305.
  • Mohandas R, Segal M, Srinivas TR, et al. Mild renal dysfunction and long-term adverse outcomes in women with chest pain: results from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE). Am Heart J 2015;169(3):412-8.
  • Calabia J, Torguet P, Garcia I, et al. The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation. J Clin Hypertens (Greenwich) 2014;16(3):186-91.
  • Akgul A, Sasak G, Basaran C, Colak T, Ozdemir FN, Haberal M. Relationship of renal resistive index and cardiovascular disease in renal transplant recipients. Transplant Proc 2009;41(7):2835-7.
  • Kawai T, Kamide K, Onishi M, et al. Usefulness of the resistive index in renal Doppler ultrasonography as an indicator of vascular damage in patients with risks of atherosclerosis. Nephrol Dial Transplant 2011;26(10):3256-62.

Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency

Yıl 2016, Cilt: 16 Sayı: 2, 0 - 0, 20.05.2016

Bircan Alan Adem Aktan Abdurrahim Dusak

https://doi.org/10.17098/amj.75211

Öz

Objectives: The aim of this study was to determine the renal resistive index (RRI) in patients with mild to moderate renal insufficiency, and to investigate the relationship between RRI and the severity of coronary artery disease (CAD) and renal function.

Materials and Methods: The study included 76 patients diagnosed with CAD on coronary angiography. The patients comprised 41 males and 35 females. Renal resistive index was determined using renal Doppler ultrasonography (RDU). Renal length, width, and parenchymal thickness was measured. The severity of CAD was graded according to Gensini score, and the patients were divided into two groups: mild atherosclerosis (Gensini score <20 points) and severe atherosclerosis (Gensini score ≥20 points). The estimated glomerular filtration rate (eGFR) was calculated for each patient. Based on GFR stage, the patients were divided into three groups, and the relationship between RRI and GFR stage was investigated.

Results: Gensini scores indicated that the RRI was significantly higher in the patients with severe CAD compared to those with mild CAD  [0.62 (0.58-0.71)] vs. [0.71 (0.63-0.78)], p<0.001). No significant differences were observed in renal length, width, and parenchymal thickness. The eGFR was significantly lower in the patients with severe CAD compared to those with mild CAD (p=0.02). Grading of the patients based on GFR values indicated a significant correlation between GFR and RRI. RRI was [0.63(0.59-0.68)] in patients with stage 1 (GFR ≥ 90), was [0.77(0.71-0.84)]in patients with stage 2 (GFR 60–89) and was [0.81(0.73-0.85)]in patients with stage 3 (GFR 30–59) (p<0.001). The sensitivity and specificity of RRI in the diagnosis of CAD severity were 80.60% and 66.70%, respectively.

Conclusion: RRI shows a parallel increase with the severity of CAD and with the severity of renal insufficiency. RRI, as determined with non-invasive RDU, may provide additional information on the severity of CAD, kidney function and microcirculation.

Anahtar Kelimeler

Renal resistive index renal parenchymal thickness coronary artery disease Gensini score eGFR chronic kidney disease

Kaynakça

  • Komuro K. Evaluation of kidney circulation using duplex Doppler ultrasonography. Rinsho Byori 2010;58(8):816-22.
  • Edwards MS, Craven TE, Burke GL, Dean RH, Hansen KJ. Renovascular disease and the risk of adverse coronary events in the elderly: a prospective, population-based study. Arch Intern Med 2005;165(2):207-13.
  • Edwards MS, Hansen KJ, Craven TE, et al. Relationships between renovascular disease, blood pressure, and renal function in the elderly: a population-based study. Am J Kidney Dis 2003;41(5):990-6.
  • Hansen KJ, Tribble RW, Reavis SW, et al. Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990;12(3):227-36.
  • Crutchley TA, Pearce JD, Craven TE, Stafford JM, Edwards MS, Hansen KJ. Clinical utility of the resistive index in atherosclerotic renovascular disease. J Vasc Surg 2009;49(1):148-55.
  • Veglio F, Provera E, Pinna G, et al. Renal resistive index after captopril test by echo-Doppler in essential hypertension. Am J Hypertens 1992;5(7):431-6.
  • Tedesco MA, Natale F, Mocerino R, Tassinario G, Calabrò R. Renal resistive index and cardiovascular organ damage in a large population of hypertensive patients. J Hum Hypertens 2007;21(4):291-6.
  • Pearce JD, Craven TE, Edwards MS, et al. Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study. Am J Kidney Dis 2010;55(2):281-90.
  • Sugiura T, Nakamori A, Wada A, et al. Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol 2004;61:119-26.
  • Bashore TM, Balter S, Barac A, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012;59:2221-305.
  • Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988;78:486-502.
  • Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • Oishi Y, Wakatsuki T, Nishikado A, et al. Circulating adhesion molecules and severity of coronary atherosclerosis. Coron Artery Dis 2000;11:77-81.
  • Kaya H, Ertaş F, İslamoğlu, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost 2014;20:50-4.
  • Radermacher J, Ellis S, Haller H. Renal resistance index and progression of renal disease. Hypertension 2002;39(2 Pt 2):699-703.
  • Splendiani G, Parolini C, Fortunato L, Sturniolo A, Costanzi S. Resistive index in chronic nephropathies: predictive value of renal outcome. Clin Nephrol 2002;57(1):45-50.
  • Chonchol MB, Aboyans V, Lacroix P, Smits G, Berl T, Laskar M. Long-term outcomes after coronary artery bypass grafting: preoperative kidney function is prognostic. J Thorac Cardiovasc Surg 2007;134(3):683-9.
  • Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004 23;351(13):1296-305.
  • Mohandas R, Segal M, Srinivas TR, et al. Mild renal dysfunction and long-term adverse outcomes in women with chest pain: results from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE). Am Heart J 2015;169(3):412-8.
  • Calabia J, Torguet P, Garcia I, et al. The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation. J Clin Hypertens (Greenwich) 2014;16(3):186-91.
  • Akgul A, Sasak G, Basaran C, Colak T, Ozdemir FN, Haberal M. Relationship of renal resistive index and cardiovascular disease in renal transplant recipients. Transplant Proc 2009;41(7):2835-7.
  • Kawai T, Kamide K, Onishi M, et al. Usefulness of the resistive index in renal Doppler ultrasonography as an indicator of vascular damage in patients with risks of atherosclerosis. Nephrol Dial Transplant 2011;26(10):3256-62.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Bölüm Araştırmalar
Yazarlar

Bircan Alan

Adem Aktan

Abdurrahim Dusak

Yayımlanma Tarihi 20 Mayıs 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 16 Sayı: 2

Kaynak Göster

APA Alan, B., Aktan, A., & Dusak, A. (2016). Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency. Ankara Medical Journal, 16(2). https://doi.org/10.17098/amj.75211
AMA Alan B, Aktan A, Dusak A. Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency. Ankara Med J. Mayıs 2016;16(2). doi:10.17098/amj.75211
Chicago Alan, Bircan, Adem Aktan, ve Abdurrahim Dusak. “Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients With Mild to Moderate Renal Insufficiency”. Ankara Medical Journal 16, sy. 2 (Mayıs 2016). https://doi.org/10.17098/amj.75211.
EndNote Alan B, Aktan A, Dusak A (01 Mayıs 2016) Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency. Ankara Medical Journal 16 2
IEEE B. Alan, A. Aktan, ve A. Dusak, “Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency”, Ankara Med J, c. 16, sy. 2, 2016, doi: 10.17098/amj.75211.
ISNAD Alan, Bircan vd. “Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients With Mild to Moderate Renal Insufficiency”. Ankara Medical Journal 16/2 (Mayıs 2016). https://doi.org/10.17098/amj.75211.
JAMA Alan B, Aktan A, Dusak A. Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency. Ankara Med J. 2016;16. doi:10.17098/amj.75211.
MLA Alan, Bircan vd. “Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients With Mild to Moderate Renal Insufficiency”. Ankara Medical Journal, c. 16, sy. 2, 2016, doi:10.17098/amj.75211.
Vancouver Alan B, Aktan A, Dusak A. Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency. Ankara Med J. 2016;16(2).