TY - JOUR
T1 - Diagnosis of renovascular disease by extra- and intrarenal doppler parameters
AU - Malatino, Lorenzo S.
AU - Polizzi, Gaetano
AU - Garozzo, Maurizio
AU - Rapisarda, Francesco
AU - Fatuzzo, Pasquale
AU - Bellanuova, Ignazio
AU - Cataliotti, Alessandro
AU - Brozzetti, Azelia
AU - Neri, Santo
AU - Malfa, Pier Antonio
AU - Cotroneo, Giovanni Battista
N1 - Funding Information:
Brandi Steidley, Colorado Department of Public Health and Environment; Justin Honce, University of Colorado School of Medicine; Alex Greninger, University of Washington.
Funding Information:
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Daniel M. Pastula reports receipt of honoraria from the American Academy of Neurology for lectures. Amanda L. Piquet reports institutional support from Genentech, the University of Colorado, and the Rocky Mountain MS Center, royalties from Springer Nature for editorial services, consulting fees from Alexion and Genentech/Roche, honoraria from the American Academy of Neurology for educational lectures and from Medlink for a medical article, payment for expert testimony for the U.S. Department of Health and Human Services National Vaccination Injury Compensation Program from Sands Anderson, PC and from Joe Jones Law Firm, PLLC for medicolegal work, and institutional compensation for participation on a Genentech/Roche data safety monitoring board. J. David Beckham reports grants from the National Institutes of Health, National Institute of Neurological Disorders and Stroke, the National Institute for Allergy and Infectious Diseases, Roche Diagnostics, and VAMerit. Rebecca N. Kumar reports institutional grants or contracts from Regeneron and District of Columbia Department of Health, honoraria from AstraZeneca for a presentation, and a leadership role in the Infectious Disease Community of the International Society for Heart and Lung Transplantation. Princy N. Kumar reports institutional grants or contracts from Lilly, GSK, Merck, Regeneron, Gilead Sciences, Inc., American Gene Technologies, and Biohaven Pharmaceuticals; compensation for participation on Data Safety Monitoring or Advisory Boards for Johnson & Johnson, ViiV Healthcare, Gilead Sciences, Inc., and Theratechnologies, Inc.; and owns stock or stock options in Merck, Johnson & Johnson, GSK, Gilead Sciences, Inc., Pfizer, and Moderna. No other potential conflicts of interest were disclosed.
PY - 1998/9
Y1 - 1998/9
N2 - It is still a matter of debate as to which parameters should be used for noninvasive diagnosis of renovascular disease by renal Doppler sonography (RDS). The accuracy of RDS in the detection of renal artery stenosis (RAS) was tested in 95 consecutive, moderate to severe hypertensive patients (I-II World Health Organization [WHO] stages). Reno-aortic ratio (RAR) for peak systolic velocity (PSV) was also calculated to assist in the diagnosis of significant (>50%) RAS. Paired receiver-operating characteristic (ROC) analysis was plotted for evaluating the relationship between sensitivity and specificity for each parameter. In a subset of 57 kidneys, the influence of blood pressure and age on intraparenchymal parameters was evaluated. Measurements of maximal peak systolic velocity (PSV) at the site of stenosis, RAR for PSV, and minimum acceleration index in the main renal artery showed high accuracy (areas under the ROC curve 0.97, 0.88, and 0.80, respectively). Among intraparenchymal parameters, early systolic acceleration showed the best area under the ROC curve (0.90), but provided a low positive predictive value (29%) and was significantly influenced by blood pressure (multiple r=0.56; p=0.001). Pulsatility and resistive indices were found to be less powerful as absolute values, and both significantly influenced by blood pressure and age (multiple r= 0.60 and 0.50; p=0.001, p=0.02, respectively). However, interindividual variance of intrarenal indices should be minimized by calculation of side difference, although this procedure would become misleading or impossible in patients with bilateral RAS or a single kidney, respectively. These results support the use of extraparenchymal parameters for noninvasive detection of PAS, and emphasize that intrarenal parameters cannot be considered as absolute values.
AB - It is still a matter of debate as to which parameters should be used for noninvasive diagnosis of renovascular disease by renal Doppler sonography (RDS). The accuracy of RDS in the detection of renal artery stenosis (RAS) was tested in 95 consecutive, moderate to severe hypertensive patients (I-II World Health Organization [WHO] stages). Reno-aortic ratio (RAR) for peak systolic velocity (PSV) was also calculated to assist in the diagnosis of significant (>50%) RAS. Paired receiver-operating characteristic (ROC) analysis was plotted for evaluating the relationship between sensitivity and specificity for each parameter. In a subset of 57 kidneys, the influence of blood pressure and age on intraparenchymal parameters was evaluated. Measurements of maximal peak systolic velocity (PSV) at the site of stenosis, RAR for PSV, and minimum acceleration index in the main renal artery showed high accuracy (areas under the ROC curve 0.97, 0.88, and 0.80, respectively). Among intraparenchymal parameters, early systolic acceleration showed the best area under the ROC curve (0.90), but provided a low positive predictive value (29%) and was significantly influenced by blood pressure (multiple r=0.56; p=0.001). Pulsatility and resistive indices were found to be less powerful as absolute values, and both significantly influenced by blood pressure and age (multiple r= 0.60 and 0.50; p=0.001, p=0.02, respectively). However, interindividual variance of intrarenal indices should be minimized by calculation of side difference, although this procedure would become misleading or impossible in patients with bilateral RAS or a single kidney, respectively. These results support the use of extraparenchymal parameters for noninvasive detection of PAS, and emphasize that intrarenal parameters cannot be considered as absolute values.
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U2 - 10.1177/000331979804901002
DO - 10.1177/000331979804901002
M3 - Article
C2 - 9756422
AN - SCOPUS:15644371730
SN - 0003-3197
VL - 49
SP - 707
EP - 721
JO - Angiology
JF - Angiology
IS - 9
ER -