Abstract
From growing data from the literature emerges that so-called ecoDoppler “Renal” Resistive Indexes (RRI) are not only specific markers of kidney damage and indicators of renal functional prognosis but they always express more clearly a strong link with the systemic circulation. In fact, some cardiovascular parameters such as aortic pulse pressure, aortic stiffness, abdominal aortic calcifications and clinical settings for instance heart failure progression have shown a great association with RRI. Relationships between renal and inflammatory indexes in hypertensive patients have been found and data from the literature on kidney transplants underline the capability of the graft RRI to change according to host hemodynamic features. The purpose of this article is to explain the emerging pathophysiological aspects of this relationship between renal microcirculation and cardiovascular system by emphasizing the importance for the ultrasonographer and for the nephrologist of not overlooking a global vision of the patient before interpreting the RRI.
Similar content being viewed by others
References
Stefan G, Capusa C, Stancu S, Petrescu L, Nedelcu ED, Andreiana I, Mircescu G. Abdominal aortic calcification and renal resistive index in patients with chronic kidney disease: is there a connection? J Nephrol. 2014;27(2):173–9.
Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol. 2003;180(4):885–92.
Chirinos JA, Townsend RR. Systemic arterial hemodynamics and the “Renal Resistive Index”: what is in a name? J Clin Hypertens (Greenwich). 2014;16(3):170–1.
O’Neill WC. Renal resistive index: a case of mistaken identity. Hypertension. 2014;64(5):915–7.
Bude RO, Rubin JM. Relationship between the resistive index and vascular compliance and resistance. Radiology. 1999;211:411–7.
Tublin ME, Tessler FN, Murphy ME. Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology. 1999;213:258–64.
Calabia J, Torguet P, Garcia I, Martin N, Mate G, Marin A, Molina C, Valles M. 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.
Ikee R, Kobayashi S, Hemmi N, Imakiire T, Kikuchi Y, Moriya H, Suzuki S, Miura S. Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis. 2005;46:603–9.
Hashimoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics: pathophysiological implication for microalbuminuria in hypertension. Hypertension. 2011;58(5):839–46.
Kirkpatrick AW, Colistro R, Laupland KB, et al. Renal arterial resistive index response to intraabdominal hypertension in a porcine model. Crit Care Med. 2007;35:207–13.
Pozniak MA, Kelcz F, Stratta RJ, Oberley TD. Extraneous factors affecting resistive index. Investig Radiol. 1988;23:899–904.
Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WH. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53:589–96.
Boddi M, Natucci F, Ciani E. The internist and the renal resistive index: truths and doubts. Intern Emerg Med. 2015;10(8):893–905.
Kuznetsova T, Cauwenberghs N, Knez J, Thijs L, Liu YP, Gu YM, Staessen JA. Doppler indexes of left ventricular systolic and diastolic flow and central pulse pressure in relation to renal resistive index. Am J Hypertens. 2015;28(4):535–45.
Mostbeck GH, Gössinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D. Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology. 1990;175:511–3.
Ennezat PV, Maréchaux S, Six-Carpentier M, Pinçon C, Sediri I, Delsart P, Gras M, Mounier-Véhier C, Gautier C, Montaigne D, Jude B, Asseman P, Le Jemtel TH. Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction. Nephrol Dial Transplant. 2011;26(12):3908–13.
Ciccone MM, Iacoviello M, Gesualdo L, Puzzovivo A, Antoncecchi V, Doronzo A, Monitillo F, Citarelli G, Paradies V, Favale S. The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression. Eur J Heart Fail. 2014;16(2):210–6.
Ohuchi H, Ikado H, Noritake K, Miyazaki A, Yasuda K, Yamada O. Impact of central venous pressure on cardiorenal interactions in adult patients with congenital heart disease after biventricular repair. Congenit Heart Dis. 2013;8(2):103–10.
O’Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007;50(1):1–13.
Boddi M, Sacchi S, Lammel RM, et al. Age-related and vasomotor stimuli-induced changes in renal vascular resistance detected by Doppler ultrasound. Am J Hypertens. 1996;9:461–6.
O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46(1):200–4.
Pontremoli R, Viazzi F, Martinoli C, Ravera M, Nicolella C, Berruti V, Leoncini G, Ruello N, Zagami P, Bezante GP, Derchi LE, Deferrari G. Increased renal resistive index in patients with essential hypertension: a marker of target organ damage. Nephrol Dial Transplant. 1999;14(2):360–5.
Doi Y, Iwashima Y, Yoshihara F, Kamide K, Takata H, Fujii T, Kubota Y, Nakamura S, Horio T, Kawano Y. Association of renal resistive index with target organ damage in essential hypertension. Am J Hypertens. 2012;25(12):1292–8.
Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, Rousson V, Mohaupt MG, Alwan H, Ehret G, Pechere-Bertschi A, Paccaud F, Staessen JA, Vogt B, Burnier M, Martin PY, Bochud M. Reference values and factors associated with renal resistive index in a family-based population study. Hypertension. 2014;63(1):136–42.
Celebi H, Donder E, Celiker H. Renal blood flow detection with Doppler ultrasonography in patients with hepatic cirrhosis. Arch Intern Med. 1997;157:564–6.
Mindikoglu AL, Dowling TC, Wong-You-Cheong JJ, Christenson RH, Magder LS, Hutson WR, Seliger SL, Weir MR. A pilot study to evaluate renal hemodynamics in cirrhosis by simultaneous glomerular filtration rate, renal plasma flow, renal resistive indices and biomarkers measurements. Am J Nephrol. 2014;39(6):543–52.
Granata A, Zanoli L, Clementi S, Fatuzzo P, Di Nicolò P, Fiorini F. Resistive intrarenal index: myth or reality? Br J Radiol. 2014;87(1038):20140004.
Corradi F, Brusasco C, Garlaschi A, Santori G, Vezzani A, Moscatelli P, Pelosi P. Splenic Doppler resistive index for early detection of occult hemorrhagic shock after polytrauma in adult patients. Shock. 2012;38(5):466–73.
Corradi F, Brusasco C, Vezzani A, Palermo S, Altomonte F, Moscatelli P, Pelosi P. Hemorrhagic shock in polytrauma patients: early detection with renal Doppler resistive index measurements. Radiology. 2011;260(1):112–8.
Grün OS, Herath E, Weihrauch A, Flügge F, Rogacev KS, Fliser D, Heine GH. Does the measurement of the difference of resistive indexes in spleen and kidney allow a selective assessment of chronic kidney injury? Radiology. 2012;264:894–902.
Lennartz CS, Pickering JW, Seiler-Mußler S, Bauer L, Untersteller K, Emrich IE, Zawada AM, Radermacher J, Tangri N, Fliser D, Heine GH. External validation of the kidney failure risk equation and re-calibration with addition of ultrasound parameters. Clin J Am Soc Nephrol. 2016;11(4):609–15.
Heine GH, Gerhart MK, Ulrich C, Köhler H, Girndt M. Renal Doppler resistance indices are associated with systemic atherosclerosis in kidney transplant recipients. Kidney Int. 2005;68:878–85.
Naesens M, Heylen L, Lerut E, Claes K, De Wever L, Claus F, et al. Intrarenal resistive index after renal transplantation. N Engl J Med. 2013;369:1797–806.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors Pierpaolo Di Nicolò and Antonio Granata have declared that no conflict of interest exists.
Human and animal rights
This article does not contain any studies with human participants or animal performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the article.
About this article
Cite this article
Di Nicolò, P., Granata, A. Renal Resistive Index: not only kidney. Clin Exp Nephrol 21, 359–366 (2017). https://doi.org/10.1007/s10157-016-1323-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-016-1323-3