Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000200006
Jornal Vascular Brasileiro
Original Article

Avaliação da perfusão renal pelo Power Doppler em pacientes transplantados renais

Assessment of renal perfusion by Power Doppler in renal transplanted patients

Ana Luiza Engelhorn; José Gastão R. de Carvalho; Carlos Alberto Engelhorn; Maria Fernanda Cassou

http://dx.doi.org/10.1590/S1677-54492006000200006 J Vasc Bras, vol.5, n2, p.109-116, 2006
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Resumo

OBJETIVOS: O objetivo deste estudo é testar a aplicabilidade do estudo ultra-sonográfico com Power Doppler na identificação das alterações da perfusão dos rins transplantados e sua correlação com a reserva funcional renal e microalbuminúria antes e após a infusão de solução de aminoácidos intravenosos. MÉTODOS: Vinte e três pacientes transplantados renais foram avaliados pelo Power Doppler antes (fase basal), após 120 minutos (fase 1) e após 240 minutos (fase 2) da infusão intravenosa de aminoácidos. Concomitantemente, foram realizadas, nas três fases, dosagem de creatinina, avaliação do índice de filtração glomerular, da reserva funcional renal e de microalbuminúria. RESULTADOS: De acordo com os padrões de perfusão na fase basal pelo Power Doppler, descritos por Hoyer et al. em 1999, os pacientes foram divididos em três grupos: 12 pacientes com escore I, seis com escore II e cinco com escore III de perfusão renal. Nos enxertos renais com excelente perfusão renal (escore I), observou-se variação significativa das variáveis estudadas, tanto na fase 1 como na 2 (P CONCLUSÕES: Os achados sugerem que os transplantes com escore I de perfusão apresentam reserva funcional renal quando submetidos a estímulo com aminoácidos. No entanto, com a progressiva diminuição no grau de perfusão renal pelo Power Doppler, observa-se perda da capacidade dos rins transplantados em aumentar o índice de filtração glomerular como resposta a estímulos externos, com seqüente ausência de reserva funcional renal. A partir deste estudo, será possível criar novos horizontes para o entendimento da evolução dinâmica do processo de perda da função renal nos transplantados renais.

Palavras-chave

Power Doppler, perfusão renal, transplante renal

Abstract

OBJECTIVES: The aim of this study was to determine the applicability of Power Doppler ultrasound in the identification of changes in perfusion of renal transplants and their correlation with renal functional reserve and microalbuminuria before and after the infusion of intravenous amino acids. METHODS: Twenty-three renal transplanted patients were assessed by Power Doppler before (baseline), 120 minutes (stage 1) and 240 minutes (stage 2) after the infusion of intravenous amino acids. At the same time, during the three stages, we measured serum creatinine, index of glomerular filtration, renal functional reserve, and microalbuminuria. RESULTS: According to predefined patterns of perfusion by Power Doppler, described by Hoyer et al. in 1999, the patients were divided into three groups: 12 patients with score I, six with score II, and five with score III of renal perfusion. In the renal grafts with an excellent perfusion (score I), there was a significant variation of the variables in stages 1 and 2 (P CONCLUSIONS: The findings suggest that the transplants with perfusion score I have renal functional reserve when stimulated with amino acids. Nevertheless, with the progressive reduction in renal perfusion by Power Doppler, there is a loss in the ability of transplanted kidneys to increase the index of glomerular filtration in response to external stimuli, resulting in absence of renal functional reserve. This study allows for the further understanding of the dynamic evolution of the process of renal function loss in renal transplanted patients.

Keywords

Power Doppler, renal perfusion, renal transplant

References

Manns BJ, Taub KJ, Donaldson C. Economic evaluation and end-stage renal disease: from basics to bedside. Am J Kidney Dis.. 2000;36:12-28.

Kaufman DB, Matas AJ, Arrazola L. Transplantation of kidney from zero haplotype-matched living donors and from distantly related and unrelated donors in the cyclosporine era. Transplant Proc.. 1993;25:1530-1.

Jakobsen JA, Brabrand K, Egge TS, Hartmann A. Doppler examination of the allografted kidney. Acta Radiol.. 2003;44:3-12.

Laupacis A, Keown P, Pus N. A study of the quality of life and cost-utility of renal transplantation. Kidney Int.. 1996;50:235-42.

Russell JD, Beecroft ML, Ludwin D, Churchill DN. The quality of life in renal transplantation: a prospective study. Transplantation. 1992;54:656-60.

Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med.. 1982;307:652-9.

Bosch JP, Lew S, Glabman S, Lauer A. Renal hemodynamic changes in humans: Response to protein loading in normal and diseased kidney. Am J Med.. 1986;81:809-15.

Rubin JM, Adler RS. Power Doppler expands standard color capability. Diagn Imaging (San Franc). 1993;15:66-9.

Wang SM, Lai MK, Chueh SC, Chen J. The utility of resistance index of distal interlobular arteries in evaluating renal graft function. Transplant Proc.. 2004;36:2184-5.

Friedewald SM, Molmenti EP, Friedewald JJ, Dejong MR, Hamper UM. Vascular and nonvascular complications of renal transplants: sonographic evaluation and correlation with other imaging modalities, surgery and pathology. J Clin Utrasound. 2005;33:127-39.

Hoyer PF, Schmid R, Wunsch L, Vester U. Color Doppler energy: a new technique to study tissue perfusion in renal transplants. Pedriatr Nephrol. 1999;13:559-63.

Bigazzi R, Bianchi S. Microalbuminuria as a marker of cardiovascular and renal disease in essential hypertension. Nephrol Dial Transplant.. 1995;10:10-4.

Trillaud H, Merville P, Tran Le Linh P, Palussiere J, Potaux L, Grenier N. Color Doppler sonography in early renal transplantation follow-up: resistive index measurements versus power Doppler sonography. AJR Am J Roentgenol.. 1998;171:1611-5.

Datta R, Sandhu M, Saxena AK, Sud K, Minz M, Suri S. Role of duplex Doppler and Power Doppler sonography in transplanted kidneys with acute renal parenchymal dysfunction. Australas Radiol.. 2005;49:15-20.

Krumme B, Grotz W, Kirste G, Schollmeyer P, Rump LC. Determinants of intrarenal Doppler indices in stable renal allografts. J Am Soc Nephrol.. 1997;8:813-6.

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