Protected: Hepatorenal Syndrome – AKI in Decompensated Liver Disease: Clinical Characteristics, Risk Factors, Ultrasound Applications, and Outcomes

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Yarramachu Dharanidhar Reddy

Yarramachu Dharanidhar Reddy1, K.Sai Sindhu Singh1, Pavuluri Lakshmi Aishwarya2, Jayaram JK2, Indhumathi Elayaperumal3

1 Senior resident, Department of Nephrology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India- 602105
2 Assistant Professor, Department of Nephrology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India- 602105
3 Professor, Department of Nephrology, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India- 602105

Corresponding author:
Yarramachu Dharanidhar Reddy,
Department of Nephrology, Saveetha Institute of Medical and Technical Sciences,
Chennai, Tamil Nadu, India- 602105.
Ph.No.+91-9513894603
E-mail: yarramachudharanidharreddy@gmail.com

 

Abstract

Background. Acute kidney injury (AKI) is a common and serious complication in patients with decompensated liver disease (DLD), often resulting from ischemic acute tubular necrosis or hepatorenal syndrome. This study examines the role of biochemical markers and ultrasound parameters, such as right atrial pressure, right ventricular hypertrophy, inferior vena cava diameter, hepatic venous flow dynamics, left ventricular diastolic dysfunction, the E/e’ ratio, renal peak systolic velocity, renal end-diastolic velocity, and renal resistive index (RI), in predicting AKI severity and outcomes.
Methods. A prospective observational study was conducted on 50 DLD patients with AKI, admitted to a tertiary care Hospital. Biochemical parameters including serum creatinine, bilirubin, and albumin along with ultrasound parameters were assessed. AKI was classified according to KDIGO criteria, and renal recovery and mortality were monitored. Diagnostic accuracy was evaluated through ROC analysis.
Results. 30% of patients had stage 3 AKI, with 60% of them being male (average age 54 ± 12 years). Stage 3 AKI was a significant predictor of mortality (OR 3.5, p < 0.001), along with renal resistive index (OR 2.8, p = 0.003). ROC analysis showed that serum creatinine and the E/e’ ratio, along with the RI, were significant predictors for AKI severity and mortality. Renal recovery occurred in 58%.
Conclusion. The simultaneous assessment of clinical, biochemical, and ultrasound parameters enhances the prediction of AKI severity and patient outcomes in DLD. This approach facilitates earlier detection and better management of AKI in this population.

Keywords: Hepatorenal syndrome, acute kidney injury, decompensated liver disease, risk factors, ultrasound

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Quantitative imaging in nephrology: limits and potentials of elastosonography

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Giulio Distefano

Antonio Granata1, Giulio Distefano2, Rosario Maccarrone1, Francesco Pesce3, Costanza Giuseppa4, Antonio Digiacomo2, Antonio Basile5, Marcello Romano6, Vito Cantisani7

1 U.O.C. Nefrologia e Dialisi, A.O. per l’emergenza “Cannizzaro” - Catania (CT), Italia
2 U.O.C. Medicina Generale, Dipartimento di Medicina, Ospedale “R. Guzzardi” di Vittoria, ASP Ragusa, Ragusa, Italia
3 U.O.C. di Nefrologia, Dialisi e Trapianto d’organo, Dipartimento di Emergenze e Trapianti d’organo, Università “Aldo Moro” di Bari, Bari, Italia
4 UOC Nefrologia e Dialisi, P.O. "Vittorio Emanuele" - Gela, Caltanissetta, Italia
5 U.O.C. Radiologia I, Azienda Ospedaliero-Universitaria “Policlinico-San Marco, Università di Catania, Catania, Italia
6 U.O.C. Geriatria, Azienda Ospedaliera Garibaldi, Catania, Italia
7 Dipartimento di Radiologia, Policlinico Umberto I, “Università La sapienza” di Roma, Roma, Italia

Corresponging author:
Giulio Distefano
U.O.C. Medicina Genrale, Dipartimento di Medicina, Ospedale Guzzardi, ASP Ragusa
Via Papa Giovanni XXIII, 97019, Vittoria (RG), Italy
Fax/Tel number: +393385020778
e-mail address: giuliodistefano@gmail.com

 

Abstract

Chronic kidney disease is characterized by increasingly amplified fibrotic processes regardless of etiology. The severity of renal fibrosis seems to correlate with an increased risk of end-stage renal disease; therefore, monitoring of renal fibrosis over time may play an important role in the follow-up of both focal and diffuse renal diseases and in evaluating the response to treatments. Renal biopsy is the only method capable of providing objective and comparable information on the extent of fibrosis, but it is not suitable for outpatient monitoring of chronic kidney disease due to its invasiveness. Elastosonography is an innovative and non-invasive ultrasound method that allows the measurement of tissue elasticity through the transmission of mechanical waves and the measurement of their propagation speed. Although some authors have demonstrated the usefulness of elastosonographic techniques for the quantification of liver fibrosis, few studies have investigated the applications of elastosonography in renal pathology. Furthermore, the depth of native kidneys, the high anisotropy of the renal tissue, and the possibility of examining only a small region of interest currently limit its spread in clinical practice. The aim of this review is to examine the physical principles of elastosonography and to review the latest evidence about the possible applications of the ARFI (acoustic radiation force impulse) technique in the study of kidney diseases.

Keywords: ultrasound, fibrosis, renal elastosonography, ARFI, quantitative imaging

Sorry, this entry is only available in Italiano.

Introduzione

La malattia renale cronica (Chronic Kidney Disease, CKD) è una condizione patologica ad elevata prevalenza nella popolazione generale, caratterizzata da alterazioni della funzione renale e/o anomalie strutturali presenti per più di tre mesi, con variabile tendenza alla progressione verso forme più gravi di insufficienza d’organo [1]. Sebbene numerose patologie del parenchima, dei vasi o delle vie escretrici (sia primitive che secondarie) possano provocare la CKD, la fibrosi d’organo rappresenta la caratteristica comune a tutti i differenti meccanismi patogenetici responsabili di danno renale. Il grado di fibrosi sembra inoltre essere correlato con un maggior rischio di progressione verso l’End Stage Renal Disease (ESRD), pertanto possiede un elevato valore predittivo negativo per l’outcome delle patologie renali croniche [2].

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The new frontier in endovascular treatment of arteriovenous fistula stenosis: the role of ultrasound-guided percutaneous transluminal angioplasty

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Rosario Maccarrone

Rosario Maccarrone1, Luca Zanoli2, Lillo Pace3, Giulio Di Stefano4, Antonio Basile4, Luca Di Lullo5, Francesco Pesce6, Fulvio Fiorini7, Giovanni Giorgio Battaglia8, Antonio Granata1

1 UOC di Nefrologia e Dialisi, P.O. "San Giovanni di Dio", Agrigento, Italia
2 Dip. di Medicina Interna, AOU "Policlinico - V. Emanuele" Università di Catania, Catania, Italia
3 UOC di Radiologia, P.O. "San Giovanni di Dio", Agrigento, Italia
4 Dip. di Radiologia, AOU "Policlinico - V. Emanuele" Università di Catania, Catania, Italia
5 UOC di Nefrologia e Dialisi, P.O. "L. Parodi - Delfino", Colleferro, Roma, Italia
6 Dip. di Nefrologia, Dialisi e Trapianto, AOU "A. Moro" Università di Bari, Bari, Italia
7 UOC di Nefrologia e Dialisi, P.O. "Santa Maria della Misericordia", Rovigo, Italia
8 U.O.C. Nefrologia e Dialisi, P.O. “S. Marta e S. Venera”, Acireale, Catania, Italia

Corrispondenza a:
Rosario Maccarrone
UOC di Nefrologia e Dialisi, P.O. "San Giovanni di DIO" - Agrigento
C/da Consolida, 92100 Agrigento, Italia
Fax/Tel number: +393465185754
e-mail: rosario.maccarrone88@gmail.com

 

Abstract

Native arteriovenous fistula is the preferred vascular access because of it does not usually cause infections and seems to be closely related with prolonged patient survival, compared to prosthetic grafts and central venous catheters; it also is cost effective. Venous stenosis is one of the main causes of AVF failure. It is caused by a number of upstream and downstream events. The former group comprises hemodynamic and surgical stressors, inflammatory stimuli and uraemia, while downstream events involve the proliferation of smooth muscle cells and myofibroblasts and the development of neo-intimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for arteriovenous fistula stenosis. It allows the visualization of the whole vascular circuit and the immediate use of the vascular access for the next dialysis session. Ultrasound-guided percutaneous endovascular angioplasty is a feasible and safe alternative to conventional fluoroscopic technique: it is equally effective in treating arteriovenous fistula stenosis, but it presents the advantage of not using contrast media or ionizing radiation. The aim of this review is to report the latest evidence on cellular and molecular mechanisms that contribute to the development of neo-intimal hyperplasia, as well as the current and future therapeutic perspectives, especially concerning the use of anti-proliferative drugs, and the efficacy of the ultrasound-guided angioplasty in restoring and maintaining the vascular access patency over time.

Key words: Percutaneous angioplasty, ultrasound, arteriovenous fistula, hemodialysis, stenosis.

Sorry, this entry is only available in Italiano.

Introduzione

La prevalenza della malattia renale cronica terminale aumenta di anno in anno. Nel 2010, il numero dei pazienti sottoposti a terapia emodialitica in tutto il mondo era pari a 2,618 milioni e, secondo alcune recenti stime, è destinato a crescere fino a 5,439 milioni entro il 2030 [1]. A livello nazionale, i dati estrapolati dal Report 2015 del Registro Italiano di Dialisi e Trapianto evidenziano un’incidenza e una prevalenza di 154 pazienti/pmp e di 770/pmp rispettivamente [2]. Indipendentemente dalla metodica utilizzata, il buon funzionamento dell’accesso vascolare (AV) rappresenta un requisito irrinunciabile per una ottimale adeguatezza dialitica.

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Management of the incidental renal masses

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Anna Mudoni

Anna Mudoni1, Marina Cornacchiari2, Amelia Liccardo3, Pierpaolo Di Nicolo'4, Luca Di Lullo5, Carlo Guastoni2, Marco Mereghetti6

1 Unità Operativa di Nefrologia e Dialisi Ospedale Cardinale G Panico Tricase (LE)
2 Unità Operativa di Nefrologia, ASST MILANO OVEST
3 Unità Operativa di Nefrologia e Dialisi Multimedica Presidio di Castellanza (VA)
4 Unità Operativa di Nefrologia e Dialisi S. Maria della Scaletta, Imola-Bologna
5 Unità Operativa Complessa di Nefrologia e Dialisi, Ospedale “L. Parodi – Delfino”, Colleferro (RM)
6 Unità Operativa di Medicina, ASST MILANO OVEST

Autore corrispondente:
Anna Mudoni
Unità Operativa di Nefrologia e Dialisi
Ospedale Cardinale G Panico Tricase (LE)
Telefono 333 6868124; 0833 773111
E-mail mudonia@libero.it

 

Abstract

The diagnosis of renal masses has increased in the last decades owing to the widespread use of imaging (ultrasound, computed tomography and magnetic resonance).

Majority of the renal masses are detected incidentally on routine ultrasound examination.

Solid masses detected on ultrasound require further imaging evaluation with CT and/or MRI for suitable characterization. US-guided renal biopsy is a safe, effective and accurate method for evaluating the small renal masses with ambiguous radiologic findings.

Navigation technology and multimodality image fusion represent an important development in interventional radiology, especially for performing difficult percutaneous biopsies and ablations of small renal masses.

Multidisciplinary approach is required which results from experience and knowledge and in hard cases the use of serial imaging can be helpful.

 

Keywords: renal masses, imaging, ultrasound, renal biopsy, active surveillance

Sorry, this entry is only available in Italiano.

Introduzione

Il riscontro di masse renali durante gli ultimi trent’anni è andato via via aumentando (1) grazie alla diffusione delle tecniche di imaging, in primo luogo l’ecografia (US), ma anche la tomografia assiale computerizzata (TC) e la risonanza magnetica nucleare (MRI).

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