Ultrasound examination as a method of early “bedside” diagnosis of acute kidney injury in geriatric patients after urgent abdominal surgery

Authors

DOI:

https://doi.org/10.14739/2310-1237.2021.2.237934

Keywords:

elderly, acute kidney injury, renal resistive index

Abstract

Geriatric patients are particularly vulnerable to the development of postoperative complications, one of which is acute kidney injury (AKI). Early diagnosis of AKI is an important component of the effectiveness of its prevention and treatment. It is believed that ultrasound examination of renal blood flow may be a promising method for bedside diagnosis of AKI.

The aim is to evaluate the predictive value of renal resistance index (RRI) and semiquantitative renal perfusion (SQP) as methods for early diagnosis of AKI in geriatric patients after urgent abdominal surgery.

Materials and methods. A prospective single-center study included 40 patients (72.5 (65; 81.5) y. o.) who were assessed for the risk of development, the presence and stage of AKI, and additionally measured hemodynamic parameters, intra-abdominal pressure (IAP), and abdominal perfusion pressure (APP). Renal resistance index (RRI) and semi-quantitative renal perfusion score (SQP) were determined using Doppler ultrasound (ultrasound probe CH-6, SIEMENS, Acuson Antares). Statistical analysis was performed using the STATISTICA for Windows 13 program (StatSoftInc., No. JPZ804I382130ARCN10-J).

Results. In the postoperative period, AKI developed in 26 patients (65%). Compared with patients without AKI, they had a 14% lower level of mean arterial pressure (MAP) (p=0.008), as well as an average of 4 mmHg higher IAP (p=0.005) and significantly lower APP (p=0.0348). Correlation analysis revealed a weak relationship between the values of MAP, IAP, APP and the development of AKI (r=0.34, r=0.41, r=0.392, respectively, p˂0.05).

Patients with AKI had a 13.9% higher RRI than patients without AKI (0.75 (0.72; 0.81) r.u. vs 0.66 (0.61; 0.69) r.u., respectively, p=0.000001), however, the degree of SQP of the kidneys did not differ significantly between the groups (p=0.636). The correlation between the RRI and the development of AKI was of moderate strength (r=0.57, p˂0.05). MAP, IAP, and APP were significantly very weakly correlated with RRI (r=0.34; r=0.41, r=0.392, respectively, p˂0.05). ROC analysis showed that RRI>0.71 r.u. is the threshold level for AKI with 87.2% sensitivity and 73.5% specificity, and it has a high predictive value (area under the curve AUC 0.868 (p<0.0001)).

Conclusions. High RRI values are associated with AKI in geriatric patients after urgent abdominal surgery. RRI may be a bedside diagnostic tool for AKI, in contrast to renal SQP, which has shown no predictive value.

Author Biographies

N. V. Momot, Zaporizhzhia State Medical University, Ukraine

PhD student of the Department of Anesthesiology and Intensive Care

N. V. Tumanska, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Propaedeutics of Internal Medicine, Radiation Diagnostics and Therapy

S. I. Vorotyntsev, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Head of the Department of Anesthesiology and Intensive Care

References

Rewa, O., & Bagshaw, S. M. (2014). Acute kidney injury-epidemiology, outcomes and economics. Nature reviews. Nephrology, 10(4), 193-207. https://doi.org/10.1038/nrneph.2013.282

Kork, F., Balzer, F., Spies, C. D., Wernecke, K. D., Ginde, A. A., Jankowski, J., & Eltzschig, H. K. (2015). Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients. Anesthesiology, 123(6), 1301-1311. https://doi.org/10.1097/ALN.0000000000000891

Cho, E., Kim, S. C., Kim, M. G., Jo, S. K., Cho, W. Y., & Kim, H. K. (2014). The incidence and risk factors of acute kidney injury after hepatobiliary surgery: a prospective observational study. BMC nephrology, 15, 169. https://doi.org/10.1186/1471-2369-15-169

Hobson, C., Ozrazgat-Baslanti, T., Kuxhausen, A., Thottakkara, P., Efron, P. A., Moore, F. A., Moldawer, L. L., Segal, M. S., & Bihorac, A. (2015). Cost and Mortality Associated With Postoperative Acute Kidney Injury. Annals of surgery, 261(6), 1207-1214. https://doi.org/10.1097/SLA.0000000000000732

Teixeira, C., Rosa, R., Rodrigues, N., Mendes, I., Peixoto, L., Dias, S., Melo, M. J., Pereira, M., Bicha Castelo, H., & Lopes, J. A. (2014). Acute kidney injury after major abdominal surgery: a retrospective cohort analysis. Critical care research and practice, 2014, 132175. https://doi.org/10.1155/2014/132175

Gameiro, J., Fonseca, J. A., Neves, M., Jorge, S., & Lopes, J. A. (2018). Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes. Annals of intensive care, 8(1), 22. https://doi.org/10.1186/s13613-018-0369-7

Biteker, M., Dayan, A., Tekkeşin, A. İ., Can, M. M., Taycı, İ., İlhan, E., & Şahin, G. (2014). Incidence, risk factors, and outcomes of perioperative acute kidney injury in noncardiac and nonvascular surgery. American journal of surgery, 207(1), 53-59. https://doi.org/10.1016/j.amjsurg.2013.04.006

Acuña, K., Costa, E., Grover, A., Camelo, A., & Santos Júnior, R. (2007). Características clínico-epidemiológicas de adultos e idosos atendidos em unidade de terapia intensiva pública da Amazônia (Rio Branco, Acre) [Clinical-epidemiological characteristics of adults and aged interned in an intensive care unity of the Amazon (Rio Branco, Acre)]. Revista Brasileira de terapia intensiva, 19(3), 304-309.

Coca, S. G., Singanamala, S., & Parikh, C. R. (2012). Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney international, 81(5), 442-448. https://doi.org/10.1038/ki.2011.379

Bellomo, R., Ronco, C., Mehta, R. L., Asfar, P., Boisramé-Helms, J., Darmon, M., Diehl, J. L., Duranteau, J., Hoste, E., Olivier, J. B., Legrand, M., Lerolle, N., Malbrain, M., Mårtensson, J., Oudemans-van Straaten, H. M., Parienti, J. J., Payen, D., Perinel, S., Peters, E., Pickkers, P., … Laterre, P. F. (2017). Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference. Annals of intensive care, 7(1), 49. https://doi.org/10.1186/s13613-017-0260-y

Bucuvic, E. M., Ponce, D., & Balbi, A. L. (2011). Risk factors for mortality in acute kidney injury. Revista da Associacao Medica Brasileira (1992), 57(2), 158-163. https://doi.org/10.1590/s0104-42302011000200012

Uchino, S., Kellum, J. A., Bellomo, R., Doig, G. S., Morimatsu, H., Morgera, S., Schetz, M., Tan, I., Bouman, C., Macedo, E., Gibney, N., Tolwani, A., Ronco, C., & Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators (2005). Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA, 294(7), 813-818. https://doi.org/10.1001/jama.294.7.813

Gumbert, S. D., Kork, F., Jackson, M. L., Vanga, N., Ghebremichael, S. J., Wang, C. Y., & Eltzschig, H. K. (2020). Perioperative Acute Kidney Injury. Anesthesiology, 132(1), 180-204. https://doi.org/10.1097/ALN.0000000000002968

Maier, H. T., Ashraf, M. I., Denecke, C., Weiss, S., Augustin, F., Messner, F., Vallant, N., Böcklein, M., Margreiter, C., Göbel, G., Pratschke, J., Öfner-Velano, D., & Aigner, F. (2018). Prediction of delayed graft function and long-term graft survival by serum and urinary neutrophil gelatinase-associated lipocalin during the early postoperative phase after kidney transplantation. PloS one, 13(1), e0189932. https://doi.org/10.1371/journal.pone.0189932

Cui, L. Y., Zhu, X., Yang, S., Zhou, J. S., Zhang, H. X., Liu, L., & Zhang, J. (2015). Prognostic Value of Levels of Urine Neutrophil Gelatinase-associated Lipocalin and Interleukin-18 in Patients With Delayed Graft Function After Kidney Transplantation. Transplantation proceedings, 47(10), 2846-2851. https://doi.org/10.1016/j.transproceed.2015.10.042

Yong, Z., Pei, X., Zhu, B., Yuan, H., & Zhao, W. (2017). Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials. Scientific reports, 7, 41012. https://doi.org/10.1038/srep41012

Bellos, I., Pergialiotis, V., & Kontzoglou, K. (2019). Renal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis. Journal of critical care, 50, 36-43. https://doi.org/10.1016/j.jcrc.2018.11.001

Calabia, J., Torguet, P., Garcia, I., Martin, N., Mate, G., Marin, A., Molina, C., & Valles, M. (2014). The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation. Journal of clinical hypertension, 16(3), 186-191. https://doi.org/10.1111/jch.12248

Bellos, I., Perrea, D. N., & Kontzoglou, K. (2019). Renal resistive index as a predictive factor of delayed graft function: A meta-analysis. Transplantation reviews, 33(3), 145-153. https://doi.org/10.1016/j.trre.2019.03.003

Schnell, D., Reynaud, M., Venot, M., Le Maho, A. L., Dinic, M., Baulieu, M., Ducos, G., Terreaux, J., Zeni, F., Azoulay, E., Meziani, F., Duranteau, J., & Darmon, M. (2014). Resistive Index or color-Doppler semi-quantitative evaluation of renal perfusion by inexperienced physicians: results of a pilot study. Minerva anestesiologica, 80(12), 1273-1281.

Barozzi, L., Valentino, M., Santoro, A., Mancini, E., & Pavlica, P. (2007). Renal ultrasonography in critically ill patients. Critical care medicine, 35(5 Suppl), S198-S205. https://doi.org/10.1097/01.CCM.0000260631.62219.B9

American College of Surgeons. (2021). ACS NSQIP Surgical Risk Calculator. https://riskcalculator.facs.org/RiskCalculator/

MDCalc. (2021). Sequential Organ Failure Assessment (SOFA) Score. https://www.mdcalc.com/sequential-organ-failure-assessment-sofa-score

Khwaja A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron. Clinical practice, 120(4), c179-c184. https://doi.org/10.1159/000339789

Bosch, J. P., Saccaggi, A., Lauer, A., Ronco, C., Belledonne, M., & Glabman, S. (1983). Renal functional reserve in humans. Effect of protein intake on glomerular filtration rate. The American journal of medicine, 75(6), 943-950. https://doi.org/10.1016/0002-9343(83)90873-2

Ronco, C., & Rosner, M. H. (2012). Acute kidney injury and residual renal function. Critical care, 16(4), 144. https://doi.org/10.1186/cc11426

Mehta, R. L., Kellum, J. A., Shah, S. V., Molitoris, B. A., Ronco, C., Warnock, D. G., Levin, A., & Acute Kidney Injury Network (2007). Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical care, 11(2), R31. https://doi.org/10.1186/cc5713

Lerolle, N., Guérot, E., Faisy, C., Bornstain, C., Diehl, J. L., & Fagon, J. Y. (2006). Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive care medicine, 32(10), 1553-1559. https://doi.org/10.1007/s00134-006-0360-x

Bossard, G., Bourgoin, P., Corbeau, J. J., Huntzinger, J., & Beydon, L. (2011). Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass. British journal of anaesthesia, 107(6), 891-898. https://doi.org/10.1093/bja/aer289

Darmon, M., Schortgen, F., Vargas, F., Liazydi, A., Schlemmer, B., Brun-Buisson, C., & Brochard, L. (2011). Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive care medicine, 37(1), 68-76. https://doi.org/10.1007/s00134-010-2050-y

Schnell, D., Deruddre, S., Harrois, A., Pottecher, J., Cosson, C., Adoui, N., Benhamou, D., Vicaut, E., Azoulay, E., & Duranteau, J. (2012). Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Shock, 38(6), 592-597. https://doi.org/10.1097/SHK.0b013e318271a39c

Wu, H. B., Qin, H., Ma, W. G., Zhao, H. L., Zheng, J., Li, J. R., & Sun, L. Z. (2017). Can Renal Resistive Index Predict Acute Kidney Injury After Acute Type A Aortic Dissection Repair?. The Annals of thoracic surgery, 104(5), 1583-1589. https://doi.org/10.1016/j.athoracsur.2017.03.057

Haitsma Mulier, J., Rozemeijer, S., Röttgering, J. G., Spoelstra-de Man, A., Elbers, P., Tuinman, P. R., de Waard, M. C., & Oudemans-van Straaten, H. M. (2018). Renal resistive index as an early predictor and discriminator of acute kidney injury in critically ill patients; A prospective observational cohort study. PloS one, 13(6), e0197967. https://doi.org/10.1371/journal.pone.0197967

Regolisti, G., Maggiore, U., Cademartiri, C., Belli, L., Gherli, T., Cabassi, A., Morabito, S., Castellano, G., Gesualdo, L., & Fiaccadori, E. (2017). Renal resistive index by transesophageal and transparietal echo-doppler imaging for the prediction of acute kidney injury in patients undergoing major heart surgery. Journal of nephrology, 30(2), 243-253. https://doi.org/10.1007/s40620-016-0289-2

Marty, P., Szatjnic, S., Ferre, F., Conil, J. M., Mayeur, N., Fourcade, O., Silva, S., & Minville, V. (2015). Doppler renal resistive index for early detection of acute kidney injury after major orthopaedic surgery: a prospective observational study. European journal of anaesthesiology, 32(1), 37-43. https://doi.org/10.1097/EJA.0000000000000120

Boddi, M., Bonizzoli, M., Chiostri, M., Begliomini, D., Molinaro, A., Tadini Buoninsegni, L., Gensini, G. F., & Peris, A. (2016). Renal Resistive Index and mortality in critical patients with acute kidney injury. European journal of clinical investigation, 46(3), 242-251. https://doi.org/10.1111/eci.12590

Gornik, I., Godan, A., & Gašparović, V. (2014). Renal resistive index at ICU admission and its change after 24 hours predict acute kidney injury in sepsis. Critical Care, 18(Suppl 1), P366. https://doi.org/10.1186/cc13556

Darmon, M., Bourmaud, A., Reynaud, M., Rouleau, S., Meziani, F., Boivin, A., Benyamina, M., Vincent, F., Lautrette, A., Leroy, C., Cohen, Y., Legrand, M., Morel, J., Terreaux, J., & Schnell, D. (2018). Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study. Intensive care medicine, 44(11), 1904-1913. https://doi.org/10.1007/s00134-018-5386-3

Ninet, S., Schnell, D., Dewitte, A., Zeni, F., Meziani, F., & Darmon, M. (2015). Doppler-based renal resistive index for prediction of renal dysfunction reversibility: A systematic review and meta-analysis. Journal of critical care, 30(3), 629-635. https://doi.org/10.1016/j.jcrc.2015.02.008

Schnell, D., & Darmon, M. (2012). Renal Doppler to assess renal perfusion in the critically ill: a reappraisal. Intensive care medicine, 38(11), 1751-1760. https://doi.org/10.1007/s00134-012-2692-z

Lerolle N. (2012). Please don't call me RI anymore; I may not be the one you think I am!. Critical care, 16(6), 174. https://doi.org/10.1186/cc11831

Dewitte, A., Coquin, J., Meyssignac, B., Joannès-Boyau, O., Fleureau, C., Roze, H., Ripoche, J., Janvier, G., Combe, C., & Ouattara, A. (2012). Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury. Critical care, 16(5), R165. https://doi.org/10.1186/cc11517

Bude, R. O., & Rubin, J. M. (1999). Relationship between the resistive index and vascular compliance and resistance. Radiology, 211(2), 411-417. https://doi.org/10.1148/radiology.211.2.r99ma48411

Published

2021-08-20

How to Cite

1.
Momot NV, Tumanska NV, Vorotyntsev SI. Ultrasound examination as a method of early “bedside” diagnosis of acute kidney injury in geriatric patients after urgent abdominal surgery. Pathologia [Internet]. 2021Aug.20 [cited 2024Mar.29];18(2):142-51. Available from: http://pat.zsmu.edu.ua/article/view/237934

Issue

Section

Original research