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Changes of Renal Blood Flow in Nephroptosis: Assessment by Color Doppler Imaging, Isotope Renography and Correlation With Clinical Outcome After Laparoscopic Nephropexy
2024
IMAGING
appear to impact the appearance or the degree of hypertension in this matched study. For urologists caring for patients with urolithiasis a careful check of blood pressure at each office visit is important. Indeed, the timely treatment of this condition may factor more favorably in patient longevity than actually treating the urolithiasis. Now the key question is whether preventing recurrent stone disease will favorably alter blood pressure, and whether both objectives can be achieved simply through an effective weight loss program! Ralph V. Clayman, M.D.
IMAGING Changes of Renal Blood Flow in Nephroptosis: Assessment by Color Doppler Imaging, Isotope Renography and Correlation With Clinical Outcome After Laparoscopic Nephropexy D. M. STROHMEYER, R. PESCHEL, P. EFFERT, O. BORCHERT, G. JANETSCHEK, G. BARTSCH AND F. FRAUSCHER, Departments of Urology and Biostatistics, University of Innsbruck, Innsbruck and Department of Urology, Hospital of Linz, Linz, Austria, and Department of Urology, St. Franziskus Hospital, Aachen, Germany Eur Urol, 45: 790 –793, 2004 Objective: Previously, we have detected changes in renal blood flow secondary to nephroptosis by assessing the renal resistive index (RI) using color Doppler imaging (CDI). The aim of the current study was to compare two diagnostic methods, CDI and isotope renography (IRG), for detection of renal blood flow impairment in patients with nephroptosis. Methods: 26 patients with nephroptosis and flank pain underwent CDI and isotope renography (IRG) before and after laparoscopic nephropexy. The RI was assessed in segmental arteries with the patient in both the supine and erect position. Pre- and postoperative patient symptoms, results of Doppler measurements and IRG findings were assessed. Results: Preoperatively, 23 of 26 symptomatic patients showed a mean reduction in RI of more than 0.10 on the affected side, while only 7 of 26 patients had abnormal findings on preoperative IRGs. Postoperatively, none of the patients with preoperative changes in Doppler parameters showed any posture-related changes in RI. On postoperative IRG, obtained in 4 of 7 patients, normalization of renal perfusion was documented. Twenty out of 26 patients were asymptomatic postoperatively; in the remaining 6 patients symptoms were markedly improved. Conclusion: Impairment of renal blood flow due to nephroptosis was detected with both CDI and IRG. RI measurement by CDI appears to be significantly more sensitive in detecting renal blood flow impairment. RI should be assessed in patients with nephroptosis and may impact on the decision for laparoscopic nephropexy. Editorial Comment: Nephroptosis, significant downward displacement of the kidney when the patient is in the upright position, may manifest as flank pain. My experience is that some radiologists and urologists are skeptical about whether this is a true disease entity. I believe it is. However, this is a diagnosis of exclusion, where other causes of flank pain are excluded. I have occasionally seen patients with dramatic improvement in symptoms after laparoscopic nephropexy. The question is how best to identify these patients and document renal blood flow. This study compared color Doppler imaging and resistive indices measurement with nuclear medicine renogram. Ultrasound examination with resistive index was slightly more sensitive and the authors recommend this examination. The resistive index measurement is (peak systolic velocity– diastolic velocity)/peak systolic velocity. Other variables such as angle corrected peak systolic velocity and volumetric flow (which can be calculated with ultrasound) may also be valuable features in examining this entity. Cary Siegel, M.D.
IMAGING
appear to impact the appearance or the degree of hypertension in this matched study. For urologists caring for patients with urolithiasis a careful check of blood pressure at each office visit is important. Indeed, the timely treatment of this condition may factor more favorably in patient longevity than actually treating the urolithiasis. Now the key question is whether preventing recurrent stone disease will favorably alter blood pressure, and whether both objectives can be achieved simply through an effective weight loss program! Ralph V. Clayman, M.D.
IMAGING Changes of Renal Blood Flow in Nephroptosis: Assessment by Color Doppler Imaging, Isotope Renography and Correlation With Clinical Outcome After Laparoscopic Nephropexy D. M. STROHMEYER, R. PESCHEL, P. EFFERT, O. BORCHERT, G. JANETSCHEK, G. BARTSCH AND F. FRAUSCHER, Departments of Urology and Biostatistics, University of Innsbruck, Innsbruck and Department of Urology, Hospital of Linz, Linz, Austria, and Department of Urology, St. Franziskus Hospital, Aachen, Germany Eur Urol, 45: 790 –793, 2004 Objective: Previously, we have detected changes in renal blood flow secondary to nephroptosis by assessing the renal resistive index (RI) using color Doppler imaging (CDI). The aim of the current study was to compare two diagnostic methods, CDI and isotope renography (IRG), for detection of renal blood flow impairment in patients with nephroptosis. Methods: 26 patients with nephroptosis and flank pain underwent CDI and isotope renography (IRG) before and after laparoscopic nephropexy. The RI was assessed in segmental arteries with the patient in both the supine and erect position. Pre- and postoperative patient symptoms, results of Doppler measurements and IRG findings were assessed. Results: Preoperatively, 23 of 26 symptomatic patients showed a mean reduction in RI of more than 0.10 on the affected side, while only 7 of 26 patients had abnormal findings on preoperative IRGs. Postoperatively, none of the patients with preoperative changes in Doppler parameters showed any posture-related changes in RI. On postoperative IRG, obtained in 4 of 7 patients, normalization of renal perfusion was documented. Twenty out of 26 patients were asymptomatic postoperatively; in the remaining 6 patients symptoms were markedly improved. Conclusion: Impairment of renal blood flow due to nephroptosis was detected with both CDI and IRG. RI measurement by CDI appears to be significantly more sensitive in detecting renal blood flow impairment. RI should be assessed in patients with nephroptosis and may impact on the decision for laparoscopic nephropexy. Editorial Comment: Nephroptosis, significant downward displacement of the kidney when the patient is in the upright position, may manifest as flank pain. My experience is that some radiologists and urologists are skeptical about whether this is a true disease entity. I believe it is. However, this is a diagnosis of exclusion, where other causes of flank pain are excluded. I have occasionally seen patients with dramatic improvement in symptoms after laparoscopic nephropexy. The question is how best to identify these patients and document renal blood flow. This study compared color Doppler imaging and resistive indices measurement with nuclear medicine renogram. Ultrasound examination with resistive index was slightly more sensitive and the authors recommend this examination. The resistive index measurement is (peak systolic velocity– diastolic velocity)/peak systolic velocity. Other variables such as angle corrected peak systolic velocity and volumetric flow (which can be calculated with ultrasound) may also be valuable features in examining this entity. Cary Siegel, M.D.