Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery.
View Article and Find Full Text PDFThe correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, it has been proposed as a marker of volaemic status by indirect assessment of central venous pressure or fluid responsiveness. Although ultrasonographic evaluation of IVC is relatively easy to perform, correct interpretation of the results may not be that simple and multiple pitfalls hamper its wider application in the clinical setting.
View Article and Find Full Text PDFBackground: Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies can be put into place to improve outcomes. Materials and methods: This was a prospective, observational study, involving 63 critically ill patients, that aimed to explore the diagnostic accuracy of different Doppler parameters in predicting AKI in critically ill patients from a mixed ICU.
View Article and Find Full Text PDFUltrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost- and time-saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis.
View Article and Find Full Text PDFBackground: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis.
View Article and Find Full Text PDFIn recent years imaging techniques that use radionuclides have become more and more clinically relevant as they can provide functional information for specific anatomical districts. This has also involved nephrology, where radionuclides are used to study patients with different degrees of renal function failure up to terminal uremia. Although chronic kidney disease, and dialysis in particular, may affect the distribution and the elimination of radiopharmaceuticals, to date there are no consistent data on the risks associated with their use in this clinical context.
View Article and Find Full Text PDFArteriovenous access ischemic steal is a fairly uncommon complication associated with the creation of a vascular access for hemodialysis, which can sometimes cause potentially devastating complications, with permanent disability. Several old names for this syndrome have now been replaced by two new denominations: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and Distal Hypoperfusion Ischemic Syndrome (DHIS). Clinically, we distinguish between the Peripheral Hypoperfusion Syndrome, which can cause gangrene of the fingers, and the Monomelic Syndrome, characterized by low incidence and by the presence of neurological dysfunctions.
View Article and Find Full Text PDFThe use of renal resistive indices (RRIs) for the study of renal microcirculation has in the past been proposed for the identification of renal organ damage or even to specifically identify injury to some areas of the renal parenchyma. Nevertheless, according to the most recent evidences from literature this organ-based conception of RRIs has been proven to be partial and unable to explain the RRIs variations in clinical settings of sepsis or combined organ failure of primitively extrarenal origin or, more generally, the deep connection between RRIs and hemodynamic factors such as compliance and pulsatility of the large vessels. The aim of this review is to explain the physiopathological basis of RRIs determination and the most common interpretative errors in their analysis.
View Article and Find Full Text PDFThe 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.
View Article and Find Full Text PDFRenal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate. Nevertheless, the concept emerging from accumulating clinical and experimental evidence is that in complex clinical pictures, kidney failure is strongly linked to the hemodynamic alterations occurring in the renal venous micro and macrocirculation.
View Article and Find Full Text PDFBackground: Internal jugular vein cannulation has become increasingly widespread. Compared to the left internal jugular vein (LIJV), the right internal jugular vein (RIJV) is the preferred choice for the placement of central venous catheter (CVC) for hemodialysis, mostly due to the major technical difficulties and higher rate of complications of the LIJV approach. We aimed to investigate whether variability in the direction of the LIJV/brachiocephalic vein (BV) axis on the frontal plane could be a decisive factor in determining CVC dysfunctions.
View Article and Find Full Text PDFThe end-stage renal disease is characterized by a profound impairment in the regulation of body fluid distribution, and volume assessment in hemodialysis is one of the challenging goals for the nephrologist. To determine a state of euvolemia, different validated techniques have been employed and among them lung ultrasonography (LUS) has recently attracted growing attention on account of its capacity to estimate accurately extra vascular lung water and to detect lung edema even in its early asymptomatic stage, that is, hidden lung congestion.With its noninvasiveness, freedom from radiation, the ease of use, acceptable intra/inter-operator reproducibility and availability of portable ultrasound devices, LUS can be considered one of the most interesting "cards to play" for the volume assessment in patients on hemodialysis.
View Article and Find Full Text PDFThis paper deals with two recent cases of Inferior Caval Vein (IVC) duplicity, congenital anomaly often but not always asymptomatic that should be considered in the differential diagnosis of flank pain when other more common disorders have been excluded. Here are described the clinical and surgical significance together with the typical sonographic findings useful for the diagnosis of IVC duplicity. Particular attention is given to a peculiar and easily repeatable sonographic aspect associated with IVC duplicity, not previously reported in Literature and that we called the "Neptune's sign".
View Article and Find Full Text PDFAs a consequence of the central role of the arteriovenous fistula for dialysis (AVF) in the clinical management of the dialysis patient the necessity to limit the puncture-related complications to extend as much as possible the life of the vascular access. Accordingly, the AVF needling technique has gained growing attention. Alongside the traditional rope ladder (RL) puncture method, the buttonhole technique (BH) is increasingly popular; this technique employs the same cannulation sites of AVF in every dialysis associated with the use of dull needles to minimize vessels damage.
View Article and Find Full Text PDFFrom 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.
View Article and Find Full Text PDFHistory A 52-year-old man with a history of urinary tract infections and a previous clinical diagnosis of left inguinal hernia presented to the nephrologist with recent onset of dysuria and increasing swelling in the left inguinoscrotal region in the absence of fever or scrotal trauma. There was no relevant surgical or family history. The general physical examination findings were unremarkable, with a normal abdomen at both visual inspection and palpation; urogenital examination revealed a small left-sided palpable mass of the testis, compatible with an inguinal hernia or hydrocele.
View Article and Find Full Text PDFKidney transplantation is the treatment of choice in end-stage renal disease, given the better quality of life of transplanted patients when compared with patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, parts of transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function.
View Article and Find Full Text PDFA large amount of recent epidemiological studies have shown the worldwide growth on the incidence and prevalence of diabetes mellitus type II (DM2), especially in industrialized countries where DM2 is the most frequent cause of chronic kidney disease. Diabetic nephropathy progression to ESRD (End Stage Renal Disease) may be slowed down only with a tight glycemic control, since no hypoglycemic drugs have been shown to possess renoprotective effects. Treatment with oral hypoglycemic agents should be closely and regularly monitored in patients with diabetic nephropathy since the decline of renal function below 60 ml/min of glomerular filtration rate (GFR) could cause multiple pharmacokinetic alterations.
View Article and Find Full Text PDFBackground And Objectives: Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated.
Design, Setting, Participants & Measurements: We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute.