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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2007; 17(03): 188-192
DOI: 10.4103/0971-3026.34725
GU Radiology

Doppler sonography in acute renal obstruction

Sonali S Saboo
Department of Radiodiagnosis, Yashoda Superspeciality Hospitals, Hyderabad (AP), India
,
Sachin S Soni
Department of Nephrology, MediCiti Hospitals, Hyderabad (AP), India
,
Suresh H Saboo
Sai Diagnostics, Jalna, Maharashtra, India
,
Naga Ramesh Chinapuvvula
Department of Radiodiagnosis, Yashoda Superspeciality Hospitals, Hyderabad (AP), India
,
Sashidhar Kaza
Department of Radiodiagnosis, Yashoda Superspeciality Hospitals, Hyderabad (AP), India
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Abstract

Aims and Objectives: This prospective analysis was carried out to study the utility of Doppler waveform alterations in the diagnosis of unilateral acute renal obstruction and to study the factors affecting Doppler indices. Methods: In this prospective analysis between May 2005 and March 2006, patients presenting to the emergency medical division with symptoms of unilateral acute renal colic underwent Doppler analysis. Obstruction was confirmed by intravenous urography (IVU) or computed tomography (CT) scan. The duration of renal colic and the site and degree of obstruction were recorded. Patients with medical or surgical renal disease were excluded. Results: 40 patients (80 kidneys) satisfying the inclusion criteria were part of this analysis. The mean resistivity Index (RI) in obstructed kidneys was significantly higher than in the contralateral unobstructed kidneys (0.72 Vs 0.64; p < 0.001). Thirty (75%) cases had proximal while 10 (25%) cases had distal obstruction with higher RI in proximal obstruction (0.73 Vs 0.72). Twenty-five (62.5%) patients had complete, while 15 (37.5%) patients had partial obstruction. The RI value in completely obstructed kidneys was significantly higher than in partially obstructed kidneys (0.74 Vs 0.70; p < 0.05). Using the discriminatory value of 0.70 for obstruction, the overall sensitivity was 87.5% and specificity 90%. Sensitivity was 95% and specificity 100% at a delta RI of 0.06. The degree of obstruction altered the resistivity indices, while the site of obstruction and duration of symptoms did not. Conclusions: Doppler sonography is a useful diagnostic tool in unilateral acute renal obstruction.

Keywords

Doppler sonography - resistivity indices - unilateral acute renal obstruction


Publication History

Article published online:
31 July 2021

© 2007. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ellenbogen PH, Scheible FW, Talner LB, Leopold GR. Sensitivity of gray-scale ultrasound in detecting urinary tract obstruction. AJR Am J Roentgenol 1978;130:731-3.
  • 2 Platt JF, Rubin JM, Ellis JH. Acute renal obstruction: Evaluation with intrarenal duplex Doppler and conventional US. Radiology 1993;186:685-8.
  • 3 Dodd GD 3rd, Kaufman PN, Bracken RB. Renal arterial duplex Doppler ultrasound in dogs with urinary obstruction. J Urol 1991;145:644-6.
  • 4 Platt JF, Rubin JM, Ellis JH, DiPietro M. Duplex Doppler US of the kidney: Differentiation of obstructive from non-obstructive dilatation. Radiology 1989;171:515-7.
  • 5 Platt JF, Rubin JM, Ellis JH. Lupus nephritis: predictive value of conventional and Doppler US and comparison with serologic and biopsy parameters. Radiology 1997;203:82-6.
  • 6 Laing FC, Jeffrey RB Jr, Wing VW. USG versus excretory urography in evaluating acute flank pain. Radiology 1985;154:613-6.
  • 7 Mostbeck GH, Zontsich T, Turetschek K. Ultrasound of the kidney: Obstruction and medical diseases. Eur Radiol 2001;11:1878-89.
  • 8 Webb JA. Ultrasonography and Doppler studies in the diagnosis of renal obstruction. BJU Int 2000;86:25-32.
  • 9 Amis ES Jr, Cronan JJ, Pfister RC, Yoder IC. Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 1982;19:101-5.
  • 10 Rascoff JH, Golden RA, Spinowitz BS, Charytan C. Non-dilated obstructive nephropathy. Arch Intern Med 1983;143:696-8.
  • 11 Millet PJ, Pelle-Francoz DP, Laville M, Gay F, Pinet A. Non-dilated obstructive acute renal failure: Diagnostic procedures and therapeutic management. Radiology 1986;160:659-62.
  • 12 Talner LB, Scheible W, Ellenbogen PH, Beck CH, Gosink BB. How accurate is ultraUSG in detecting hydro-nephrosis in azotaemic patients? Urol Radiol 1981;3:1-6.
  • 13 Webb JA, Reznek RH, White FE, Cattell WR, Fry IK, Baker LR. Can ultrasound and computed tomography replace high-dose urography in patients with impaired renal function? Quart J Med 1984;53:411-25.
  • 14 Fried AM. Hydronephrosis of pregnancy: Ultrasonographic study and classification of asymptomatic women. Am J Obstet Gynaecol 1979;135:1066-70.
  • 15 Scola FH, Cronan JJ, Schepps B. Grade I hydronephrosis pulsed Doppler US evaluation. Radiology 1989;171:519-20.
  • 16 Patel U, Huntley L, Kellett MJ. Sonographic features of renal obstruction mimicked by peripelvic cysts. Clin Radiol 1994;49:481-4.
  • 17 Gulmi FA, Felsen D, et al. Pathophysiology of urinary tract obstruction. In Walsh PC, Reti KAB, Vaughan ED, Wein AJ, eds. Campbell′s Urology. 7th ed. Chapt 9. WB Saunders: Philadelphia; 1998. p. 350.
  • 18 Gottlieb RH, Luhman K, Oates RP. Duplex ultrasound evaluation of normal kidneys and native kidneys with urinary tract obstruction. J Ultrasound Med 1989;8:609-11.
  • 19 Rodgers PM, Bates JA, Irving HC. Intrarenal Doppler ultrasound studies in normal and acutely obstructed kidneys. Br J Radiol 1992;65:207-12.
  • 20 Tublin ME, Dodd GD 3rd, Verdile VP. Acute renal colic: Diagnosis with duplex Doppler US. Radiology 1994;193:697-701.
  • 21 Shokeir AA, Abdulmaaboud. Resistive index in renal colic: A prospective study. BJU Int 1999;83:378-82.
  • 22 Platt JF, Ellis JH, Rubin JM. Role of renal Doppler imaging in the evaluation of acute renal obstruction. AJR Am J Roentgentol 1995;164:379-80.
  • 23 Miletic D, Fuckar Z, Sustic A, Mozetic V, Smokvina A, Stancic M. Resistance and pulsatility indices in acute renal obstruction. J Clin Ultrasound 1998;26:79-84.
  • 24 de Toledo LS, Martinez-Berganza Asensio T, Cozcolluela Cabrejas R, de Gregorio Ariza MA, Pardina Cortina P, Ripa Saldias L. Doppler duplex ultrasound in renal colic. Eur J Radiol 1996;23:143-8.