Hanamura Kikuno, Tojo Akihiro, Kinugasa Satoshi, Asaba Kensuke, Fujita Toshiro
Division of Nephrology and Endocrinology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Int J Nephrol. 2012;2012:139565. doi: 10.1155/2012/139565. Epub 2012 Dec 16.
To evaluate the significance of the renal resistive index (RI) as a noninvasive marker of renal histological damage and a prognostic indicator, we examined RI by Doppler ultrasonography in 202 chronic kidney disease (CKD) patients who underwent renal biopsy. RI increased as the CKD stage progressed and correlated with age, systolic blood pressure, estimated glomerular filtration rate (eGFR), and renal histological changes, including glomerulosclerosis, arteriolosclerosis, and tubulointerstitial damage. Prognostic evaluation with a median follow-up period of 38.5 months revealed that patients with RI ≥ 0.7 (high RI group, n = 39) had significantly poorer renal survival than those with RI < 0.65 (normal RI group, n = 120) and 0.65 ≤ RI < 0.7 (high-normal RI group, n = 43). The patients in the high-normal RI group showed good response to steroids. However, in the high RI group, steroid therapy did not significantly improve renal survival. Of the clinical indices studied, RI ≥ 0.7, hypertension, proteinuria, and low eGFR at diagnosis were independent risk factors for worsening renal dysfunction. In conclusion, RI in CKD patients was considered as a marker of renal function, histological damage, and renal prognosis, and a possible determinant of indication for steroids.
为评估肾阻力指数（RI）作为肾脏组织学损伤的非侵入性标志物和预后指标的意义，我们通过多普勒超声检查了202例接受肾活检的慢性肾脏病（CKD）患者的RI。RI随着CKD分期的进展而升高，并与年龄、收缩压、估计肾小球滤过率（eGFR）以及肾脏组织学变化相关，包括肾小球硬化、小动脉硬化和肾小管间质损伤。中位随访期为38.5个月的预后评估显示，RI≥0.7的患者（高RI组，n = 39）的肾脏生存率明显低于RI<0.65的患者（正常RI组，n = 120）和0.65≤RI<0.7的患者（高正常RI组，n = 43）。高正常RI组的患者对类固醇治疗反应良好。然而，在高RI组中，类固醇治疗并未显著改善肾脏生存率。在所研究的临床指标中，诊断时RI≥0.7、高血压、蛋白尿和低eGFR是肾功能恶化的独立危险因素。总之，CKD患者的RI被认为是肾功能、组织学损伤和肾脏预后的标志物，也是类固醇治疗适应证的一个可能决定因素。
