Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania.
Department of Anatomic and Molecular Pathology, Laboratoire National de Santé , Dudelange , Luxembourg.
Ren Fail. 2019 Nov;41(1):930-936. doi: 10.1080/0886022X.2019.1674159.
We aimed to evaluate the relationship between biopsy-proven kidney lesions, subclinical markers of atherosclerosis and intrarenal resistive index (RRI) in chronic kidney disease (CKD) patients. This cross-sectional, single-center study prospectively enrolled 44 consecutive CKD patients (57% male gender, 54.1 (95%CI, 49.7-58.6) years, median eGFR 28.1 (15.0-47.7) mL/min) diagnosed by renal biopsy during 6 months in our clinic. RRI, carotid intima-media thickness (IMT), Kauppila score for abdominal aortic calcification (AACs) were assessed. Traditional and nontraditional atheroscleosis risk factors were also evaluated. Most of the patients had a diagnosis of glomerular nephropathy, with IgA nephropathy and diabetic nephropathy being the most frequent. RRI increased proportionally with CKD stages. Patients with RRI >0.7 (39%) were older, had diabetic and vascular nephropathies more frequently, higher mean arterial blood pressure, increased systemic atherosclerosis burden (IMT and AACs), higher percentage of global glomerulosclerois, GBM thickness, arteriolosclerosis and interstitial fibrosis/tubular atrophy. RRI directly correlated with age (rs = 0.55, < 0.001) and with all the studied atherosclerosis markers (clinical atherosclerosis score rs = 0.50, = 0.02; AACs rs = 0.50, < 0.01; IMT rs = 0.34, = 0.02). Also, global glomerulosclerosis (rs = 0.31, = 0.03) and interstitial fibrosis/tubular atrophy (rs = 0.35, = 0.01) were directly correlated with RRI. In multivariable adjusted binomial logistic regression models, only arteriolosclerosis was retained as independent predictor of RRI >0.7. The analysis of RRI may be useful in the evaluation of the general vascular condition of the patient with CKD, supplying information about both microvascular and macrovascular impairment. Moreover, RRI correlates well with renal histopathologic characteristics, particularly with arteriolosclerosis.
我们旨在评估经活检证实的肾脏病变、亚临床动脉粥样硬化标志物与慢性肾脏病（CKD）患者肾内阻力指数（RRI）之间的关系。这项横断面、单中心研究前瞻性纳入了在我们诊所接受肾活检诊断的 44 例 CKD 患者（57%为男性，54.1（95%CI，49.7-58.6）岁，中位 eGFR 为 28.1（15.0-47.7）mL/min）。评估了 RRI、颈动脉内膜中层厚度（IMT）、Kauppila 评分评估腹主动脉钙化（AACs）。还评估了传统和非传统动脉粥样硬化危险因素。大多数患者诊断为肾小球肾炎，最常见的是 IgA 肾病和糖尿病肾病。RRI 随 CKD 分期呈比例增加。RRI>0.7（39%）的患者年龄较大，更常患有糖尿病和血管性肾病，平均动脉血压较高，全身性动脉粥样硬化负担（IMT 和 AACs）增加，肾小球硬化、GBM 厚度、小动脉粥样硬化和间质纤维化/肾小管萎缩的比例较高。RRI 与年龄呈直接相关（rs=0.55， < 0.001），与所有研究的动脉粥样硬化标志物呈直接相关（临床动脉粥样硬化评分 rs=0.50， = 0.02；AACs rs=0.50， < 0.01；IMT rs=0.34， = 0.02）。此外，全球肾小球硬化（rs=0.31， = 0.03）和间质纤维化/肾小管萎缩（rs=0.35， = 0.01）与 RRI 直接相关。在多变量调整的二项逻辑回归模型中，只有小动脉粥样硬化被保留为 RRI>0.7 的独立预测因子。RRI 的分析可能有助于评估 CKD 患者的一般血管状况，提供有关微血管和大血管损伤的信息。此外，RRI 与肾脏组织病理学特征密切相关，特别是与小动脉粥样硬化相关。
