Mahjabin S, Islam M N, Rahman R, Akhter M, Mobin M E, Nobi F, Hasan N, Sarker B
Dr Sonia Mahjabin, Assistant Professor, Department of Nephrology, Bangladesh Medical College, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2025 Jul;34(3):777-785.
Acute kidney injury (AKI) a life threatening condition, one of the most dreadful disease with a broad etiological profile, a challenging problem in our community and specially in critically ill patients and also associated with high morbidity and mortality. Accurate and rapid diagnosis of the cause of AKI is particularly important for selecting appropriate therapy. Measurement of renal indices is commonly used to differentiate prerenal AKI from ATN, often cannot be used and also may not be accurate in many conditions. As renal biopsy is gold standard but this invasive procedure may not be feasible in critically ill patients. Therefore, this cross sectional study was conducted among patients with AKI at Department of Nephrology in Dhaka Medical College Hospital, Bangladesh from November 2017 to June 2019, to assess the ability of Resistive index (RI) to differentiate prerenal AKI and ATN. Mean age were 39.45±10.96 years, with male 65.0%. Among all, 19.0% of AKI patients were found to be sepsis followed by acute watery diarrhea (17.5%), when all causes of hypovolemia were combined, hypovolemia constituted the most prevalent cause. According to renal indices 47.0% patients had prerenal AKI and 53.0%, ATN. On the basis of RI, about 45.0% patients were as a case of prerenal AKI with mean RI 0.63±0.07 and 55.0% were ATN with Mean RI 0.77±0.71. But, type of AKI based on clinical diagnosis was considered as standard and were 46.0% prerenal AKI and 54.0% patients ATN. When compared with clinical diagnosis, RI was found to be more correlated with clinical diagnosis with p<0.001 than renal indices. RI had 91.89% sensitivity and 95.35% specificity to differentiate prerenal AKI and ATN. On the other hand, renal indices had low sensitivity (62.16%) and specificity (65.12%). Moreover, a statistically significant difference were noted between type of AKI diagnosed by RI and by renal indices (p<0.05). So, RI derived from Doppler ultrasound is superior to renal indices and can be used as a useful differentiating tool.
急性肾损伤（AKI）是一种危及生命的疾病，是病因广泛的最可怕疾病之一，在我们的社区中是一个具有挑战性的问题，尤其是在危重症患者中，并且还与高发病率和死亡率相关。准确、快速地诊断AKI的病因对于选择合适的治疗方法尤为重要。测量肾指标通常用于区分肾前性AKI和急性肾小管坏死（ATN），但在许多情况下往往无法使用，也可能不准确。由于肾活检是金标准，但这种侵入性操作在危重症患者中可能不可行。因此，2017年11月至2019年6月在孟加拉国达卡医学院医院肾病科对AKI患者进行了这项横断面研究，以评估阻力指数（RI）区分肾前性AKI和ATN的能力。平均年龄为39.45±10.96岁，男性占65.0%。在所有患者中，发现19.0%的AKI患者患有败血症，其次是急性水样腹泻（17.5%），当所有低血容量原因合并时，低血容量是最常见的原因。根据肾指标，47.0%的患者患有肾前性AKI，53.0%的患者患有ATN。基于RI，约45.0%的患者为肾前性AKI病例，平均RI为0.63±0.07，55.0%的患者为ATN，平均RI为0.77±0.71。但是，基于临床诊断的AKI类型被视为标准，肾前性AKI为46.0%，ATN患者为54.0%。与临床诊断相比，发现RI与临床诊断的相关性高于肾指标，p<0.001。RI区分肾前性AKI和ATN的敏感性为91.89%，特异性为95.35%。另一方面，肾指标的敏感性（62.16%）和特异性（65.12%）较低。此外，RI诊断的AKI类型与肾指标诊断的AKI类型之间存在统计学显著差异（p<0.05）。因此，多普勒超声得出的RI优于肾指标，可作为一种有用的鉴别工具。
