Time-intensity curve analysis of contrast-enhanced ultrasound is unable to differentiate renal dysfunction in the early post-transplant period - a prospective study

Abstract Background Contrast enhanced ultrasonography (CEUS) assessment of kidney allografts mainly focuses on graft rejection. However, studies on delayed graft function (DGF) without acute rejection are still lacking. The aim of this study was to build a time-intensity curve (TIC) using CEUS in non-immunological DGF to understand the utility of CEUS in early transplantation. Methods Twenty-eight patients in the short-term postoperative period (<14 days) were divided according to the need for dialysis (early graft function [EGF] and [DGF]) and 37 subjects with longer than 90 days follow-up were divided into creatinine tertiles. Time to peak [TTP] and rising time [RT were compared between groups. Results EGF and DGF were similar, except for creatinine. In comparison to the late group, medullary TTP and RT were shorter in the early group as well as the delay regarding contrast arrival in the medulla (in relation to cortex) and reaching the medullary peak (in relation to artery and cortex). In the late group, patients with renal dysfunction showed shorter temporal difference to reach medullary peak in relation to artery and cortex. Conclusions Although it was not possible to differentiate EGF and DGF using TIC, differences between early and late groups point to blood shunting in renal dysfunction

Doença parenquimatosa renal: correlação histológico-sonográfica Renal parenchymal disease: histopathologic-sonographic correlation

OBJETIVO: Este estudo foi planejado para avaliar a correlação da ecografia do rim com as lesões histológicas e com os achados clínico-laboratoriais na doença parenquimatosa renal, por análise de regressão logística multivariada. MÉTODOS: Os dados clínicos, laboratoriais, ecográficos e as biópsias foram avaliados em 154 pacientes. A ecogenicidade cortical foi graduada como menor que grau zero, igual a grau um ou maior que grau dois a do parênquima hepático ou esplênico. As lesões histológicas - proliferação mesangial (PM), permeação leucocitária (PL), crescente e necrose fibrinóide (CNF), infiltrado inflamatório intersticial (II), esclerose glomerular segmentar (ES), obsolescência glomerular (OG), atrofia tubular (AT), fibrose intersticial (FI) e edema intersticial (EI) - foram graduadas de acordo com a extensão, em normal (0%), leve (<25%), moderada (>25% <50%), e grave (>50%). RESULTADOS: a) II, FI, ES, EI e creatinina elevada ocorreram menos no grau 0 de ecogenicidade cortical; b) PM, hipertensão arterial e espessura normal do parênquima foram preditores do grau 1 de ecogenicidade cortical; c) FI, EI, creatinina elevada e parênquima fino foram preditores do grau 2 de ecogenicidade cortical; d) Excluindos os obesos, em jovens com hematócrito baixo, a pirâmide proeminente foi mais comum; e) Creatinina elevada e OG foram preditores de rins pequenos. CONCLUSÃO: A ecogenicidade cortical foi um sensível marcador de doença parenquimatosa renal. Lesões distintas mais do que o grau de severidade da lesão contribuiram para o aumento da ecogenicidade cortical. O EI aumenta exponencialmente o efeito da FI na ecogenicidade cortical.<br>PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma. Histological lesions - mesangial proliferation (MP), leukocyte permeation (LP), fibrinoid necrosis and crescents (FNC), interstitial infiltrate (II), segmental glomerular sclerosis (SGS), glomerular obsolescence (GO), tubular atrophy (TA) interstitial fibrosis (IF) and interstitial edema (IE) - were graded according to extension and severity as normal (0%), mild (<25%), moderate (>25% <50%), and severe (>50%). RESULTS: a) II, IF, SGS, IE and increased creatinine occurred less in cortical echogenicity grade 0; b) MP, arterial hypertension and normal parenchymal thickness predict cortical echogenicity grade 1; c) IF, IE, increased creatinine and thin parenchyma predict occurrence of echogenicity grade 2; d) Excluding obese patients, both youth and hematocrit accounted for pyramid prominence; e) increased creatinine and GO was probable in patients with small kidneys. CONCLUSIONS: Increased cortical echogenicity was a very sensitive marker of renal parenchymal disease. Different lesions rather than degree of lesion severity accounted for progressive increase of cortical echogenicity. IE exponentially increased the effect of IF on cortical echogenicity

Um índice clínico preditor de sobrevida renal A clinical predictor index for renal survival

INTRODUÇÃO: Um índice capaz de antecipar a progressão da doença renal independente dos achados histológicos seria de inestimável valor para a indicação da biópsia renal. OBJETIVO: Avaliar se um índice clínico baseado na ecogenicidade cortical renal, na relação diâmetro longitudinal do rim/altura do indivíduo (KL/H) e na creatinina sérica pode predizer a sobrevida renal. MÉTODOS: As lesões crônicas (obsolescência glomerular, esclerose segmentar e focal, atrofia tubular e fibrose intersticial) e agudas (proliferação mesangial, permeação leucocitária, necrose fibrinoide e crescentes e infiltrado intersticial) das biópsias de 154 pacientes foram graduadas e somadas para geração de índices. Um índice clínico de cronicidade foi criado pela soma da gradação da ecogenicidade cortical relativa a do fígado ou baço, dos níveis de creatinina sérica e da relação KL/H. O desfecho do estudo foi a necessidade de iniciar diálise. RESULTADOS: Os maiores graus do índice clínico de cronicidade e do índice crônico de biópsia foram associados com sobrevida renal mais curta. Dos seis pacientes com creatinina sérica > 2,5 mg/dL, maior ecogenicidade cortical e KL/H < 0,60 antes da biópsia, cinco iniciaram diálise e um elevou a creatinina para 4,5 mg/dL. O índice clínico apresentou boa correlacão com o índice crônico de biópsia. CONCLUSÕES: O índice clínico pode ser útil para predizer uma situação na qual a biópsia mostrará lesões crônicas avançadas e irreversíveis. Nos pacientes com os graus mais altos dos parâmetros clínicos, a biópsia pode ser descartada. Para grupos de pacientes, o índice pode ser utilizado na comparação de desfechos e eficácia terapêutica.<br>INTRODUCTION: A clinical index that discriminates disease progression independent of histopathologic features may be valuable in the best timing of biopsy. OBJECTIVE: This study addresses the question if a clinical index based on cortical echogenicity, renal length to body height ratio (KL/H), and serum creatinine levels predicts renal survival. METHODS: The study enrolled 154 patients. Biopsy specimens were graded for chronic (glomerular obsolescence, segmental glomerular sclerosis, tubular atrophy and interstitial fibrosis) and acute (mesangial proliferation, leucocyte permeation, crescent and fibrinoid necrosis and interstital infiltrate) index by the sum of scored lesions. A chronic clinical index was created by the sum of scored cortical echogenicity relative to liver or spleen, creatinine serum levels and KL/H. The study end point was start on dialisis. RESULTS: Higher grade of chronic clinical and biopsy indices were associated with poorer long-term renal survival. Five out of six patients with serum creatinine levels > 2.5mg/dL, highest cortical echogenicity and KL/H < 0.60, before biopsy, startet on dialysis and one increased creatinine levels up to 4.5 mg/dL. The chronic clinical index correlates well with chronic biopsy index. CONCLUSIONS: The chronic clinical index could be useful to predict a clinical setting in which a renal biopsy will show advanced chronic and irreversible lesion. In patients with highest grade of clinical parameters renal biopsy can be obviate. As a chronicity of illness index for groups of patients with renal medical diseases, the system could be useful in outcome comparisons and evaluation of therapeutic efficacy

A Ultrassonografia transcraniana como método diagnóstico para a doença de Parkinson: um estudo piloto na cidade do Rio de Janeiro, Brasil

Submitted by Santos Bárbara ([email protected]) on 2014-12-19T13:40:46Z No. of bitstreams: 1 Transcranial sonography as a diagnostic tool for Parkinson's disease A pilot study in the city of Rio de Janeiro, Bra.pdf: 1553497 bytes, checksum: fd7a29d95d4119fcec0cd73d75d5c32b (MD5)Approved for entry into archive by Santos Bárbara ([email protected]) on 2014-12-19T15:03:45Z (GMT) No. of bitstreams: 1 Transcranial sonography as a diagnostic tool for Parkinson's disease A pilot study in the city of Rio de Janeiro, Bra.pdf: 1553497 bytes, checksum: fd7a29d95d4119fcec0cd73d75d5c32b (MD5)Made available in DSpace on 2014-12-19T15:37:16Z (GMT). No. of bitstreams: 1 Transcranial sonography as a diagnostic tool for Parkinson's disease A pilot study in the city of Rio de Janeiro, Bra.pdf: 1553497 bytes, checksum: fd7a29d95d4119fcec0cd73d75d5c32b (MD5) Previous issue date: 2011Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Serviço de Neurologia Professor Sérgio Novis. Rio de Janeiro RJ, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Setor de Distúrbios do Movimento. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Adjunto de Neurologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Hospital Universitário Pedro Ernesto. Rio de Janeiro RJ, Brasil.University of Tübingen. Hertie Institute of Clinical Brain Research. German Center of Neurodegenerative Diseases. Department of Neurodegeneration. Germany.No Brasil não há estudos sistemáticos sobre a Ultrassonografia Transcraniana (USTC), modalidade de neuroimagem que visualiza estruturas ecogênicas profundas do parênquima cerebral utilizando ultrassom. Objetivo: Determinar a porcentagem de indivíduos com janelas ósseas adequadas e a capacidade da USTC da substância negra (SN) de discernir pacientes parkinsonianos em amostra brasileira. Método: USTC realizada com equipamento AcusonX300 (Siemens, Germany) em 37 indivíduos: 23 com doença de Parkinson (DP) e 14 controles saudáveis. Resultados: 10,8% dos participantes apresentaram janelas acústicas temporais inadequadas. As áreas de ecogenicidade da SN foram maiores nos pacientes (média±desvio padrão, 0,31±0,08 cm 2 ) do que nos controles (média±desvio padrão, 0,17±0,02 cm 2 ). A USTC identificou 88,2% dos pacientes com DP. Conclusão: Grande proporção de brasileiros parece ser elegível para a realização de USTC. Um número expressivo dos pacientes com DP poderia ser diagnosticado com base no aumento da área ecogênica da SN. Contudo, esses dados preliminares devem ser corroborados com amostra mais numerosa.In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. Objective: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. Method: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson’s disease (PD) and 14 healthy controls. Results: 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean±SD, 0.31±0.08cm 2 ) compared to controls (mean±SD, 0.17±0.02cm 2 ). TCS accurately identified 88.2% of PD patients. Conclusion: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. OBJECTIVE: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. METHOD: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson's disease (PD) and 14 healthy controls. RESULTS: 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean±SD, 0.31±0.08cm²) compared to controls (mean±SD, 0.17±0.02cm²). TCS accurately identified 88.2% of PD patients. CONCLUSION: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies