INTRODUCTION :
Applications of Doppler Ultrasound in Nephrology are increasing day by day. Gray scale sonography is often routinely performed to evaluate the patient with suspected or known renal disease. Although this provides anatomic information it lacks the ability to provide significant physiologic data. Duplex Doppler ultrasound has the potential to provide physiologic information concerning renal arterial blood flow and resistance. Studies published in the last two decades indicated that Doppler can be used reliably in several types of intrinsic renal diseases, obstructive uropathy, Acute renal failure and Reno vascular hypertension.
Doppler has been found to be useful for detection of acute rejection and also for distinction between obstructive and non obstructive pelvi calyceal system dilatation. It is also widely used for diagnosis of Reno vascular hypertension with variable sensitivity and specificity. In acute renal failure it is used to differentiate pre-renal azotemia from acute tubular necrosis and to predict recovery from acute tubular necrosis.
AIMS AND OBJECTIVES :
The objectives of the study are :
1. To find out the role of Doppler in glomerular diseases to predict extent of tubulointerstitial injury as demonstrated by renal biopsy.
2. The role of resistive and atrophic indices in predicting tubulointerstitial disease.
3. Value of these indices as prognostic markers to identify patients at risk of progression.
MATERIALS & METHODS :
A total of 75 patients underwent Doppler examination of both kidneys immediately before percutaneous needle biopsy. The criteria adopted for biopsy were :
1. Proteinuria >1 g/day,
2. Proteinuria >0.5g/day with hematuria,
3. Hematuria with RBC casts,
4. Rapidly worsening renal function.
71 patients found to have glomerular disease after biopsy were included in the study.
Rest of the four had interstitial nephritis or hypertensive nephrosclerosis were excluded. Renal
biopsies were performed under ultrasound guidance with spring loaded automated biosy gun
needle. (C.R.BARD 22mm) from the lower pole of the left kidney.
Data regarding age, sex, serum creatinine, 24hr urine protein, Body Mass Index,
presence or absence of microhematuria, hypertension, renal failure were noted. Glomerular
filtration rate was calculated by the Cockcroft-Gault formula.
CONCLUSION :
1. We conclude that resistive and atrophic indices can be used to predict the presence of
tubulointerstitial lesion in glomerular disease with high sensitivity and specificity.
2. There is a good correlation between resistive and atrophic indices. The combination of
the two has not been found to be superior to either index alone.
3. There is a good correlation between resistive index and severity of the tubulo interstitial
injury.
4. Resistive index and atrophic index can be useful as prognostic markers to identify
patients at risk of progression.
5. Hence whenever possible Doppler might be considered as a supplementary diagnostic
and prognostic tool in glomerular diseases
