Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis

Abstract Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting includin...

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Autores principales:	Paul Spiesecke, Frédéric Münch, Thomas Fischer, Bernd Hamm, Markus H. Lerchbaumer
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/45fe05bc20e8464bb48f83f57b6b891a
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spelling	oai:doaj.org-article:45fe05bc20e8464bb48f83f57b6b891a2021-12-02T15:23:47ZMultiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis10.1038/s41598-021-81690-x2045-2322https://doaj.org/article/45fe05bc20e8464bb48f83f57b6b891a2021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-81690-xhttps://doaj.org/toc/2045-2322Abstract Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.Paul SpieseckeFrédéric MünchThomas FischerBernd HammMarkus H. LerchbaumerNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Paul Spiesecke Frédéric Münch Thomas Fischer Bernd Hamm Markus H. Lerchbaumer Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
description	Abstract Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.
format	article
author	Paul Spiesecke Frédéric Münch Thomas Fischer Bernd Hamm Markus H. Lerchbaumer
author_facet	Paul Spiesecke Frédéric Münch Thomas Fischer Bernd Hamm Markus H. Lerchbaumer
author_sort	Paul Spiesecke
title	Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
title_short	Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
title_full	Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
title_fullStr	Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
title_full_unstemmed	Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
title_sort	multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/45fe05bc20e8464bb48f83f57b6b891a
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Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis

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