| Detection of chronic allograft nephropathy by quantitative doppler imaging. | |
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MedLine Citation:
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PMID: 12134105 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chronic allograft nephropathy (CAN) is the major cause of graft loss, and early detection is desirable to avoid irreversible graft damage. We have evaluated a new technique of color Doppler quantification using Cineloop (Philips Medical Systems, Bothell, WA) imaging for noninvasive diagnosis of CAN. METHODS: Provisional normal ranges were defined by pilot study (n=13) and prospectively tested in stable recipients in whom CAN was independently quantified by contemporaneous histology (n=67), using the Banff schema. RESULTS: The maximal fractional area (MFA, systolic color pixels/total area) was 28.7+/-9.7% in normal subjects and reduced to 18.8+/-8.0% in grade 1 and 12.5+/-6.4% in grade 2 CAN (both P<0.001). The minimum color fractional area was reduced from 10.3+/-5.3% in normal subjects to 3.1+/-2.6% in grade 2 CAN (P<0.001), but was less useful. Distance from peripheral color pixels to capsule increased in CAN grade 2 versus 0 (6.0+/-1.6 vs. 3.9+/-1.0 mm, respectively; P<0.001). Calcineurin inhibitor nephrotoxicity reduced MFA (18.0+/-9.3 vs. 26.9+/-10.7%; P<0.001) and other dynamic measurements. Parenchymal damage exerted minimal effect on resistance index, mean variance, and peak Doppler velocity. MFA (cutoff<17.3%) can diagnose CAN (sensitivity 69%, specificity 88%, positive predictive value 86%) and severe CAN (sensitivity 87%, specificity 71%, negative predictive value 95%). Distance to capsule >5 mm was less sensitive (49%) but more specific (91% alone, and 97% combined with MFA). CONCLUSIONS: In conclusion, quantitative Doppler ultrasound can reliably detect CAN and, although imperfect at correctly grading, allows recognition of significant tubulointerstitial damage for initiation of a confirmatory needle core biopsy. |
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Authors:
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Brian J Nankivell; Jeremy R Chapman; Simon M Gruenewald |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Transplantation Volume: 74 ISSN: 0041-1337 ISO Abbreviation: Transplantation Publication Date: 2002 Jul |
Date Detail:
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Created Date: 2002-07-22 Completed Date: 2002-08-08 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0132144 Medline TA: Transplantation Country: United States |
Other Details:
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Languages: eng Pagination: 90-6 Citation Subset: IM |
Affiliation:
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Department of Renal Medicine, University of Sydney, Westmead Hospital, Australia. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Chronic Disease Female Graft Rejection / ultrasonography* Humans Kidney Diseases / surgery, ultrasonography* Kidney Transplantation / ultrasonography* Logistic Models Male Middle Aged Prospective Studies Reproducibility of Results Transplantation, Homologous Ultrasonography, Doppler, Color / methods*, standards |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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