Renal Resistive İndeks’in Hafif Orta Böbrek Yetersizliği Olan Koroner Arter Hastalarında Hastalık Şiddetini Belirlemedeki Yeri

Öz

Amaç: Çalışmamızda hafif orta renal yetersizliği olan hastalarda renal resistive indeksini (RRİ)saptayarak bunun renal fonksiyonlar ve koroner arter hastalığının (KAH) şiddetiyle ilişkisini araştırdık.

Materyal ve Metot: Çalışmaya koroner angiografisi yapılarak KAH  tanısı konmuş 41 erkek,35 kadın toplam 76  hasta alındı. Tüm hastalarda renal doppler ultrasonografi (US) ile RRİ’ leri ölçüldü. Renal parankim kalınlığı, böbrek uzunluk ve genişlikleri ölçüldü.  Gensini risk skorlama sistemiyle KAH şiddeti skorlanarak hastalar hafif-KAH (Gensini skoru ≤ 20)  ve şiddetli-KAH (Gensini skoru > 20) olmak üzere iki guruba ayrılarak karşılaştırıldı. Ayrıca tüm hastalarda glomerular filtrasyon  hızı (eGFR) hesaplanarak 3 ayrı sub gruba ayrıldı ve RRI ile ilişkisi araştırıldı.  

Bulgular: Gensini skoruna göre şiddetli KAH olanlarda hafif KAH olanlara göre anlamlı derecede yüksek RRİ değerleri saptandı [0.62 (0.58-0.71)] karşı [0.71 (0.63-0.78)], p < 0.01]. Böbrek uzunluğu, böbrek genişliği, böbrek parankim kalınlıkları arasında anlamlı fark saptanmadı. eGFR, şiddetli KAH’lı hastalarda hafif KAH grubuna göre anlamlı derecede düşüktü(p= 0.02).

eGFR değerlerine göre evrelendirilen KAH’lı hastalarda ,renal yetersizlik evresi ile RRİ arasında anlamlı ilişki saptanmıştır. Evre 1 (GFR≥90) olanlarda RI  [0.63(0.59-0.68)], evre 2( GFR 60-59) olanlarda RI [0.77(0.71-0.84)],evre 3(GFR 30-59)  olanlarda ise RI [0.81(0.73-0.85)]idi, (p<0.01).

RRİ değerinin hafif ciddi koroner arter hastalığı tanısında, sensivite % 77, spesifite % 66 bulundu.

Sonuç: RRI değerleri KAH’ lı hastalarda hastalık şiddetine paralel şekilde artış göstermektedir. İlaveten renal yetersizlik derecesi artıkça RRİ değerleri artmaktadır. Doppler US ile RRİ ölçümü KAH şiddetini saptamada aynı zamanda böbrek fonksiyon ve mikrosirkülasyonu hakkında noninvaziv bir yöntem olarak ilave bilgiler sağlayabilir.

Anahtar Kelimeler

• Renal resistive indeks,renal parankim kalınlığı,koroner arter hastalığı,Gensini skoru,eGFR,kronik böbrek hastalığı

Role of Renal Resistive Index in Predicting the Severity of Coronary Artery Disease in Patients with Mild to Moderate Renal Insufficiency

Abstract

Objectives: The aim of this study was to determine the renal resistive index (RRI) in patients with mild to moderate renal insufficiency, and to investigate the relationship between RRI and the severity of coronary artery disease (CAD) and renal function.

Materials and Methods: The study included 76 patients diagnosed with CAD on coronary angiography. The patients comprised 41 males and 35 females. Renal resistive index was determined using renal Doppler ultrasonography (RDU). Renal length, width, and parenchymal thickness was measured. The severity of CAD was graded according to Gensini score, and the patients were divided into two groups: mild atherosclerosis (Gensini score <20 points) and severe atherosclerosis (Gensini score ≥20 points). The estimated glomerular filtration rate (eGFR) was calculated for each patient. Based on GFR stage, the patients were divided into three groups, and the relationship between RRI and GFR stage was investigated.

Results: Gensini scores indicated that the RRI was significantly higher in the patients with severe CAD compared to those with mild CAD  [0.62 (0.58-0.71)] vs. [0.71 (0.63-0.78)], p<0.001). No significant differences were observed in renal length, width, and parenchymal thickness. The eGFR was significantly lower in the patients with severe CAD compared to those with mild CAD (p=0.02). Grading of the patients based on GFR values indicated a significant correlation between GFR and RRI. RRI was [0.63(0.59-0.68)] in patients with stage 1 (GFR ≥ 90), was [0.77(0.71-0.84)]in patients with stage 2 (GFR 60–89) and was [0.81(0.73-0.85)]in patients with stage 3 (GFR 30–59) (p<0.001). The sensitivity and specificity of RRI in the diagnosis of CAD severity were 80.60% and 66.70%, respectively.

Conclusion: RRI shows a parallel increase with the severity of CAD and with the severity of renal insufficiency. RRI, as determined with non-invasive RDU, may provide additional information on the severity of CAD, kidney function and microcirculation.

Keywords

• Renal resistive index,renal parenchymal thickness,coronary artery disease,Gensini score,eGFR,chronic kidney disease

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