The relationship between renal renal resistive index and hypertensive end-organ damage

Renal resistive index and hypertensive retinopathy

Authors

Keywords:

hypertensive end-organ damage, renal resistive index, retinopathy, nephropathy

Abstract

Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients.

Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria).

Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). 

Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.

Downloads

Download data is not yet available.

References

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. doi: 10.1093/eurheartj/ehy339. Erratum in: Eur Heart J. 2019 Feb 1;40(5):475. PMID: 30165516. DOI: https://doi.org/10.1093/eurheartj/ehy686

Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-57. doi:10.1161/HYPERTENSIONAHA.120.15026. Epub 2020 May 6. PMID: 32370572. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.120.15026

Vernooij JW, van der Graaf Y, Nathoe HM, Bemelmans RH, Visseren FL, Spiering W. Hypertensive target organ damage and the risk for vascular events and all-cause mortality in patients with vascular disease. J Hypertens. 2013 Mar;31(3):492-9; discussion 499-500. doi: 10.1097/HJH.0b013e32835cd3cd. PMID: 23303394. DOI: https://doi.org/10.1097/HJH.0b013e32835cd3cd

Mulè G, Nardi E, Andronico G, Cottone S, Raspanti F, Piazza G, et al. Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension. Blood Press Monit. 2001 Jun;6(3):115-23. doi: 10.1097/00126097-200106000-00001. PMID: 11518833. DOI: https://doi.org/10.1097/00126097-200106000-00001

Chen X, Liu L, Liu M, Huang X, Meng Y, She H, et al. Hypertensive Retinopathy and the Risk of Stroke Among Hypertensive Adults in China. Invest Ophthalmol Vis Sci. 2021 Jul 1;62(9):28. doi: 10.1167/iovs.62.9.28. PMID: 34283210; PMCID: PMC8300046. DOI: https://doi.org/10.1167/iovs.62.9.28

Thiagarajah R, Kandasamy R, Sellamuthu P. Hypertensive Retinopathy and the Risk of Hemorrhagic Stroke. J Korean Neurosurg Soc. 2021 Jul;64(4):543-51. doi: 10.3340/jkns.2020.0285. Epub 2021 Jul 1. PMID: 34237912; PMCID: PMC8273771. DOI: https://doi.org/10.3340/jkns.2020.0285

Duncan BB, Wong TY, Tyroler HA, Davis CE, Fuchs FD. Hypertensive retinopathy and incident coronary heart disease in high risk men. Br J Ophthalmol. 2002 Sep;86(9):1002-6. doi: 10.1136/bjo.86.9.1002. PMID: 12185127; PMCID: PMC1771277. DOI: https://doi.org/10.1136/bjo.86.9.1002

Tso MO, Jampol LM. Pathophysiology of hypertensive retinopathy. Ophthalmology. 1982 Oct;89(10):1132-45. doi: 10.1016/s0161-6420(82)34663-1. PMID: 7155524. DOI: https://doi.org/10.1016/S0161-6420(82)34663-1

Nabbaale J, Kibirige D, Ssekasanvu E, Sebatta ES, Kayima J, Lwabi P, et al. Microalbuminuria and left ventricular hypertrophy among newly diagnosed black African hypertensive patients: a cross sectional study from a tertiary hospital in Uganda. BMC Res Notes. 2015 May 14;8:198. doi: 10.1186/s13104-015-1156-2. PMID: 25971452; PMCID: PMC4434545. DOI: https://doi.org/10.1186/s13104-015-1156-2

Pontremoli R, Viazzi F, Martinoli C, Ravera M, Nicolella C, Berruti V, et al. Increased renal resistive index in patients with essential hypertension: a marker of target organ damage. Nephrol Dial Transplant. 1999 Feb;14(2):360-5. doi: 10.1093/ndt/14.2.360. PMID: 10069189. DOI: https://doi.org/10.1093/ndt/14.2.360

Dhand NK, Khatkar MS. Statulator: An online statistical calculator. Sample Size Calculator for Comparing Two Independent Means. Accessed 10 September 2021 at http://statulator.com/SampleSize/ss2M.html

SCHEIE HG. Evaluation of ophthalmoscopic changes of hypertension and arteriolar sclerosis. AMA Arch Ophthalmol. 1953 Feb;49(2):117-38. doi: 10.1001/archopht.1953.00920020122001. PMID: 13007237. DOI: https://doi.org/10.1001/archopht.1953.00920020122001

Awua-Larbi S, Wong TY, Cotch MF, Durazo-Arvizu R, Jacobs DR Jr, Klein BE, et al. Retinal arteriolar caliber and urine albumin excretion: the Multi-Ethnic Study of Atherosclerosis. Nephrol Dial Transplant. 2011 Nov;26(11):3523-8. doi: 10.1093/ndt/gfr095. Epub 2011 Mar 11. PMID: 21398363; PMCID: PMC3247797. DOI: https://doi.org/10.1093/ndt/gfr095

Li J, Kokubo Y, Arafa A, Sheerah HA, Watanabe M, Nakao YM, et al. Mild Hypertensive Retinopathy and Risk of Cardiovascular Disease: The Suita Study. J Atheroscler Thromb. 2022 Nov 1;29(11):1663-71. doi: 10.5551/jat.63317. Epub 2022 Jan 15. PMID: 35034920; PMCID: PMC9623077. DOI: https://doi.org/10.5551/jat.63317

Jian G, Lin W, Wang N, Wu J, Wu X. Urine Albumin/Creatinine Ratio and Microvascular Disease in Elderly Hypertensive Patients without Comorbidities. Biomed Res Int. 2021 Feb 13;2021:5560135. doi: 10.1155/2021/5560135. PMID: 33628790; PMCID: PMC7899778. DOI: https://doi.org/10.1155/2021/5560135

Jinadu YO, Raji YR, Ajayi SO, Salako BL, Arije A, Kadiri S. Resistivity index in the diagnosis and assessment of loss of renal function in diabetic nephropathy. Cardiovasc J Afr. 2022 Jan-Feb 23;33(1):26-32. doi: 10.5830/CVJA-2021-032. Epub 2021 Jul 26. PMID: 34309616; PMCID: PMC9198679.

García-García A, Gómez-Marcos MA, Recio-Rodriguez JI, González-Elena LJ, Parra-Sanchez J, Fe Muñoz-Moreno M, et al. Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients. Hypertens Res. 2011 Feb;34(2):180-6. doi: 10.1038/hr.2010.195. Epub 2010 Oct 21. PMID: 20962781. DOI: https://doi.org/10.1038/hr.2010.195

Boddi M. Renal Ultrasound (and Doppler Sonography) in Hypertension: An Update. Adv Exp Med Biol. 2017;956:191-208. doi: 10.1007/5584_2016_170. PMID: 27966109. DOI: https://doi.org/10.1007/5584_2016_170

Ozmen ND, Mousa U, Aydin Y, Deren T, Unlu EB. Association of the renal resistive index with microvascular complications in type 2 diabetic subjects. Exp Clin Endocrinol Diabetes. 2015 Feb;123(2):112-7. doi: 10.1055/s-0034-1390448. Epub 2014 Oct 24. PMID: 25343266. DOI: https://doi.org/10.1055/s-0034-1390448

Miyoshi K, Okura T, Tanino A, Kukida M, Nagao T, Higaki J. Usefulness of the renal resistive index to predict an increase in urinary albumin excretion in patients with essential hypertension. J Hum Hypertens. 2017 Jan;31(1):66-9. doi: 10.1038/jhh.2016.38. Epub 2016 Jun 9. PMID: 27278927. DOI: https://doi.org/10.1038/jhh.2016.38

Faubel S, Patel NU, Lockhart ME, Cadnapaphornchai MA. Renal relevant radiology: use of ultrasonography in patients with AKI. Clin J Am Soc Nephrol. 2014 Feb;9(2):382-94. doi: 10.2215/CJN.04840513. Epub 2013 Nov 14. PMID: 24235286; PMCID: PMC3913238. DOI: https://doi.org/10.2215/CJN.04840513

Boddi M, Natucci F, Ciani E. The internist and the renal resistive index: truths and doubts. Intern Emerg Med. 2015 Dec;10(8):893-905. doi: 10.1007/s11739-015-1289-2. Epub 2015 Sep 4. PMID: 26337967. DOI: https://doi.org/10.1007/s11739-015-1289-2

Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, et al. Reference values and factors associated with renal resistive index in a family-based population study. Hypertension. 2014 Jan;63(1):136-42. doi: 10.1161/HYPERTENSIONAHA.113.02321. Epub 2013 Oct 14. PMID: 24126174. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.113.02321

Downloads

Published

2023-01-22

Issue

Section

Research Article

How to Cite

1.
Karagöz Özen DS, Aydın MM, Genç İpek, Demirağ MD. The relationship between renal renal resistive index and hypertensive end-organ damage : Renal resistive index and hypertensive retinopathy. J Surg Med [Internet]. 2023 Jan. 22 [cited 2024 Feb. 22];7(1):86-90. Available from: https://jsurgmed.com/article/view/7627