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AVANCES DEL ULTRASONIDO DOPPLER RENAL EN LA ESTENOSIS DE LAS ARTERIAS RENALES

AVANCES DEL ULTRASONIDO DOPPLER RENAL EN LA ESTENOSIS DE LAS ARTERIAS RENALES

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Utilidad del ultrasonido Doppler renal para el diagnóstico de estenosis de las arterias renales con la propuesta de un nuevo índice renal-renal, y análisis del índice de resistencia intrarrenal para valorar estado cardiovascular, función renal y beneficio de la angioplastia renal.
chain9.jpg Autor:
Sergio Chain
Columnista Experto de SIIC
Artículos publicados por Sergio Chain
Recepción del artículo
6 de Octubre, 2006
Aprobación
16 de Noviembre, 2006
Primera edición
16 de Enero, 2007
Segunda edición, ampliada y corregida
29 de Septiembre, 2008

Resumen
La hipertensión renovascular afecta a un 15% a 30% de los pacientes con criterios clínicos sugestivos de enfermedad renovascular. El ultrasonido Doppler renal surgió como una valiosa herramienta no invasiva que puede diagnosticar la estenosis de las arterias renales. Los parámetros Doppler clásicos de método directo son la velocidad sistólica pico de la arteria renal > 200 cm/s y el índice renal-aórtico > 3. Un nuevo índice renal renal con un valor de corte > 2.7, mostró una mayor especificidad comparada con los parámetros Doppler convencionales. El índice renal renal y la velocidad sistólica pico mostraron mayor sensibilidad para el diagnóstico de estenosis de las arterias renales. La aplicación clínica del ultrasonido Doppler de la vasculatura intrarrenal aumentó en los años recientes. Un índice de resistencia elevado se asocia con la gravedad y extensión de la hipertensión esencial. Este índice se correlaciona además con factores de riesgo cardiovasculares, con daño de órgano blanco y con deterioro de la función renal. También el índice de resistencia > 0.80 identifica los pacientes en los cuales la angioplastia y la cirugía no mejorarán la presión arterial o la función y la supervivencia renal.

Palabras clave
ultrasonido Doppler renal, estenosis de las arterias renales, índice renal renal, índice de resistencia, angioplastia transluminal renal


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Abstract
Renovascular hypertension affects 15-30% of patients who have clinical criteria suggestive of renovascular disease. Renal color Doppler ultrasound (US) has been proposed as an effective modality for the diagnosis of renal artery stenosis. The use of Doppler US in patients with hypertension has led to an increase in the diagnosis of renal artery stenosis. The conventional direct method Doppler US parameters are renal artery peak systolic velocity (> 200 cm/s) and renal aortic ratio (> 3). The new direct method Doppler parameter, the renal renal ratio, with a cut-off value > 2.7, shows significantly improved specificity and sensitivity compared with conventional direct method Doppler US parameters for renal artery stenosis diagnosis. Clinical usefulness of Doppler US in intrarenal vessels has grown in recent years. A high renal resistive index has been correlated with the severity of essential hypertension. Moreover, cardiovascular risk factors, decreased renal function and hypertensive end-organ damage are related to an increased renal resistive index. In addition, a renal resistive index value of at least 0.80 identifies patients with renal artery stenosis in whom angioplasty or surgery will not improve blood pressure or renal function.

Key words
renal Doppler ultrasound, renal artery stenosis, renal index


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Imágenes
Relacionadas: Cardiología, Medicina Interna, Nefrología y Medio Interno



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Sergio Chain, Centro Modelo de Cardiología y Centro Radiológico Méndez Collado, Universidad Nacional de Tucumán, 4000, Muñecas 444, Tucumán, Argentina
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