Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.133
Filtrar
1.
Nephrol Ther ; 20(2): 131-139, 2024 05 15.
Artigo em Francês | MEDLINE | ID: mdl-38742299

RESUMO

Fibromuscular dysplasia (FMD) is a rare nonatherosclerotic, noninflammatory vascular disease affecting mostly renal and carotid arteries and is the second most frequent cause of renal artery stenosis. The symptomatology is dominated by arterial hypertension due to the frequent involvement of the renal arteries and depends on the location of the lesions. Most of the cases are middle-aged women of Caucasian origin. There are two subtypes based on angiographic aspect: multifocal FMD (80% of the cases) and focal FMD (rarer with a more balanced sex ratio). Angioplasty of the renal arteries is generally disappointing with less than 50% cure of hypertension. It appears necessary to improve our knowledge of the FMD and to optimize the selection of eligible patients for revascularization with transdisciplinary collegial therapeutic decision.


La dysplasie fibromusculaire (DFM) est une maladie rare caractérisée par des sténoses segmentaires non artérioscléreuses, non inflammatoires, des artères de moyens calibres, touchant surtout les artères rénales et les carotides. Elle constitue la seconde cause de sténoses des artères rénales. La symptomatologie dépend de la localisation des lésions et est dominée par l'hypertension artérielle (HTA) en raison de l'atteinte fréquente des artères rénales. Cette pathologie touche majoritairement les femmes caucasiennes d'âge moyen. Il en existe deux sous-types, basés sur l'aspect angiographique : la DFM multifocale (80 % des cas) et la DFM focale (plus rare, sex ratio plus équilibré). Les résultats des prises en charge interventionnelles s'avèrent globalement décevants avec moins de 50 % de guérison de l'HTA. Il est nécessaire d'améliorer nos connaissances sur la physiopathologie de la DFM et d'optimiser la sélection des patients éligibles à une revascularisation par une prise de décision thérapeutique collégiale, en réunion de concertation pluridisciplinaire.


Assuntos
Displasia Fibromuscular , Artéria Renal , Humanos , Displasia Fibromuscular/complicações , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/complicações
2.
Sci Rep ; 14(1): 11768, 2024 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-38782971

RESUMO

Accurate selection of sampling positions is critical in renal artery ultrasound examinations, and the potential of utilizing deep learning (DL) for assisting in this selection has not been previously evaluated. This study aimed to evaluate the effectiveness of DL object detection technology applied to color Doppler sonography (CDS) images in assisting sampling position selection. A total of 2004 patients who underwent renal artery ultrasound examinations were included in the study. CDS images from these patients were categorized into four groups based on the scanning position: abdominal aorta (AO), normal renal artery (NRA), renal artery stenosis (RAS), and intrarenal interlobular artery (IRA). Seven object detection models, including three two-stage models (Faster R-CNN, Cascade R-CNN, and Double Head R-CNN) and four one-stage models (RetinaNet, YOLOv3, FoveaBox, and Deformable DETR), were trained to predict the sampling position, and their predictive accuracies were compared. The Double Head R-CNN model exhibited significantly higher average accuracies on both parameter optimization and validation datasets (89.3 ± 0.6% and 88.5 ± 0.3%, respectively) compared to other methods. On clinical validation data, the predictive accuracies of the Double Head R-CNN model for all four types of images were significantly higher than those of the other methods. The DL object detection model shows promise in assisting inexperienced physicians in improving the accuracy of sampling position selection during renal artery ultrasound examinations.


Assuntos
Aprendizado Profundo , Obstrução da Artéria Renal , Artéria Renal , Ultrassonografia Doppler em Cores , Humanos , Artéria Renal/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Feminino , Masculino , Obstrução da Artéria Renal/diagnóstico por imagem , Pessoa de Meia-Idade , Idoso , Adulto
3.
Sci Rep ; 14(1): 11773, 2024 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783071

RESUMO

Patients with ischemic cerebrovascular disease (ICVD) frequently develop concomitant peripheral artery disease (PAD) or renal artery stenosis (RAS), and multiterritorial atherosclerotic patients usually have a worse prognosis. We aimed to evaluate the status of peripheral atherosclerosis (AS) and cervicocephalic AS (CAS) in ICVD patients with AS, their correlation, and related risk factors contributing to coexisting cervicocephalic-peripheral AS (CPAS). Based on the severity and extent of AS evaluated by computed tomography angiography and ultrasound, the degree of AS was triple categorized to assess the correlation between CAS and PAD/RAS. CAS and PAD/RAS were defined as the most severe stenosis being ≥ 50% luminal diameter in cervicocephalic or lower limb arteries, and a peak systolic velocity at the turbulent site being ≥ 180 cm/s in the renal artery. Among 403 patients with symptom onset within 30 days, CAS, PAD, and RAS occurrence rates were 68.7%, 25.3%, and 9.9%, respectively. PAD was independently associated with the degree of extracranial and intracranial CAS (p = 0.042, OR = 1.428, 95% CI 1.014-2.012; p = 0.002, OR = 1.680, 95% CI 1.206-2.339), while RAS was independently associated with the degree of extracranial CAS (p = 0.001, OR = 2.880, 95% CI 1.556-5.329). Independent CPAS risk factors included an ischemic stroke history (p = 0.033), increased age (p < 0.01), as well as elevated fibrinogen (p = 0.021) and D-dimer levels (p = 0.019). In conclusion, the occurrence rates of RAS and PAD in ICVD patients with AS is relatively high, and with the severity of RAS or PAD increase, the severity of CAS also increase. Strengthening the evaluation of peripheral AS and controlling elevated fibrinogen might be crucial for preventing and delaying the progression of multiterritorial AS in ICVD patients with AS, thereby improving risk stratification and promoting more effective prevention and treatment strategies.


Assuntos
Doença Arterial Periférica , Humanos , Feminino , Masculino , Fatores de Risco , Idoso , Pessoa de Meia-Idade , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/complicações , Aterosclerose/complicações , Isquemia Encefálica/etiologia , Angiografia por Tomografia Computadorizada , Transtornos Cerebrovasculares/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/epidemiologia
4.
J Nephrol ; 37(4): 1093-1105, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38594599

RESUMO

BACKGROUND AND OBJECTIVES: Atherosclerotic renal artery stenosis may cause hypertension, chronic kidney disease and heart failure, but large randomized control trials to date have shown no major additional benefit of renal revascularization over optimal medical management. However, these trials did not consider outcomes specifically in relation to clinical presentations. Given that atherosclerotic renal artery stenosis is a heterogenous condition, measures of success likely differ according to the clinical presentation. Our retrospective study objectives were to determine the effects of revascularization when applied to specific clinical presentations and after careful multi-disciplinary team review. METHODS: All patients presenting to our centre and its referring hospitals with radiological findings of at least one renal artery stenosis > 50% between January 2015 and January 2020 were reviewed at the renovascular multi-disciplinary team meeting with revascularization considered in accordance with international guidelines, notably for patients with anatomically significant renal artery stenosis, adequately sized kidney and presentations with any of; deteriorating kidney function, heart failure syndrome, or uncontrollable hypertension. Optimal medical management was recommended for all patients which included lipid lowering agents, anti-platelets and anti-hypertensives targeting blood pressure ≤ 130/80 mmHg. The effect of revascularization was assessed according to the clinical presentation; blood pressure and number of agents in those with renovascular hypertension, delta glomerular filtration rate in those with ischaemic nephropathy and heart failure re-admissions in those with heart failure syndromes. RESULTS: During this 5-year period, 127 patients with stenosis ≥ 50% were considered by the multidisciplinary team, with 57 undergoing revascularization (17 primarily for severe hypertension, 25 deteriorating kidney function, 6 heart failure syndrome and 9 for very severe anatomical stenosis). Seventy-nine percent of all revascularized patients had a positive outcome specific to their clinical presentation, with 82% of those with severe hypertension improving blood pressure control, 72% with progressive ischaemic nephropathy having attenuated GFR decline, and no further heart failure admissions in those with heart failure. Seventy-eight percent of patients revascularized for high grade stenosis alone had better blood pressure control with 55% also manifesting renal functional benefits. CONCLUSIONS: Multi-disciplinary team discussion successfully identified a group of patients more likely to benefit from revascularization based on 3 key factors: clinical presentation, severity of the renal artery lesion and the state of the kidney beyond the stenotic lesion. In this way, a large proportion of patients can clinically improve after revascularization if their outcomes are considered according to the nature of their clinical presentation.


Assuntos
Hipertensão Renovascular , Obstrução da Artéria Renal , Humanos , Obstrução da Artéria Renal/terapia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/fisiopatologia , Estudos Retrospectivos , Idoso , Feminino , Masculino , Hipertensão Renovascular/terapia , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Hipertensão Renovascular/diagnóstico , Resultado do Tratamento , Pessoa de Meia-Idade , Aterosclerose/complicações , Taxa de Filtração Glomerular , Equipe de Assistência ao Paciente , Anti-Hipertensivos/uso terapêutico
5.
J Clin Ultrasound ; 52(6): 763-772, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38660883

RESUMO

PURPOSE: Contrast-enhanced duplex ultrasound (CEUS) might be a useful tool to diagnosing renal artery stenosis (RAS). We amalgamated and reviewed the evidence assessing the diagnostic accuracy of CEUS on detecting RAS compared to angiography. METHODS: This preregistered systematic review included studies that compared the presence of RAS via CEUS with angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (n = 1717). The Quality Assessment of Diagnostic Studies 2 tool assessed study quality. Results are presented narratively. RESULTS: The studies included (n = 11) had a total of 447 unique participants (193 females) and average age of 56 ± 9 years. Five of eleven studies investigated CEUS using SonoVue contrast agent and reported an average accuracy (91% ± 2%), sensitivity (91% ± 3%), specificity (90% ± 5%), negative predictive value (86% ± 6%), and positive predictive value (94% ± 1%) with all values >80%. The accuracy of CEUS using other types of contrast agent (n = 6), including Levovsit (n = 3/6), Definity (n = 1/6), perfienapent emulsion (n = 1/6), and perfluorocarbon-exposed sonicated dextrose albumin (n = 1/6) was mixed. These studies detected an average accuracy of 91 ± 11% (n = 2/3% > 80%), sensitivity of 98% ± 4%, (n = 3/3% > 80%), and specificity of 86% ± 10% (n = 2/3% > 80%). Included studies had generally low risk of bias and applicability concerns except for unclear flow and timing (n = 7/11) and applicability of patient selection (n = 4/11). CONCLUSION: Despite being limited by the heterogeneity of included studies, our review indicates a high overall diagnostic accuracy for CEUS to detect RAS compared to angiography, with the largest evidence-base for SonoVue contrast. Radiologists and hospital decision makers should consider CEUS as an acceptable alternative to angiography.


Assuntos
Meios de Contraste , Obstrução da Artéria Renal , Ultrassonografia Doppler Dupla , Humanos , Obstrução da Artéria Renal/diagnóstico por imagem , Ultrassonografia Doppler Dupla/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Artéria Renal/diagnóstico por imagem , Aumento da Imagem/métodos
6.
Arch Dis Child ; 109(6): 497-502, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38627026

RESUMO

BACKGROUND: 3D printing has been used in different medical contexts, although it is underutilised in paediatrics. We present the first use of 3D printing in the management of three paediatric patients with complex renovascular disease. METHODS: Patient-specific 3D models were produced from conventional 2D imaging and manufactured using 3D polyjet printing technology. All three patients had different underlying pathologies, but all underwent multiple endovascular interventions (renal artery balloon angioplasty) prior to 3D printing and subsequent vascular surgery. The models were verified by an expert radiologist and then presented to the multidisciplinary team to aid with surgical planning. RESULTS: Following evaluation of the 3D-printed models, all patients underwent successful uni/bilateral renal auto-transplants and aortic bypass surgery. The 3D models allowed more detailed preoperative discussions and more focused planning of surgical approach, therefore enhancing safer surgical planning. It influenced clinical decision-making and shortened general anaesthetic time. The families and the patients reported that they had a significantly improved understanding of the patient's condition and had more confidence in understanding proposed surgical intervention, thereby contributing to obtaining good-quality informed consent. CONCLUSION: 3D printing has a great potential to improve both surgical safety and decision-making as well as patient understanding in the field of paediatrics and may be considered in wider surgical areas.


Assuntos
Impressão Tridimensional , Criança , Humanos , Angioplastia com Balão/métodos , Modelos Anatômicos , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/instrumentação
7.
Catheter Cardiovasc Interv ; 104(1): 92-96, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38686525

RESUMO

The double-kiss mini-crush (DKMC) technique has been successfully deployed in the past for the treatment of complex coronary lesions even for left main lesions. Our case report consists of a proof-of-principle that the DKMC technique can be successfully translated as well to the field of complex renal artery lesions. Insightful thinking out-of-the "coronary" box in concert with skillful off-label application of coronary stenting procedures may open the gate for unprecedented opportunities for the treatment of difficult-to-tackle in-stent restenosis in the renal circulation.


Assuntos
Recidiva , Obstrução da Artéria Renal , Stents , Humanos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/terapia , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/etiologia , Resultado do Tratamento , Masculino , Angioplastia com Balão/instrumentação , Grau de Desobstrução Vascular , Idoso , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia
8.
BMJ Case Rep ; 17(4)2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38663899

RESUMO

Renal artery stenosis can complicate the management of heart failure with reduced ejection fraction, as it is a conventional contraindication to the use of ACE inhibitors. We report a case in which bilateral renal artery revascularisation allowed the safe reintroduction of enalapril (and subsequently sacubitril valsartan) in a patient with severe left ventricular systolic dysfunction. There is a role for renal artery angioplasty in selected patients to allow optimal medical therapy for patients with heart failure due to impaired systolic function.


Assuntos
Enalapril , Insuficiência Cardíaca , Obstrução da Artéria Renal , Artéria Renal , Valsartana , Humanos , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/terapia , Artéria Renal/cirurgia , Valsartana/uso terapêutico , Enalapril/uso terapêutico , Masculino , Tetrazóis/uso terapêutico , Combinação de Medicamentos , Aminobutiratos/uso terapêutico , Disfunção Ventricular Esquerda , Compostos de Bifenilo , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico
9.
PLoS One ; 19(3): e0297975, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38551934

RESUMO

BACKGROUND: This study evaluated the long-term effects of percutaneous intervention in children and adolescents with transplant renal artery stenosis (TRAS). METHODS: Twenty patients had significant stenosis (>50%) and underwent percutaneous transluminal angioplasty (PTA/stenting) (TRAS group-intervention); 14 TNS (non-significant group -control) patients did not have significant stenosis (≤50%) and were treated clinically. The combined primary endpoints were death from all causes and late graft failure. The secondary endpoints were serum creatinine (SCr), systolic blood pressure (SBP), and diastolic blood pressure (DBP). RESULTS: No statistically significant difference was found between TRAS-Intervention(N = 20) and TNS groups-Control (N = 14) for these clinical parameters: deaths, 1 (5.0%) vs. 0 (0.0%) (p = 1.000) and graft loss, 4 (20.0%) vs. 2 (14.3%) (p = 1.000). For the secondary endpoints, after 1 month and 1 year the values of SCr, SBP, and DBP were similar between the two groups but not statistically significant. DISCUSSION: In the TRAS group (intervention), the stent implantation was beneficial for treating refractory hypertension and reducing blood pressure (BP) in children and adolescents. Despite the outcomes being similar in the two groups, it can be inferred that the patients in the TRAS group (intervention) would have had a worse outcome without the percutaneous intervention. CONCLUSION: TRAS treatment with stenting can be considered for children and adolescents. Because the sample in the present study comprised of only a specific population, further studies are needed for generalization. TRIAL REGISTRATION: The trial was registered at clinictrials.gov with trial registration number NCT04225338.


Assuntos
Angioplastia com Balão , Transplante de Rim , Obstrução da Artéria Renal , Adolescente , Criança , Humanos , Angioplastia com Balão/efeitos adversos , Constrição Patológica/complicações , Hospitais Públicos , Rim , Transplante de Rim/efeitos adversos , Artéria Renal , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
10.
Clin Nucl Med ; 49(7): e370-e372, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38537216

RESUMO

ABSTRACT: A 10-year-old hypertensive girl underwent 131 I-MIBG scan to rule out neural crest derived tumor. The whole-body images revealed diffuse intense tracer uptake in the right kidney, which persisted in 96-hour images as well. CT renal angiography revealed 90% to 95% right renal artery stenosis. Thereafter, she underwent baseline and angiotensin receptor blockade renal dynamic imaging, which revealed hemodynamically significant renal artery stenosis. Pattern of diffuse and intense 131 I-MIBG uptake, albeit rare, still warrants further evaluation to rule out renal artery stenosis and investigate its hemodynamic significance for appropriate management.


Assuntos
3-Iodobenzilguanidina , Hipertensão , Rim , Obstrução da Artéria Renal , Humanos , Feminino , Obstrução da Artéria Renal/diagnóstico por imagem , Criança , Rim/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Hipertensão/complicações , Transporte Biológico , Cintilografia , Radioisótopos do Iodo
12.
BMJ Case Rep ; 17(3)2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38538096

RESUMO

Transplant renal artery stenosis (TRAS) represents a significant vascular complication subsequent to renal transplantation. This pathology is associated with grave implications including graft dysfunction and mortality. Early identification and therapeutical intervention are imperative for preserving graft longevity and achieving optimal clinical outcomes. We detail the case of a male in his 20s, following renal transplantation, who encountered recurrent TRAS, aetiologically linked to mechanical arterial kinking. Initial management using endovascular techniques yielded insufficient resolution. Consequently, the persistence of endovascular-resistant stenosis necessitated a surgical bypass intervention using the great saphenous vein, granting a 2-year period devoid of restenosis. The existing literature emphasises the indispensability of discerning the appropriate juncture for transitioning from endovascular to surgical management in TRAS cases. The robustness and durability of bypass grafts present an efficacious therapeutical strategy in contemporaneous practice.


Assuntos
Procedimentos Endovasculares , Transplante de Rim , Obstrução da Artéria Renal , Humanos , Masculino , Procedimentos Endovasculares/efeitos adversos , Transplante de Rim/efeitos adversos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Estudos Retrospectivos , Veia Safena , Resultado do Tratamento , Adulto Jovem , Adulto
13.
Hypertension ; 81(4): 669-675, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38507507

RESUMO

Fibromuscular dysplasia is the most common cause of renovascular hypertension in young adults under 40 years old. It is potentially amenable to renal artery angioplasty, which frequently normalizes blood pressure. However, limited options exist if angioplasty is not technically possible, or restenosis occurs. Here, we describe 2 patients who presented with hypertension secondary to renal artery stenosis. In the first case, a young adult with hypertension secondary to renal artery stenosis (fibromuscular dysplasia), developed restenosis 11 weeks after an initially successful renal artery angioplasty. In the second case, a patient with neurofibromatosis type 1 was diagnosed with hypertension secondary to renal artery stenosis. Angioplasty was not possible due to multiple branch occlusions. Both individuals went on to have successful renal autotransplantations, which ultimately cured their hypertension. In this article, we review the background, indications, and blood pressure outcomes in relation to renal autotransplantation in nonatherosclerotic renal artery stenosis.


Assuntos
Angioplastia com Balão , Displasia Fibromuscular , Hipertensão Renovascular , Hipertensão , Obstrução da Artéria Renal , Adulto Jovem , Humanos , Adulto , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/cirurgia , Transplante Autólogo/efeitos adversos , Displasia Fibromuscular/complicações , Displasia Fibromuscular/cirurgia , Hipertensão/complicações , Hipertensão Renovascular/cirurgia , Hipertensão Renovascular/complicações
14.
Urol J ; 21(3): 195-199, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38493318

RESUMO

Transplant renal artery stenosis is the most common vascular complication that occurs following kidney transplantation and can lead to graft dysfunction and even its loss. The present report describes A patient with endstage renal disease who underwent living related renal transplantation. He had oliguria and creatinine rise in the post-operative course but all doppler ultrasonography (DUS) during the 2 months post-operation for the renal graft showed a normal mean resistive index in the graft renal artery. Hemodialysis treatment started and continued for 4.5 months. On post-operative day 137, because of the patient's anuria and resistant hypertension, another DUS carried out and reported evidence that suggested arterial stenosis. A computed tomographic (CT) renal angiogram showed a small filling defect in the proximal graft artery that was highly suggestive for transplant renal artery stenosis (TRAS). Following angiography revealed a short linear stenosis. Endovascular intervention and stent placement were performed successfully for the patient on post-operative day 139. This case was initially diagnosed as ongoing acute rejection for which he received antirejection therapy without any significant improvement. After percutaneous transluminal angioplasty (PTA), serum creatinine trended down and urine output improved within 12 h, and they were stable at one-year follow up with a good renal function. It was noteworthy that, despite after a 4.5-month delay in diagnosis and maintenance need for dialysis, the patient responded to endovascular treatment and the graft function became normalized. Our case demonstrates that graft can be saved even if renal artery stenosis is diagnosed after several months of dialysis and diagnosis of end stage renal disease post transplantation.


Assuntos
Transplante de Rim , Obstrução da Artéria Renal , Humanos , Masculino , Pessoa de Meia-Idade , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/etiologia , Stents
15.
J Appl Clin Med Phys ; 25(3): e14298, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38373294

RESUMO

PURPOSE: Diagnosing Renal artery stenosis (RAS) presents challenges. This research aimed to develop a deep learning model for the computer-aided diagnosis of RAS, utilizing multimodal fusion technology based on ultrasound scanning images, spectral waveforms, and clinical information. METHODS: A total of 1485 patients received renal artery ultrasonography from Peking Union Medical College Hospital were included and their color doppler sonography (CDS) images were classified according to anatomical site and left-right orientation. The RAS diagnosis was modeled as a process involving feature extraction and multimodal fusion. Three deep learning (DL) models (ResNeSt, ResNet, and XCiT) were trained on a multimodal dataset consisted of CDS images, spectrum waveform images, and individual basic information. Predicted performance of different models were compared with senior physician and evaluated on a test dataset (N = 117 patients) with renal artery angiography results. RESULTS: Sample sizes of training and validation datasets were 3292 and 169 respectively. On test data (N = 676 samples), predicted accuracies of three DL models were more than 80% and the ResNeSt achieved the accuracy 83.49% ± 0.45%, precision 81.89% ± 3.00%, and recall 76.97% ± 3.7%. There was no significant difference between the accuracy of ResNeSt and ResNet (82.84% ± 1.52%), and the ResNeSt was higher than the XCiT (80.71% ± 2.23%, p < 0.05). Compared to the gold standard, renal artery angiography, the accuracy of ResNest model was 78.25% ± 1.62%, which was inferior to the senior physician (90.09%). Besides, compared to the multimodal fusion model, the performance of single-modal model on spectrum waveform images was relatively lower. CONCLUSION: The DL multimodal fusion model shows promising results in assisting RAS diagnosis.


Assuntos
Aprendizado Profundo , Obstrução da Artéria Renal , Humanos , Obstrução da Artéria Renal/diagnóstico por imagem , Angiografia , Ultrassonografia Doppler em Cores/métodos
16.
Rev Med Suisse ; 20(863): 430-435, 2024 Feb 28.
Artigo em Francês | MEDLINE | ID: mdl-38415729

RESUMO

Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by recurrent arterial and venous thromboembolic events. Renal complications occur in 3 % of patients. Renal artery stenosis is the most common, and APS-related nephropathy is the predominant microvascular complication. APS nephropathy has heterogeneous manifestations ranging from hematuria and non-nephrotic range proteinuria to hypertension and multi-organ failure caused by catastrophic antiphospholipid antibody syndrome. Anticoagulation and thromboprophylaxis are key to management. Immunosuppression has been used with some success but lacks randomized controlled trial validation for their use.


Le syndrome des anticorps antiphospholipides (SAPL) est une maladie auto-immune rare caractérisée par des événements thromboemboliques artériels et veineux récurrents. Les complications rénales surviennent chez 3 % des patients. La sténose de l'artère rénale est la plus courante et la néphropathie liée au SAPL représente la complication microvasculaire principale. La maladie rénale liée au SAPL se traduit par des manifestations hétérogènes allant de l'hématurie et de la protéinurie non néphrotique à l'hypertension jusqu'à la défaillance multi-organique causée par le syndrome catastrophique des anticorps antiphospholipides (SCAPL). L'anticoagulation et la thromboprophylaxie sont clés dans la prise en charge. L'immunosuppression a été utilisée avec un certain succès, mais manque de validation par des essais contrôlés randomisés pour leur utilisation.


Assuntos
Síndrome Antifosfolipídica , Doenças Autoimunes , Obstrução da Artéria Renal , Tromboembolia Venosa , Humanos , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Doenças Raras
17.
Transplant Proc ; 56(3): 734-737, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38320869

RESUMO

BACKGROUND: Kidney transplantation is the preferred treatment option for eligible patients with end-stage renal disease. With advanced transplantation technology and novel immunosuppressive agents, kidney transplant recipients survive significantly longer. However, the chance of developing malignant tumors has increased, posing a serious challenge to the survival of transplanted kidneys and patients. CASE PRESENTATION: We report a male patient (the patient's informed consent has been obtained) who underwent kidney transplantation 23 years ago. Subsequently, he developed transplant renal artery stenosis, primary renal clear cell carcinoma, and papillary thyroid cancer. The narrowed blood vessels were dilated through percutaneous transluminal angioplasty, and the malignant tumor was removed surgically. Currently, antirejection drugs are regularly taken, and the transplanted kidney function is good. The patient is satisfied with his living conditions. CONCLUSIONS: Hypertension that is difficult to control after kidney transplantation should be suspected as a possibility of graft vascular stenosis. When B-ultrasound cannot accurately diagnose it, magnetic resonance angiography should be used as early as possible to clarify the diagnosis and relieve the stenosis before graft dysfunction. Transplantation patients have a high incidence of malignant tumors after surgery, and the risk increases with the prolongation of the disease course. The focus should be on symptomatic treatment of related diseases, and antirejection drugs can be reduced or not reduced as appropriate.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Transplante de Rim , Obstrução da Artéria Renal , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Humanos , Transplante de Rim/efeitos adversos , Masculino , Carcinoma de Células Renais/cirurgia , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/complicações , Neoplasias Renais/complicações , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações , Carcinoma Papilar/cirurgia , Pessoa de Meia-Idade
18.
J Cardiovasc Magn Reson ; 26(1): 100993, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38218433

RESUMO

BACKGROUND: Percutaneous-transluminal renal angioplasty (PTRA) and stenting aim to halt the progression of kidney disease in patients with renal artery stenosis (RAS), but its outcome is often suboptimal. We hypothesized that a model incorporating markers of renal function and oxygenation extracted using radiomics analysis of blood oxygenation-level dependent (BOLD)-MRI images may predict renal response to PTRA in swine RAS. MATERIALS AND METHODS: Twenty domestic pigs with RAS were scanned with CT and BOLD MRI before and 4 weeks after PTRA. Stenotic (STK) and contralateral (CLK) kidney volume, blood flow (RBF), and glomerular filtration rate (GFR) were determined, and BOLD-MRI R2 * maps were generated before and after administration of furosemide, a tubular reabsorption inhibitor. Radiomics features were extracted from pre-PTRA BOLD maps and Robust features were determined by Intraclass correlation coefficients (ICC). Prognostic models were developed to predict post-PTRA renal function based on the baseline functional and BOLD-radiomics features, using Lasso-regression for training, and testing with resampling. RESULTS: Twenty-six radiomics features passed the robustness test. STK oxygenation distribution pattern did not respond to furosemide, whereas in the CLK radiomics features sensitive to oxygenation heterogeneity declined. Radiomics-based model predictions of post-PTRA GFR (r = 0.58, p = 0.007) and RBF (r = 0.68; p = 0.001) correlated with actual measurements with sensitivity and specificity of 92% and 67%, respectively. Models were unsuccessful in predicting post-PTRA systemic measures of renal function. CONCLUSIONS: Several radiomics features are sensitive to cortical oxygenation patterns and permit estimation of post-PTRA renal function, thereby distinguishing subjects likely to respond to PTRA and stenting.


Assuntos
Modelos Animais de Doenças , Taxa de Filtração Glomerular , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Obstrução da Artéria Renal , Circulação Renal , Stents , Sus scrofa , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/terapia , Animais , Oxigênio/sangue , Fatores de Tempo , Córtex Renal/diagnóstico por imagem , Córtex Renal/irrigação sanguínea , Córtex Renal/fisiopatologia , Córtex Renal/metabolismo , Furosemida/administração & dosagem , Angioplastia com Balão/instrumentação , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Feminino , Masculino , Diuréticos , Interpretação de Imagem Assistida por Computador , Resultado do Tratamento , Radiômica
20.
Cardiovasc Ther ; 2024: 4618868, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38234331

RESUMO

Background: Quantitative flow ratio (QFR) is an angiography-based fractional flow reserve measurement without pressure wire or induction of hyperemia. A recent innovation that uses combined geometrical data and hemodynamic boundary conditions to measure QFR from a single angiographic view has shown the potential to measure QFR of the renal artery-renal QFR (rQFR). Objective: The aim of this pilot study was to assess the feasibility of rQFR measurement and the contribution of rQFR in selecting patients with atherosclerotic renal artery stenosis (ARAS) undergoing revascularization. Methods: This retrospective trial enrolled patients who had ARAS (50-90%) and hypertension. The enrolled patients were treated by optimal antihypertensive medication or revascularization, respectively, and the therapeutic strategies were based on rFFR measurement and/or clinical feature. Results: A total of 55 patients underwent rQFR measurement. Among the enrolled patients, 18 underwent optimal antihypertensive medication and 37 underwent revascularization, 19 patients in whom rQFR and rFFR were both assessed. During the 180-day follow-up, 25 patients saw an improvement in their blood pressure among the 37 patients that underwent revascularization. ROC analysis revealed that rQFR had a high diagnostic accuracy for predicting blood pressure improvement (AUCrQFR = 0.932, 95% CI 0.798-0.998). The ideal cut-off value of rQFR for predicting blood pressure improvement after revascularization is ≤0.72 (sensitivity: 72.00%, specificity: 100%). The paired t test and Bland-Altman analyses demonstrated good agreement between rQFR and rFFR (t = 1.887, 95% CI -0.021 to 0.001, 95% limits of agreement: -0.035 to 0.055, p = 0.075). The Spearman correlation test reveals that there was a significant positive correlation between rQFR and rFFR (r = 0.952, 95% CI 0.874 to 0.982, p < 0.001). Conclusion: The rQFR has the potential to enhance the ability of angiography to detect functionally significant renal artery stenosis during angiography and to produce results that are comparable to invasive hemodynamic assessment.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Obstrução da Artéria Renal , Humanos , Anti-Hipertensivos/uso terapêutico , Aterosclerose/diagnóstico por imagem , Angiografia Coronária/métodos , Vasos Coronários , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Projetos Piloto , Valor Preditivo dos Testes , Artéria Renal , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA