Measurement of renal blood flow by phase-contrast magnetic resonance imaging during septic acute kidney injury: a pilot investigation.

OBJECTIVE: In septic patients, decreased renal perfusion is considered to play a major role in the pathogenesis of acute kidney injury. However, the accurate measurement of renal blood flow in such patients is problematic and invasive. We sought to overcome such obstacles by measuring renal blood flow in septic patients with acute kidney injury using cine phase-contrast magnetic resonance imaging. DESIGN: Pilot observational study. SETTING: University-affiliated general adult intensive care unit. PATIENTS: Ten adult patients with established septic acute kidney injury and 11 normal volunteers. INTERVENTIONS: Cine phase-contrast magnetic resonance imaging measurement of renal blood flow and cardiac output. MEASUREMENTS AND MAIN RESULTS: The median age of the study patients was 62.5 yrs and eight were male. At the time of magnetic resonance imaging, eight patients were mechanically ventilated, nine were on continuous hemofiltration, and five required vasopressors. Cine phase-contrast magnetic resonance imaging examinations were carried out without complication. Median renal blood flow was 482 mL/min (range 335-1137) in septic acute kidney injury and 1260 mL/min (range 791-1750) in healthy controls (p = .003). Renal blood flow indexed to body surface area was 244 mL/min/m2 (range 165-662) in septic acute kidney injury and 525 mL/min/m2 (range 438-869) in controls (p = .004). In patients with septic acute kidney injury, median cardiac index was 3.5 L/min/m2 (range 1.6-8.7), and median renal fraction of cardiac output was only 7.1% (range 4.4-10.8). There was no rank correlation between renal blood flow index and creatinine clearance in patients with septic acute kidney injury (r = .26, p = .45). CONCLUSIONS: Cine phase-contrast magnetic resonance imaging can be used to noninvasively and safely assess renal perfusion during critical illness in man. Near-simultaneous accurate measurement of cardiac output enables organ blood flow to be assessed in the context of the global circulation. Renal blood flow seems consistently reduced as a fraction of cardiac output in established septic acute kidney injury. Cine phase-contrast magnetic resonance imaging may be a valuable tool to further investigate renal blood flow and the effects of therapies on renal blood flow in critical illness.

Ciné phase-contrast magnetic resonance imaging for the measurement of renal blood flow.

During critical illness, reductions in renal blood flow (RBF) are believed to be a major cause of kidney dysfunction, and therapy is often aimed at restoration of RBF. Despite this, our ability to measure RBF during critical illness has been limited by the invasiveness of the available techniques. Ciné Phase-Contrast Magnetic Resonance Imaging (CPC-MRI) represents an entirely noninvasive, contrast-free method of measuring blood flow with the potential of enabling the measurement of blood flow to major organs including the kidney. We have recently assessed the feasibility of measuring RBF by means of CPC-MRI in 2 critically ill patients with septic acute kidney injury and were able to compare such measurements to those obtained in a normal volunteer.