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• W3209859933 abstract "We read with great interest the article by Caroli et al., in which they meticulously discuss the role of imaging in elucidating both structural and functional aspects of kidney disease. 1 Caroli A. Remuzzi A. Lerman L.O. Basic principles and new advances in kidney imaging. Kidney Int. 2021; 100: 1001-1011 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Herein, we would like to briefly comment on evaluation of renal venous congestion in clinical practice. Renal perfusion, determined by the difference between forward flow/mean arterial pressure and venous resistance/right atrial pressure, is particularly important in management of disorders associated with deranged fluid balance, such as cardiorenal syndrome and hepatocardiorenal syndrome. 2 Kazory A. Ronco C. Hepatorenal syndrome or hepatocardiorenal syndrome: revisiting basic concepts in view of emerging data. Cardiorenal Med. 2019; 9: 1-7 Crossref PubMed Scopus (27) Google Scholar However, traditional imaging primarily focuses on the adequacy of forward flow and ignores the deleterious effect of venous congestion on the kidney. In this context, point-of-care ultrasonography can provide valuable insights into renal hemodynamics by allowing qualitative and semiquantitative assessment of the venous flow pattern. Intrarenal venous Doppler assesses blood flow in the interlobar veins; in the absence of intra-abdominal hypertension, the flow pattern in these veins reflects changes in right atrial pressure. The normal waveform is relatively continuous; and as the right atrial pressure increases, it becomes increasingly pulsatile, as illustrated in Figure 1. 3 Koratala A. Kazory A. Point of care ultrasonography for objective assessment of heart failure: integration of cardiac, vascular, and extravascular determinants of volume status. Cardiorenal Med. 2021; 11: 5-17 Crossref PubMed Scopus (19) Google Scholar These waveforms not only indicate the severity of congestion but also bear prognostic significance and can be used to monitor the efficacy of decongestive therapy. 4 Yoshihisa A. Watanabe K. Sato Y. et al. Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure. Sci Rep. 2020; 10: 22257 Crossref PubMed Scopus (13) Google Scholar Moreover, as point-of-care ultrasonography can be performed by the nephrologist at bedside, it expedites care by allowing immediate clinical integration of the imaging data. Nonetheless, as with history taking and physical examination, it is of note that any point-of-care evaluation is operator dependent. Basic principles and new advances in kidney imagingKidney InternationalVol. 100Issue 5PreviewOver the past few years, clinical renal imaging has seen great advances, allowing assessments of kidney structure and morphology, perfusion, function and metabolism, and oxygenation, as well as microstructure and the interstitium. Medical imaging is becoming increasingly important in the evaluation of kidney physiology and pathophysiology, showing promise in management of patients with renal disease, in particular with regard to diagnosis, classification, and prediction of disease development and progression, monitoring response to therapy, detection of drug toxicity, and patient selection for clinical trials. Full-Text PDF" @default.
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• W3209859933 title "Point-of-care Doppler ultrasonography: a new dimension to kidney imaging" @default.
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• W3209859933 doi "https://doi.org/10.1016/j.kint.2021.06.021" @default.
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