Nephrology Dialysis Transplantation, Vol 14, Issue 2 360-365, Copyright © 1999 by Oxford University Press
R Pontremoli, F Viazzi, C Martinoli, M Ravera, C Nicolella, V Berruti, G Leoncini, N Ruello, P Zagami, G Bezante, L Derchi and G Defarrari
Background: Increased renal resistance detected by
ultrasound (US) Doppler has been reported in severe essential hypertension
(EH) and recently was shown to correlate with the degree of renal
impairment in hypertensive patients with chronic renal failure. However,
the pathophysiological significance of this finding is still controversial.
Methods: In a group of 211 untreated patients with EH,
we evaluated renal resistive index (RI) by US Doppler of interlobar
arteries and early signs of target organ damage (TOD). Albuminuria was
measured as the albumin to creatinine ratio (ACR) in three non-consecutive
first morning urine samples. Left ventricular mass was evaluated by M-B
mode echocardiography, and carotid wall thickness (IMT) by high resolution
US scan. Results: RI was positively correlated with
age (r=0.25, P=0.003) and systolic blood pressure (SBP) r=0.2, P=0.02) and
with signs of early TOD, namely ACR (r=0.22, P=0.01) and IMT (r=0.17,
P<0.05), and inversely correlated with renal volume (r=-0.22,
p=0.01) and diastolic blood pressure (r=-0.23, P=0.006). Multiple linear
regression analysis demonstrated that age, gender, ACR and SBP
independently influence RI and together account for 20% of its variations
(F=8.153, P<0.0001). When clinical data were analysed according to
the degree of RI, the patients in the top quartile were found to be older
(P<0.05) and with higher SBP (P<0.05) as well as early signs
of TOD, namely increased ACR (P<0.002) and IMT (P<0.005 by
ANOVA), despite similar body mass index, uric acid, fasting blood glucose,
lipid profile and duration of hypertension. Furthermore, patients with
higher RI showed a significantly higher prevalence of microalbuminuria (13
vs 12 vs 3
vs 33% &khgr;2=11.72,
P=0.008) and left ventricular hypertrophy (40 vs 43
vs 32 vs 60%
&khgr;2=9.25, P<0.05).
Conclusions: Increased RI is associated with early
signs of TOD in EH and could be a marker of intrarenal atherosclerosis.
Key words: atherosclerosis; essential hypertension;
microalbuminuria; renal vascular resistance; target organ damage
ORIGINAL ARTICLES
Increased renal resistive index in patients with essential hypertension: a marker of target organ damage
Department of Internal Medicine, Institute of Radiology, and Department of Neuroscience and Neurorehabilitation, University of Genoa, Viale Benedetto XV, 6, I-16132 Genova, Italy; Corresponding author
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