ArticleClinical hemorheology and microcirculation2024
Renal medullary perfusion differs from that in renal cortex in patients with sepsis associated acute kidney injury and correlates with renal function prognosis: A prospective cohort study.
Article in Clinical hemorheology and microcirculation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed.
- Assessment of renal allograft cortical perfusion in the early postoperative period using arterial spin labeling magnetic resonance imaging.Quantitative imaging in medicine and surgery · 2026Article
- Renal Veno-Arterial Carbon Dioxide Gap Fails to Detect Renal Medulla Microcirculatory Changes in a Large Animal Model of Sepsis-Associated Acute Kidney Injury.Shock (Augusta, Ga.) · 2026Article
- Effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.Journal of intensive care · 2026Article
- Effects of glucagon-like peptide-1 on systemic hemodynamics, kidney function, and intrarenal oxygenation in sheep with sepsis-associated acute kidney injury.Scientific reports · 2025Article
- Contrast-enhanced ultrasound and elastography predict histopathology and recovery in acute kidney injury.Renal failure · 2025Article
- Possibility of modern ultrasound imaging of portal venous system.Clinical hemorheology and microcirculation · 2025Review
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Abstract
backgroundRenal perfusion status remains poorly studied at the bedside during sepsis associated acute kidney injury (AKI). The aim of the study is to examine renal cortical and medullary perfusion using renal contrast enhanced ultrasound (CEUS) in septic patients.
methodsIn this single-center, prospective longitudinal study, septic patients were enrolled. Renal ultrasonography was performed within 24 hours of ICU admission (D1), then repeated at D3, D5 and D7. Each measurement consisted of three destruction replenishment sequences that were recorded for delayed analysis with dedicated software (Vuebox). Renal cortex and medulla perfusion were quantified by measuring time to peak (TTP). Receiver operating characteristic (ROC) analysis was used to evaluate 28-day renal prognosis.
resultsThe study included 149 septic patients, including 70 non-AKI patients and 79 AKI patients. Both renal cortical and medullary TTP was longer in the AKI group than in the non-AKI group. The difference of TTP between renal cortex and medulla in AKI group was higher than that in the non-AKI group (p = 0.000). Medullary TTP on day 3 had the best performance in predicting the prognosis of 28-day renal function (AUC 0.673, 95% confidence interval 0.528-0.818, p = 0.024), and its cut-off value was 45 s with a sensitivity 52.2% and a specificity of 82.1%. Cortical TTP on day 3 also had the performance in predicting the prognosis of 28-day renal function (AUC 0.657, 95% confidence interval 0.514-0.800, p = 0.039), and its cut-off value was 33 s with a sensitivity 78.3% and a specificity of 55.0%.
conclusionRenal medullary perfusion alterations differ from those in cortex, with the medulla is worse. Simultaneous and dynamic assessment of cortical and medullary microcirculatory flow alterations necessary. TTP on day 3, especially medullary TTP, seems to be a relatively stable and useful indicator, which correlates with 28-day renal function prognosis in septic patients. Early correction of renal cortical and medullary perfusion alterations reduces the incidence of adverse renal events.
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