Resistive index as a predictor of renal progression in patients with moderate renal dysfunction regardless of angiotensin converting enzyme inhibitor or angiotensin receptor antagonist medication

BACKGROUND: Previous studies have shown that a higher resistive index (RI) on renal duplex ultrasonography was related with renal progression and acute kidney injury, especially in patients with chronic kidney disease (CKD) using an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB). We evaluated whether a RI value is a predictive factor for renal progression regardless of ACEI or ARB medication in patients with moderate renal dysfunction. METHODS: We retrospectively analyzed 119 patients with moderate renal dysfunction that had been evaluated with renal duplex ultrasonography from February 2011 to April 2015. Moderate renal dysfunction was defined as a stage 3 to 4 CKD. Renal progression was defined as a doubling of the baseline serum creatinine (sCr), a decrease of baseline glomerular filtration rate by > 50%, or initiation of renal replacement therapy. RESULTS: The mean age was 64.7 ± 11.0 years and sCr level was 2.1 ± 1.2 mg/dL. The RI ≥ 0.79 group showed a higher incidence of renal progression (P = 0.004, log-rank test) compared with the RI < 0.79 group, irrespective of ACEI or ARB usage. In the Cox proportional hazard model, RI ≥ 0.79 was an independent prognostic factor after adjusting for age, sex, diabetes mellitus, sCr, proteinuria, and use of ACEI or ARB (hazard ratio, 4.88; 95% confidence interval, 1.06–22.53; P = 0.043). CONCLUSION: RI ≥ 0.79 on the renal duplex ultrasonography can be a helpful predictor for renal progression in patients with moderate renal dysfunction, regardless of their ACEI or ARB usage.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.