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Resistive index: an ideal test for renovascular disease or ischemic nephropathy?

Nature Clinical Practice Nephrology volume 2, pages 232–233 (2006)Cite this article

Resistive index is a simple parameter that can be derived from an ultrasound Doppler spectrum. The index describes the percentage reduction of end-diastolic blood flow (Vmin) in a vessel in relation to maximal systolic blood flow (Vmax): resistive index = (Vmax – Vmin)/Vmax. Resistive index can be measured in any vessel; however, this article will focus on renal resistive index values and their utility in diagnosing renovascular disease and ischemic nephropathy.

Within the kidney, the resistive index declines from the distal renal artery to the interlobular arteries. In my view, measurements should be made in the proximal segmental artery, and the index averaged from two to three measurements in each kidney. Unfortunately, intrarenal measurements of resistive index have never been standardized to allow comparison between measurements obtained in different intrarenal regions. Furthermore, resistive index can be influenced by intrarenal and extrarenal factors. Resistive index increases with age, especially in hypertensive patients,1 and is also increased in a variety of renal diseases other than ischemic nephropathy, such as diabetic glomerulosclerosis, acute renal failure, urinary tract obstruction and lupus nephritis of high chronicity index, to name just a few.1 Extrinsic factors such as kidney compression and breath-holding during the Valsalva maneuver can increase the resistive index, as can extreme bradycardia. Resistive index values measured in the kidney are also correlated with extrarenal markers of vascular stiffness such as intima-media thickness and carotid stiffness.2 So, to give a short answer to the above question: no, resistive index is not an ideal test for renovascular disease or ischemic nephropathy. Having said this, resistive index can certainly be useful in the diagnosis of these conditions.

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  1. Chief Physician at the Klinikum Minden, Minden, Germany

    Jörg Radermacher

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  1. Jörg Radermacher
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Correspondence to Jörg Radermacher.

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Radermacher, J. Resistive index: an ideal test for renovascular disease or ischemic nephropathy?. Nat Rev Nephrol 2, 232–233 (2006). https://doi.org/10.1038/ncpneph0177

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