title: [Diagnostic value of pulsed Doppler in atheromatous renal insufficiency. A study of 32 patients].
abstract: BACKGROUND
  atheromatous stenosis of both renal arteries, or of the artery of a functionally solitary kidney is a frequent cause of renal failure in the elderly. Atheromatous Ischemic Renal Insufficiency (AIRI) can be ameliorated by surgery or angioplasty. However, such procedures can be hazardous in a patient with extensive aortic atheromatous plaques. This justified a study of the validity of Pulsed Doppler (PD), a diagnostic procedure less invasive than renal angiography in AIRI.
  
  
  OBJECTIVE
  to evaluate the diagnostic interest of PD in AIRI, using renal angiography as a criterion of adequacy.
  
  
  METHODS
  renal arteries PD (Ultramak-4, 3.5 and 5 Mhz probes) followed by renal angiography (Seldinger). "Significant" stenosis = 50% on angiography. "Positive" PD = turbulences and/or acceleration.
  
  
  METHODS
  32 patients were investigated for suspected AIRI on the grounds of 1) age greater than 50; 2) atheromatous background and 3) renal insufficiency with no other evident etiology, or rapidly declining GFR in such a patient treated with ACE inhibitors.
  
  
  RESULTS
  16/32 angiographies disclosed significant stenosis of at least 1 renal artery. 56 renal arteries were investigated with both angio. and PD. Prevalence of stenoses was 16/56. PD had 93.7% sensitivity and 55% specificity. Positive predictive value was 45.5% and negative predictive value was 95.7%. Specificity was 80% when PD disclosed acceleration.
  
  
  CONCLUSIONS
  negative PD is sufficient argument to reconsider the indication of renal angiography in a high risk pt with suspected AIRI.
authors.affiliation: Hôpital Avicenne, Bobigny.
authors.forename: P
authors.initials: P
authors.lastname: Buchet
authors.forename: F
authors.initials: F
authors.lastname: Minvielle
authors.forename: M
authors.initials: M
authors.lastname: Rainfray
authors.forename: T
authors.initials: T
authors.lastname: Mahfouz
authors.forename: D
authors.initials: D
authors.lastname: Ancri
authors.forename: A
authors.initials: A
authors.lastname: Meyrier
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008875:Middle Aged; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging*; D014463:Ultrasonography
vernacular_title: Intérêt diagnostique du Doppler pulsé dans l'insuffisance rénale athéromateuse. Etude de 32 patients.