title: Acute renal failure in critically ill patients: evaluation of an ultrasound contrast agent.
abstract: The purpose of the present paper was to evaluate an ultrasound contrast agent (Levovist) in patients with oliguric acute renal failure (ARF) in order to assess renal vascularity, differentiate acute tubular from cortical necrosis and predict prognosis. Ten intensive care unit (ICU) patients with oliguric ARF were prospectively investigated by ultrasound including colour, power and pulsed Doppler before and after injection of Levovist. Doppler signals were graded as absent, equivocal or present from the inner and outer portions of the renal parenchyma, and these findings were correlated with clinical parameters and outcome. Only one patient had findings in keeping with acute cortical necrosis. All patients who survived had parenchymal vascularity while only three of six (50%) who died had parenchymal vascularity after Levovist. The ultrasound contrast caused no side effects and additional information was provided which improved diagnostic confidence, enabled appropriate classification of patients as having tubular or cortical necrosis and therefore added prognostic information.
authors.affiliation: Department of Nuclear Medicine and Ultrasound, Westmead Hospital, New South Wales, Australia. nsg@imag.wsahs.nsw.gov.au
authors.forename: S M
authors.initials: SM
authors.lastname: Gruenewald
authors.forename: T
authors.initials: T
authors.lastname: Huster
authors.forename: G
authors.initials: G
authors.lastname: Larcos
authors.forename: D C
authors.initials: DC
authors.lastname: Farlow
authors.forename: K K
authors.initials: KK
authors.lastname: Choong
authors.forename: Y
authors.initials: Y
authors.lastname: Mudaliar
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage*; D016638:Critical Illness; D005069:Evaluation Studies as Topic; D006801:Humans; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508