title: Doppler blood flow velocity waveforms in the fetal renal arteries: variability at proximal and distal sites in the right and left arteries.
abstract: OBJECTIVE
  To investigate variability in pulsatility/resistance indices and absolute velocities of blood flow in fetal renal arteries dependent on side and sampling site within each vessel.
  
  
  METHODS
  Doppler blood flow measurements of pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were performed in the renal arteries of 27 fetuses between 236 and 247 days of gestation. Velocity waveforms were sampled in both the right and left renal arteries at two different sites: proximally, close to the aorta, and distally, before any major visible bifurcation of the vessels. The intraobserver variation was measured in 15 additional fetuses.
  
  
  RESULTS
  Mean values of PI and RI were similar in the right and left renal arteries and at the proximal and distal sampling sites of these arteries. Mean PSV and EDV were higher at the proximal compared to the distal site on both sides. For all parameters the 95% limits of agreement between measurements made in the right and left arteries and at proximal and distal sites were wide but tended to be narrower for the left renal artery and at the distal site. Intraclass correlation coefficients for intraobserver variability were 0.88, 0.89, 0.83 and 0.81 for PI, RI, PSV and EDV, respectively.
  
  
  CONCLUSIONS
  It is important to standardize the precise site at which Doppler blood flow velocity waveform measurements are made in the renal arteries of the fetus. On the basis of our observations, we suggest that the left renal artery is the preferred vessel for sampling and that measurements should be made in the renal arterial trunk away from the aorta and before any visible branches.
authors.affiliation: Centre for Fetal Origins of Adult Disease, Southampton, UK. g.haugen@ukonline.co.uk
authors.forename: G
authors.initials: G
authors.lastname: Haugen
authors.forename: K
authors.initials: K
authors.lastname: Godfrey
authors.forename: S
authors.initials: S
authors.lastname: Crozier
authors.forename: M
authors.initials: M
authors.lastname: Hanson
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D005312:Fetal Blood / Q000000981:diagnostic imaging / Q000502:physiology*; D006801:Humans; D015588:Observer Variation; D011673:Pulsatile Flow / Q000502:physiology; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000196:embryology / Q000502:physiology*; D016216:Ultrasonography, Prenatal