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World J Nephrol. May 6, 2017; 6(3): 123-131
Published online May 6, 2017. doi: 10.5527/wjn.v6.i3.123
Role of imaging in the evaluation of renal dysfunction in heart failure patients
Dario Grande, Paola Terlizzese, Massimo Iacoviello
Dario Grande, Paola Terlizzese, School of Cardiology, University of Bari, 70124 Bari, Italy
Massimo Iacoviello, Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, 70124 Bari, Italy
Author contributions: Grande D and Terlizzese P reviewed the literature concerning the review; Grande D, Terlizzese P and Iacoviello M contributed to the writing and revision of the paper and finally approved the submitted version; Iacoviello M decided the structure and contents of the review.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Massimo Iacoviello, MD, PhD, FESC, FANMCO, Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy. massimo.iacoviello@policlinico.ba.it
Telephone: +39-080-5478622 Fax: +39-080-5478796
Received: October 24, 2016
Peer-review started: October 27, 2016
First decision: December 1, 2016
Revised: December 13, 2016
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: May 6, 2017
Processing time: 191 Days and 22.7 Hours
Abstract

Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction, known as cardiorenal syndrome. In heart failure patients, renal impairment is related to hemodynamic and non-hemodynamic factors. Both decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal function. Kidney disease and worsening renal function are independently associated with poor prognosis in heart failure patients, both in acute and chronic clinical settings. The aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure patients. Renal imaging techniques could complete laboratory data, as estimated glomerular filtration rate, exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and function. In particular, Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique, which has proven to be a reliable method for prognostic stratification in patients with cardiorenal syndrome. The renal resistance index, a measure related to renal hemodynamics, can be calculated from the Doppler evaluation of arterial flow. Moreover, the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal congestion. Other imaging modalities are promising, but still confined to research purposes.

Keywords: Heart failure; Doppler; Renal resistance index; Hemodynamics; Venous Doppler; Prognosis; Cardiorenal syndrome; Chronic kidney disease

Core tip: Kidney disease is a common condition affecting heart failure patients. Cardiorenal syndrome defines the complex interaction with mutual deterioration of these organs. This review aims to describe currently available renal imaging techniques, especially arterial and venous Doppler, and to discuss the potential usefulness of promising research methodologies.