Abstract：
Congestion is a common complication in the critical care setting, these patients are at increased risk of developing acute kidney injury (AKI). Congestive nephropathy (CN) has recently been described as a mechanism of worsening renal function, and evaluation of renal venous flow by pulsed Doppler (PD) is a useful tool to assess the presence of renal vein congestion. We comprehensively explore the ability of the PD in the evaluation of the intrarenal venous flow (IRVF) to predict the development of AKI in critically ill patients. We searched Pubmed-MEDLINE, Scopus, Embase, and Cochrane Library of Systematic Reviews (to 31th December 2021). We evaluated the association between Doppler-based Intrarenal venous flow demodulation and AKI. CN was defined as the presence of a pulsatile pattern (biphasic or monophasic) in the PD. A total of 4 articles (660 patients) were included in our systematic review, three of these in the metanalysis (413 patients): one study was excluded because its data were inadequate for pooling. Two studies originated in Europe and the other two in the United States. AKI occurrence ranged between 34 and 68%. Patients who developed AKI had a significant difference in PD pattern (continuous vs. pulsatile) in the IRVF (RR=0.46; 95% CI 0.28-0.76). Nevertheless, a large heterogeneity was observed among the studies (I2=68.7%; p=0.04). Albeit preliminary, these findings suggest that the presence of a pulsatile pattern in the PD of the IRVF may be involved in the development of AKI in the critically ill patient. The effect of alterations in the IRVF and renal function warrant further investigation.
摘要：
充血是重症监护环境中常见的并发症，这些患者发生急性肾损伤(AKI)的风险增加.充血性肾病（CN）最近被描述为肾功能恶化的机制，通过脉冲多普勒（PD）评估肾静脉血流是评估肾静脉充血的有用工具。我们全面探索PD在评估肾内静脉流量（IRVF）以预测危重患者AKI发展的能力。我们搜索了Pubmed-MEDLINE,Scopus,Embase,和科克伦系统审查图书馆(至2021年12月31日)。我们评估了基于多普勒的肾内静脉血流解调与AKI之间的关联。CN被定义为PD中存在脉动模式(双相或单相)。共纳入4篇(660例患者)的系统评价。meta分析中的3例(413例患者):一项研究被排除,因为其数据不足以汇集.两项研究起源于欧洲，另外两项在美国。AKI发生率介于34％和68％之间。发生AKI的患者在PD模式上有显著差异(连续与脉动)在IRVF中(RR=0.46；95%CI0.28-0.76)。然而，在研究中观察到较大的异质性(I2=68.7%;p=0.04).尽管是初步的，这些研究结果表明,IRVF的PD中存在搏动模式可能与危重患者AKI的发生有关.IRVF和肾功能改变的影响值得进一步研究。
