Renal artery Doppler in fetal sonography: A narrative review

Doppler imaging is a non-invasive method in evaluating fetal circulation. Renal artery doppler (RAD) has been used for assessing fetal well-being in several studies. The aim of this narrative review was to accumulate and classify current evidence on RAD in fetal sonography. Articles until November 2022 were searched. After removing ineligible articles, 51 studies were included. Present articles were about RAD assessment in cases with amniotic fluid level changes, fetal growth restriction, fetal renal diseases, monochorionic twin pregnancies, preeclampsia, and gestational diabetes mellitus. The complex physiology of fetal kidney function may explain different results observed in different studies about the role of RAD in fetal assessment. It seems this factor can be useful in assessing some groups like diabetic pregnant women, and it should be used accompanying other related factors like kidney size. Further research is needed to evaluate the effectiveness of RAD in clinical management.

[1] Divon MY, Ferber A. Doppler evaluation of the fetus. Clin Obstet Gynecol 2002; 45: 1015-1025.

[2] Konje JC, Abrams KR, Taylor DJ. Normative values of doppler velocimetry of five major fetal arteries as determined by color power angiography. Acta Obstet Gynecol Scand 2005; 84: 230-237.

[3] Seravalli V, Miller JL, Block-Abraham D, McShane C, Millard S, Baschat A. The relationship between the fetal volume-corrected renal artery pulsatility index and amniotic fluid volume. Fetal Diagn Ther 2019; 46: 97- 102.

[4] Brennan S, Watson D, Schneider M, Rudd D, Kandasamy Y. Fetal renal artery blood flow-normal ranges. Ultrasound 2022; 30: 62-71.

[5] Haugen G, Godfrey K, Crozier S, Hanson M. Doppler blood flow velocity waveforms in the fetal renal arteries: Variability at proximal and distal sites in the right and left arteries. Ultrasound Obstet Gynecol 2004; 23: 590- 593.

[6] Fong K, Ryan ML, Cohen H, Amankwah K, Ohlsson A, Myhr T, et al. Doppler velocimetry of the fetal middle cerebral and renal arteries: Interobserver reliability. J Ultrasound Med 1996; 15: 317-321.

[7] Figueira CO, Surita FG, Dertkigil MSJ, Pereira SL, Bennini Jr JR, Morais SS, et al. Longitudinal reference intervals for doppler velocimetric parameters of the fetal renal artery correlated with amniotic fluid index among low-risk pregnancies. Int J Gynaecol Obstet 2015; 131: 45-48.

[8] Arduini D, Rizzo G. Normal values of pulsatility index from fetal vessels: A cross-sectional study on 1556 healthy fetuses. J Perinat Med 1990; 18: 165-172.

[9] Mitra SC, Ganesh V, Apuzzio JJ. Fetal renal artery and umbilical artery doppler flow and fetal urine output. Am J Perinatol 1995; 12: 11-13.

[10] Ozkan MB, Srafrace S, Ozyazici E, Emiroglu B, Özkaya E. Hemodynamics of the fetal renal artery in cases of isolated oligohydramnios between 35 weeks’ and 40 weeks’ gestation. J Med Ultrasound 2014; 22: 207e12.

[11] Scott LL, Casey BM, Roberts S, McIntire D, Twickler DM. Predictive value of serial middle cerebral and renal artery pulsatility indices in fetuses with oligohydramnios. J Matern Fetal Med 2000; 9: 105- 109.

[12] Benzer N, Pekin AT, Yilmaz SA, Kerimoglu ÖS, Dogan NU, Çelik Ç. Predictive value of second and third trimester fetal renal artery doppler indices in idiopathic oligohydramnios and polyhydramnios in low-risk pregnancies: A longitudinal study. J Obstet Gynaecol Res 2015; 41: 523-528.

[13] Selam B, Koksal R, Ozcan T. Fetal arterial and venous doppler parameters in the interpretation of oligohydramnios in postterm pregnancies. Ultrasound Obstet Gynecol 2000; 15: 403-406.

[14] Oz AU, Holub B, Mendilcioglu I, Mari G, Bahado- Singh RO. Renal artery doppler investigation of the etiology of oligohydramnios in postterm pregnancy. Obstet Gynecol 2002; 100: 715-718.

[15] Veille JC, Penry M, Mueller-Heubach E. Fetal renal pulsed doppler waveform in prolonged pregnancies. Am J Obstet Gynecol 1993; 169: 882-884.

[16] Sahin E, Madendag Y, Tayyar AT, Sahin ME, Col Madendag I, Acmaz G, et al. Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. J Matern Fetal Neonatal Med 2018; 31: 3085-3088.

[17] Budunoglu MD, Yapca OE, Yldildiz GA, Atakan Al R. Fetal renal blood flow velocimetry and cerebro-placental ratio in patients with isolated oligohydramnios. J Gynecol Obstet Hum Reprod 2019; 48: 495-499.

[18] Madazli R, Erenel H, Ozel A, Oztunc F. Fetal left ventricular modified myocardial performance index and renal artery pulsatility index in pregnancies with isolated oligohydramnios before 37 weeks of gestation. J Turk Ger Gynecol Assoc 2021; 22: 286-292.

[19] Akdogan M, Ipek A, Kurt A, Sayit AT, Karaoglanoglu M. Renal artery doppler findings in the patients with polyhydramnios before and after the conservative treatment. Eurasian J Med 2015; 47: 85-90.

[20] Yoshimura SY, Masuzaki H, Gotoh H, Ishimaru T. Fetal redistribution of blood flow and amniotic fluid volume in growth-retarded fetuses. Early Hum Dev 1997; 47: 297- 304.

[21] Manabe A, Hata T, Kitao M. Longitudinal doppler ultrasonographic assessment of alterations in regional vascular resistance of arteries in normal and growthretarded fetuses. Gynecol Obstet Invest 1995; 39: 171- 179.

[22] Stigter RH, Mulder EJ, Bruinse HW, Visser GH. Doppler studies on the fetal renal artery in the severely growthrestricted fetus. Ultrasound Obstet Gynecol 2001; 18: 141-145.

[23] Tanabe R. Doppler ultrasonographic assessment of fetal renal artery blood flow velocity waveforms in intrauterine growth retarded fetuses. Kurume Med J 1992; 39: 203-208.

[24] Benavides-Serralde A, Scheier M, Cruz-Martinez R, Crispi F, Figueras F, Gratacos E, et al. Changes in central and peripheral circulation in intrauterine growth-restricted fetuses at different stages of umbilical artery flow deterioration: New fetal cardiac and brain parameters. Gynecol Obstet Invest 2011; 71: 274-280.

[25] Contag S, Visentin S, Goetzinger K, Cosmi E. Use of the renal artery doppler to identify small for gestational age fetuses at risk for adverse neonatal outcomes. J Clin Med 2021; 10: 1835.

[26] Adiyaman D, Kuyucu M, Konuralp Atakul B, Gölbasi H, Pala HG. Assessment of renal volume by 3D VOCAL ultrasonography method in late-onset growthrestricted fetuses with normal amniotic fluid index. Ginekol Pol 2020; 91: 679-684.

[27] Silver LE, Decamps PJ, Korst LM, Platt LD, Castro L. Intrauterine growth restriction is accompanied by decreased renal volume in the human fetus. Am J Obstet Gynecol 2003; 188: 1320-1325.

[28] Bates JA, Irving HC. Inability of color and spectral Doppler to identify fetal renal obstruction. J Ultrasound Med 1992; 11: 469-472.

[29] Gudmundsson S, Neerhof M, Weinert S, Tulzer G, Wood D, Huhta JC. Fetal hydronephrosis and renal artery blood velocity. Ultrasound Obstet Gynecol 1991; 1: 413- 416.

[30] Wladimiroff JW, Heydanus R, Stewart PA, Cohen- Overbeek TE, Brezinka C. Fetal renal artery flow velocity waveforms in the presence of congenital renal tract anomalies. Prenat Diagn 1993; 13: 545-549.

[31] Kaminopetros P, Dykes EH, Nicolaides KH. Fetal renal artery blood velocimetry in multicystic kidney disease. Ultrasound Obstet Gynecol 1991; 1: 410-412.

[32] Iura T, Makinoda S, Tomizawa H, Watanabe Y, Waseda T, Inoue H, et al. Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color doppler ultrasound-longitudinal comparison to normal fetuses. J Perinat Med 2005; 33: 226-231.

[33] Iura T, Makinoda S, Miyazaki S, Fujita S, Inoue H, Hirosaki N, et al. Prenatal diagnosis of the hemodynamics of fetal renal disease by color doppler ultrasound. Fetal Diagn Ther 2003; 18: 148-153.

[34] Jain JA, Gyamfi-Bannerman C, Simpson LL, Miller RS. Renal artery doppler studies in the assessment of monochorionic, diamniotic twin pregnancies with and without twin-twin transfusion syndrome. Am J Obstet Gynecol MFM 2020; 2: 100167.

[35] Ma’ayeh M, Krishnan V, Gee SE, Russo J, Shellhaas C, Rood KM. Fetal renal artery impedance in pregnancies affected by preeclampsia. J Perinat Med 2020; 48: aop.

[36] Liu F, Liu Y, Lai YP, Gu XN, Liu DM, Yang M. Fetal hemodynamics and fetal growth indices by ultrasound in late pregnancy and birth weight in gestational diabetes mellitus. Chin Med J 2016; 129: 2109-2114.

[37] Jamal AS, Naemi M, Eslamian L, Marsoosi V, Moshfeghi M, Nurzadeh M, et al. The association between fetal renal artery indices in late pregnancy and birth weight in gestational diabetes mellitus: A cohort study. Int J Reprod Biomed 2022; 20: 21-28.

[38] Contag S, Patel P, Payton S, Crimmins S, Goetzinger KR. Renal artery doppler compared with the cerebral placental ratio to identify fetuses at risk for adverse neonatal outcome. J Matern Fetal Neonatal Med 2021; 34: 532-540.

[39] Rasanen J, Jouppila P. Uterine and fetal hemodynamics and fetal cardiac function after atenolol and pindolol infusion: A randomized study. Eur J Obstet Gynecol Reprod Biol 1995; 62: 195-201.

[40] Mari G, Kirshon B, Moise KJ Jr, Lee W, Cotton DB. Doppler assessment of the fetal and uteroplacental circulation during nifedipine therapy for preterm labor. Am J Obstet Gynecol 1989; 161: 1514-1518.

[41] Kramer WB, Saade GR, Belfort M, Dorman K, Mayes M, Moise KJ Jr. A randomized double-blind study comparing the fetal effects of sulindac to terbutaline during the management of preterm labor. Am J Obstet Gynecol 1999; 180: 396-401.

[42] Mari G, Moise KJ Jr, Deter RL, Kirshon B, Carpenter RJ. Doppler assessment of the renal blood flow velocity waveform during indomethacin therapy for preterm labor and polyhydramnios. Obstet Gynecol 1990; 75: 199-201.

[43] Edwards A, Baker LS, Wallace EM. Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone. Ultrasound Obstet Gynecol 2002; 20: 240-244.

[44] Cohlen BJ, Stigter RH, Derks JB, Mulder EJ, Visser GH. Absence of significant hemodynamic changes in the fetus following maternal betamethasone administration. Ultrasound Obstet Gynecol 1996; 8: 252-255.

[45] Marchi L, Pasquini L, Elvan-Taspinar A, Bilardo CM. Cardiovascular hemodynamic changes after antenatal corticosteroids in growth restricted and appropriate for gestational age fetuses. Ultraschall Med 2020; 41: 292- 299.

[46] Wang Z, Li W, Ouyang W, Ding Y, Wang F, Xu L, et al. Cervical ripening in the third trimester of pregnancy with intravaginal misoprostol: A doubleblind, randomized, placebo-controlled study. J Tongji Med Univ 1998; 18: 183-186.

[47] Fok WY, Leung TY, Tsui MH, Leung TN, Lau TK. Effect of prostaglandin E2 for cervical priming on fetal hemodynamics. J Reprod Med 2005; 50: 697-700.

[48] Veille JC, Hanson R, Sivakoff M, Swain M, Henderson L. Effects of maternal ingestion of low-dose aspirin on the fetal cardiovascular system. Am J Obstet Gynecol 1993; 168: 1430-1437.

[49] Mitra SC, Ganesh V, Apuzzio JJ. Effect of maternal cocaine abuse on renal arterial flow and urine output of the fetus. Am J Obstet Gynecol 1994; 171: 1556-1559.

[50] Heisler D. Pediatric renal function. Int Anesthesiol Clin 1993; 31: 103-107.

[51] Troyano Luque JM, Clavijo MT, Reyes I, Martínez-Wallin I. Fetal hemodynamic profile in uncommon vessels. Ultrasound Rev Obstet Gynecol 2003; 3: 170-177.

Comments (0)

No login
gif