INTRODUCTION Chronic kidney disease (CKD) worldwide health problem causing progressive decline in renal function. Higher prevalence of CKD is due to obesity, hypertension diabetes etc. On ultrasonography, cortical echogenicity is also increased with progression of disease, and is due to interstitial inammation, oedema, sclerosis or brosis. Previous studies have suggested that progressive decrease in renal length and cortical thickness could predict possibility of renal failure later 1in course of disease . The resistive index (RRI) is commonly used as an index of intrarenal arterial resistance caused by various intrarenal pathologies. RRI increases in various kidney diseases including CKD. Some previous studies have shown the associations of RI with renal function and patient prognosis. Therefore, we planned to study the relationship between ultrasonographic renal parameters and renal impairment in patients with chronic kidney disease. AIMS AND OBJECTIVES To assess the role of renal resistive index, renal cortical thickness, renal length, and cortical echogenicity in CKD patient. MATERIAL AND METHOD It was hospital based cross-sectional study conducted in department of Radiodiagnosis, MGM Medical College, Indore, after getting approval from Institutional Scientic Review Board. A total of 86 patients with CKD, age more than 18 years were undergone ultrasonographic examination for kidney evaluation in B-mode grey scale using 2.5 to 5 MHz transducer after taking written consent. Bipolar renal length, cortical thickness and renal resistive index (RRI) were measured. Documentation of cortical echogenicity was done by comparing with liver echogenicity. A detailed clinical history, serum creatinine and eGFR using Cockroft-Gualt equation were recorded. Exclusion criteria: congenital renal diseases, acute kidney disease, renal malignancy, traumatic injury; and unwilling patients to consent for study were excluded. Appropriate statistical tests were applied for renal cortical thickness, renal length, cortical echogenicity, renal resistive index and eGFR values. Pearson correlation analysis was done between renal length and renal cortical thickness measurements against serum creatinine and eGFR. P-values of <0.05 was considered to be statistically signicant. RESULTS & DISCUSSION Out of total 86 CKD patients, 48 were male and 38 were females. In our study, age range was 18-82 year, with mean age 53.11 years. Common age group was 45-55 years (40%). The mean serum creatinine was 4.02mg/dl. The mean eGFR was 43.27 ml/min/1.73m2. These results were correlated with 2the studies done by Siddappa JK et al in 2013 . The mean bipolar renal length in CKD patients was 8.12cm. The mean renal cortical thickness in CKD patients was 6.25 mm (Table 11) . 78 out of 86 patients with CKD had increased cortical echogenicity. Majority of them had grade 2 cortical echogenicity (36). 48 patient out of 86 patients had maintained corticomedullary differentiation, 29 patients had poorly maintained CMD and 9 patients had lost CMD on ultrasonography. The results were in concordance with study 4conducted by Singh A et al in 2016 . In our study, serum creatinine was signicantly higher in higher grades of echogenicity (P< 0.01) and mean eGFR was also signicantly decreased with increasing grades of echogenicity (Table 2). These ndings were consistent with the 2ndings of Siddappa JK et al (2013) . In our study, bipolar renal length and cortical thickness were decreased signicantly with increasing grades of cortical echogenicity in CKD patients (P<0.01) (Table 2). Our results 5were in accordance with study by Ahmed S et al (2019) . The mean renal resistive index (RRI) was 0.92 in our study. It was signicantly higher in higher grades of increased cortical echogenicity (P=0.024) and also in advanced stages of CKD (P<0.01) (Table 2). Thus RRI had increased with progression of disease and it was well correlated with renal function (Table 3 & Figure 3). Our ndings were in accordance with study done 9by Hanamura K et al 2012 . ROLE OF RENAL PARAMETERS IN ASSESSMENT OF RENAL IMPAIRMENT IN CKD PATIENTS Original Research Paper Dr Alka Agrawal Professor & Head Of Department, Department Of Radiodiagnosis, MGM Medical College & M Y Hospital, Indore. Radiodiagnosis Aim & objectives: To study the role ultrasonographic renal parameters to assess renal impairment in CKD patients. Method: Total 86 patients with CKD were undergone ultrasonographic examination for evaluation kidneys. Renal length, cortical thickness, segmental artery Doppler and cortical echogenicity were documented on B-mode gray scale using 2-5 MHz probe. Results: 2 Mean renal length was 8.12cm, mean cortical thickness was 6.25mm and mean eGFR was 43.27 ml/min/1.73m . Serum- creatinine showed negative correlation with cortical thickness and renal length. eGFR showed positive correlation with cortical thickness and renal length. Cortical echogenicity positively correlated with serum creatinine (r=0.7102, P<0.01) and negatively with renal function (r=-0.4681, P<0.01). RRI was higher in advanced stages of CKD. Conclusion: Cortical thickness and cortical echogenicity showed signicant correlation with serum creatinine and renal function. RRI can be used as marker in CKD and to assess the risk of adverse renal outcome in CKD. ABSTRACT KEYWORDS : CKD, Cortical Thickness, Renal Length, Cortical Echogenicity, Serum Creatinine And eGFR, RRI. VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Dharmendra Singh Thakur Pg Resident, Department Of Radiodiagnosis, MGM Medical College & M.Y. Hospital, Indore. Dr Amit Shankhwar* Associate Professor, Department Of Radiodiagnosis, MGM Medical College & M.Y. Hospital, Indore. * Corresponding Author 88 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS In our study, serum creatinine showed signicant negative correlation with cortical thickness (r=-0.6504, P<0.01), renal length (r=-0.3745, P<0.05) and cortical echogenicity (r=0.7102, P<0.01). The renal function (eGFR) was positively correlated with cortical thickness (r=0.5781, P<0.01), renal length (r=0.3248, P<0.01) and negatively with cortical echogenicity (r=-0.4681, P<0.01). Thus, in our study, cortical thickness was more strongly related to serum creatinine and eGFR (Table 3). These ndings were in concordance with 3results of Yamashita SR et al (2015) . This correlation between serum creatinine and eGFR with cortical echogenicity can be explained by the fact that echogenicity of kidneys was due to glomerular sclerosis, tubular atrophy interstitial brosis and 6inammation . These ndings, on biopsy, were clinically associated with decreased renal function thereby decreasing eGFR and higher serum creatinine level. These ndings were 7further supported by Moghazi S et al (2005) and Gareeballah 8et al (2015) . Table 1: Mean values of renal parameters in CKD patients: Table 2: Comparison of various parameters according to grades of cortical echogenicity in CKD patients: Table 3: Statistical correlation of serum creatinine and eGFR with renal parameters in CKD patients: Figure 1: Scatter plot showing relationship between cortical thickness and serum creatinine: Figure 2: Scatter plot showing relationship between renal length and serum creatinine: Figure 3: Scatter plot showing relationship between eGFR and Resistive index. CONCLUSION Finally, we conclude that, ultrasonographic renal parameters such as renal cortical thickness, renal length and cortical echogenicity were well correlated with serum creatinine and renal function (eGFR) in CKD patients. Cortical thickness and cortical echogenicity had shown strong correlation with serum creatinine and renal function. These parameters can be used to assess the status of renal function and for follow-up to predict the progression of disease over the time in patients with CKD. RRI was signicantly higher in CKD patients and was more in advanced stages of CKD. Therefore, it can be used as marker in CKD and as a risk factors for adverse renal outcome in CKD. REFERENCES 1. Beland MD, Walle NL, Machan JT, et al. Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol. 2010; 195:W146–9 2. Siddappa JK, Singla S, Al Ameen M, Rakshith SC, Kumar N. Correlation of Ultrasonographic Parameters with Serum Creatinine in Chronic Kidney Disease. J Clin Imaging Sci 2013;3:28 3. Yamashita SR, von Atzingen AC, Iared W, Bezerra ASA, Ammirati AL, Canziani MEF, D’Ippolito G. Value of renal cortical thickness as a predictor of renal function impairment in chronic renal disease patients. Radiol Bras. 2015 Jan/Fev;48(1):12–16. 4. Singh A, Gupta K, Chander R, et al. Sonographic grading of renal cortical echogenicity and raised serum creatinine in patients with chronic kidney disease. J. Evolution Med. Dent. Sci. 2016;5(38):2279-2286, DOI: 10.14260/jemds/2016/530. 5. Ahmed S, Bughio S, Hassan M, et al. (March 12, 2019) Role of Ultrasound in the Diagnosis of Chronic Kidney Disease and its Correlation with Serum Creatinine Level. Cureus 11(3): e4241. DOI 10.7759/cureus.4241 6. Roseneld AT, Siegel NJ. Renal parenchymal disease: histopathologic - sonographic correlation. Am J Roentgenol 1981;137(4):793-8 7. Moghazi S, Jones E, Schroepple J, et al. Correlation of renal histopathology with sonographic ndings. Kidney Int 2005;67(4):1515-20. 8. Gareeballah, A., Gameraddin, M., Mustafa, H., Alshabi, S., Alagab, F.E., Tamboul, J. and Salih, S. 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VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Parameters Mean 1.Serum creatinine (mg/dl) 4.02 2.eGFR (ml/min/1.73m2) 43.27 3.Cortical thickness (mm) 6.25 4.Renal length (cm) 8.12 5.Renal resistive index (RRI) 0.92 Serum Creatinine (mg/dl) eGFR (ml/min/1.73 m2) Renal length (cm) Cortical thickness (mm) RRI Echogenicity Mean Mean Mean Mean Grade 0 1.45 66.41 12.54 11.86 0.73 Grade 1 1.96 45.78 10.78 9.75 0.81 Grade 2 3.24 28.75 8.81 7.31 0.89 Grade 3 4.87 21.63 7.27 5.68 0.93 Grade 4 6.91 15.65 6.68 3.46 0.98 P-value <0.01 <0.01 <0.05 <0.01 0.024 Renal Parameters Serum creatinine eGFR Correlation (r) P-value Correlation (r) P-value Cortical thickness -0.6504 <0.01 0.5781 <0.01 Renal length 0.3745 <0.01 0.3248 <0.01 Echogenicity 0.7102 <0.01 -0.4681 <0.01 RRI 0.4321 0.038 -0.5017 0.041 X 89GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS