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Assessment of renal vascular resistance and blood pressure in dogs and cats with renal disease
R. Novellas, R. Ruiz de Gopegui, Y. Espada
This study investigated the possible relationships between renal resistive index (RI) or pulsatility index (PI) and systolic blood pressure and biochemical and haematological parameters in dogs and cats with renal disease. The study included 50 dogs and 20 cats with renal disease. RI and PI were significantly higher in both dogs and cats with renal disease than in 27 healthy dogs and 10 healthy cats. In dogs, a significant negative correlation was found between RI and red blood cell count, and a positive correlation was found between PI and serum creatinine. In cats, a positive correlation was found between RI and serum urea, between PI and serum creatinine, and between PI and serum urea. No relationship could be found between either RI or PI and systolic blood pressure.
Systemic hypertension is common in dogs and cats with renal disease, and it has been reported to occur in 60 to 69 per cent of cats with renal failure (Kobayashi and others 1990, Green 2008) and in 31 to 93 per cent of dogs with renal disease (Cowgill and Kallet 1986, Jacob and others 2003, Cortadellas and others 2006). The kidney has a role in the development and persistence of hypertension, but it is also injured by it. Sustained systemic hypertension can induce glomerulosclerosis, glomerular atrophy and proliferative glomerulonephritis as a result of increased blood pressure in the glomerular capillary bed (Bartges and others 1996, Brown and Henik 1998). Dogs with renal failure and higher systolic blood pressure (SBP) have been reported to be more likely to develop a uraemic crisis, to die, or to undergo continued decline in renal function (Jacob and others 2003). In a study of induced renal failure, dogs with more severe hypertension had significantly lower glomerular filtration rates, higher urine protein:creatinine ratios and higher renal lesion scores than dogs with less severe hypertension (Finco 2004). Possible mechanisms involved in hypertension related to renal disease are an increase in noradrenaline, increased vascular response to noradrenaline, a reduction in vasodilator substances, an increase in cardiac output, an increase in peripheral resistance, secondary hyperparathyroidism, failure to excrete sodium and water (resulting in increased extracellular fluid volume), and increased activity of the renin-angiotensin-aldosterone system (Green 2008). Once hypertension has developed, it accelerates the renodestructive process, resulting in a vicious cycle of glomerulosclerosis and further loss of nephrons (Dukes 1992, Green 2008). Increased intrarenal vascular resistance as a result of glomerulosclerosis may have a role in the development of hypertension as a result of renal disease (Dukes 1992, van de Sandt and others 2003, Green 2008). Normal renal arteries have low resistance to blood flow, which can be visualised as high continuous systolic flow with a gradual decrease during diastole (Szatmari and others 2001). This vascular pattern can be evaluated by means of pulsed Doppler ultrasound, which also allows the calculation of the resistive index (RI) and pulsatility index (PI) to provide information about vascular resistance. Duplex Doppler evaluation of intrarenal RI can aid in confirmation of renal disease in dogs and cats in which the greyscale sonographic appearance of the kidney is unremarkable or when increased relative renal cortex echogenicity is the only renal parenchymal abnormality observed (Rivers and others 1997b). RI and PI have been described in healthy dogs and cats (Nyland and others 1993, Morrow and others 1996, Rivers and others 1996b, 1997a, Mitchell and others 1998, Pollard and others 1999, Novellas and others 2007). These indices have also been used in studies of renal and urinary tract disease in dogs and cats (Nyland and others 1993, Daley and others 1994, Morrow and others 1996, Rivers and others 1996a, 1997b, Choi and others 2001, 2003). Increased RI has been reported to be associated with early hypertensive renal damage and correlated with systemic blood pressure in human patients (Veglio and others 1992, Pontremoli and others 1999). In studies evaluating RI in dogs and cats with renal disease, systemic blood pressure has either not been evaluated (Morrow and others 1996) or has been within normal limits in all the animals in which it was measured (six dogs and four cats) (Rivers and others 1997b). Correlation between RI and systemic blood pressure was not assessed. If such a relationship does exist between blood pressure and renal RI and PI in dogs and cats, these indices could be used in establishing a prognosis for and following up cats and dogs with renal disease or hypertension. This study aimed to investigate the possible relationship between renal RI or PI and SBP in dogs and cats with renal disease, and between RI or PI and serum biochemical parameters related to renal disease.

Materials and methods

Veterinary Record (2010) 166, 618-623 R. Novellas, PhD, R. Ruiz de Gopegui, PhD, DipECVIM, Y. Espada, PhD, Animal Medicine and Surgery Department, Veterinary Teaching Hospital, Autonomous University of Barcelona, 08193 Cerdanyola del Valls, Spain
Veterinary Record | May 15, 2010

doi: 10.1136/vr.b4820

Correspondence to Dr Espada, e-mail: ivonne.espada@uab.es Provenance: not commissioned; externally peer reviewed

Dogs and cats with renal disease presented at the Veterinary T eaching Hospital of the Autonomous University of Barcelona between September 2004 and June 2007 were included in the study. The diagnosis was based on a combination of clinical, biochemical and diagnostic imaging findings: non-regenerative anaemia, oliguria, isosthenuria, proteinuria, azotaemia, hyperphosphataemia, abnormal kidney ultrasonographic examination and histopathology indicative of renal disease. Inclusion criteria for dogs were clinical and serum biochemistry signs indicative of chronic kidney disease (CKD) (serum creatinine

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TABLE 1: Mean (sd) values of resistive index (RI), pulsatility index (PI), systolic blood pressure (SBP) and heart rate, and median (range) age and bodyweight, of 27 healthy dogs and 50 dogs with renal disease, and 10 healthy cats and 20 cats with renal disease
Healthy Dogs RI PI SBP (mmHg) Age (years) Heart rate (bpm) Bodyweight (kg) Cats RI PI SBP (mmHg) Age (years) Heart rate (bpm) Bodyweight (kg) 0.62 (0.04) 1.15 (0.15) 148 (26) 4 (1-8) 106 (24) 12.85 (7.10-74) 0.62 (0.04) 1.02 (0.12) 151 (25) 7.12 (3.20) 176 (162-215) 4 (2.7-9.65) Renal disease 0.71 (0.08) 1.58 (0.47) 169 (41) 5 (0.25-15) 113 (29) 16.1 (1.9-45) 0.72 (0.10) 1.31 (0.63) 142 (42) 8.5 (2-12) 185 (37) 3.52 (1.03) P <0.001 <0.001 0.010 0.005 0.290 0.918 0.006 0.004 0.680 0.877 0.785 0.086

RI = (peak systolic velocityend diastolic velocity)/ peak systolic velocity PI = (peak systolic velocityend diastolic velocity)/TAMX Heart rate was also calculated from the renal pulsed Doppler waveforms by the ultrasound machine software. When possible, follow-up values were recorded, repeating all these measurements detailed above. Statistical analysis was performed with SPSS software (SPSS). The RI, PI, heart rate and arterial pressure were found to have a normal distribution in dogs; therefore, parametric tests were applied. In cats, the values were also normally distributed, except for PI in cats with renal disease; therefore, a non-parametric test was applied for PI. The values of RI and PI for the animals with renal disease were compared with the values for the healthy dogs and cats using Students t test (for parametric data) or the Mann-Whitney U test (for non-parametric data). Partial correlation was performed between RI, PI, SBP and renal parameters controlled for heart rate, age, weight and sex, to take into account the possible effect of these variables. T o evaluate the possible effect of blood pressure on the indices further, the animals with renal disease were divided into two groups: one half with higher blood pressure and one half with lower blood pressure. RI and PI values were compared between these groups using Students t test (for parametric data) or the Mann-Whitney U test (for non-parametric data). Statistical significance was accepted at P<0.05. Results are given as mean (sd) when data follow a normal distribution, or median (range) otherwise.

>132.6 mol/l, urine specific gravity [USG] <1.020) or the presence of proteinuria without abnormalities in the urinary sediment (urine protein:creatinine ratio >0.5) and abnormal renal ultrasonography. Inclusion criteria for cats were an initial serum creatinine concentration above 176.8 mol/l and USG less than 1.025 or the presence of proteinuria without abnormalities in the urinary sediment (urine protein:creatinine ratio >0.4) and abnormal renal ultrasonography. If no USG measurement was available at the time of diagnosis, the record was evaluated for clinical signs attributable to CKD (for example, persistent azotaemia, chronic polyuria and polydipsia, small or abnormal kidneys on abdominal palpation and ultrasound). Dogs or cats that were receiving glucocorticoids, erythropoietin, phenylpropanolamine or NSAIDs or had a diagnosis of diabetes mellitus, hyperadrenocorticism, hypothyroidism, hyperthyroidism, phaeochromocytoma, hypertrophic cardiomyopathy or hyperaldosteronism were not included in the study. Blood pressure values and renal indices previously obtained from 27 healthy dogs and 10 healthy cats were used as normal values for comparison with animals with renal disease. These values had been obtained using the same technique and by the same operators, to avoid variation. The cut-off upper values for normal RI and PI were calculated as mean plus 2 sd and stated as 0.72 for RI and 1.52 for PI in dogs, and 0.70 for RI and 1.29 for PI in cats (Novellas and others 2007). Physical examination, a complete blood cell count, a biochemical profile (including renal and non-renal parameters), urinalysis and a complete abdominal ultrasonographic examination were performed in the animals. When possible, biopsy or postmortem examination was performed. SBP was determined before other interventions and after five to 10 minutes to allow the animal to adapt to the environment. SBP was measured using a Doppler device (Vet BP Doppler Ultrasound Blood Flow Detector; Sonomed) with an 8 MHz transducer. The measurement was made with the animals in left lateral recumbency, and the cuff was placed proximal to the tarsus to compress the cranial tibial artery. The first measurement was made and discarded; then three measurements were obtained for each animal, as previously described (Stepien and Rapoport 1999, Brown and others 2007), and the mean value was calculated. Triplex Doppler ultrasonography was performed with an ultrasound device (128/XP; Aspen, or Aspen; Acuson) as previously described by Novellas and others (2008). In brief, interlobar or arcuate arteries were localised with colour Doppler and subsequently interrogated with pulsed Doppler. The mean RI and PI for each kidney were determined by averaging a total of nine Doppler waveforms at three separate locations, as previously described (Nyland and others 1993, Pollard and others 1999). RI and PI were calculated automatically by the software of the ultrasound machine after operator delimitation of the peak systolic velocity, end-diastolic velocity and time average maximum velocity (TAMX), as follows:

Results
The group of healthy dogs comprised 15 beagles, seven crossbreeds, two golden retrievers, one English pointer, one French bulldog and one great Dane. There were 15 entire females, four neutered females, five entire males and three neutered males; the median age of the group was four years (range one to eight years) and the median bodyweight was 12.85 kg (range 7.10 to 74 kg). Fifty dogs (28 males and 22 females) presenting with renal disease were included in the study. Their median age was five years (range three months to 15 years) and their median bodyweight was 16.1 kg (range 1.9 to 45 kg). There were 17 crossbreeds, five boxers, four schnauzers, four German shepherd dogs, four cocker spaniels, two Scottish terriers, two rottweilers and one each of the following: golden retriever, Siberian husky, pug, Irish setter, fox terrier, basset hound, West Highland white terrier, American Staffordshire bull terrier, great Dane, beagle, dogue de Bordeaux and English bull terrier. Thirty-seven of the dogs were diagnosed with CKD and 13 with other renal or urological diseases: five with hydronephrosis (two bilateral and three unilateral), four with neoplasia, two with renal cysts, one with a presumptive renal abscess in the left kidney and one with unilateral ectopic ureter. Histopathological results were available for 16 animals. Of the dogs with CKD, eight had a histopathological diagnosis: four of chronic interstitial nephritis, two of glomerulonephritis, one of chronic interstitial nephritis and glomerulonephritis, and one of non-specific nephrosclerosis. In the dogs with hydronephrosis, this was secondary to a bladder transitional cell carcinoma in two dogs, secondary to periurethral fibrous tissue in one dog and secondary to a granulomatous reaction in one dog. Lymphosarcoma, multiple renal adenoma, metastatic prostatic carcinoma and haemangiosarcoma were diagnosed in the dogs with neoplasia. In the dog with ectopic ureter this abnormality was confirmed at surgery. Nineteen of the dogs with CKD had leishmaniosis. Congenital renal disease was presumptively diagnosed in three of the animals with CKD. The values for RI, PI, heart rate, SBP, age and weight for the group with renal disease, together with values for the healthy group for comparison, are given in Table 1. On the basis of the upper normal limits (0.72 for RI and 1.52 for PI), 20 dogs with renal disease (38 per cent) had a high mean RI, and 23 (43 per cent) had a high mean PI. Of the dogs with CKD, 17 (49 per cent) had increased RI and 19 (51 per cent) had increased PI; of the dogs with other abnormalities, three (23 per cent) showed increased RI and four (31 per cent) showed increased PI.
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with bilateral hydronephrosis and in two dogs with unilateral hydronephrosis. In the dog with unilateral ectopic ureter, higher values of RI and PI were found in the affected kidney, with a difference of 0.17 for RI and 0.52 for PI, although all values were within normal limits. In the dog with a presumptive renal abscess, the indices in the affected kidney were higher than the normal values, but decreased to normal values after effective antibiotic treatment.

The group of healthy cats comprised seven domestic shorthair cats, two Siamese crosses and one Persian cross. There were 2.5 0.8 six neutered females, one entire female and three neutered males. 2.0 The mean (sd) age of the group 0.7 was 7.12 [3.20] years, and the 1.5 median body weight was 4 kg (range 2.70 to 9.65 kg). 0.6 1.0 Twenty cats (six males and 14 females) with renal disease 0.5 0.5 were included in the study. Their median age was 8.5 years (range 0 2 4 6 8 10 0.2 0.4 0.6 0.8 1.0 1.2 1.4 two to 12 years) and their mean RBC (1012 cells/l) Creatinine (mmol/l) (sd) bodyweight was 3.52 (1.03) kg. Fifteen of the cats were FIG 2: Scatter plots of (a) red blood cell (RBC) count versus resistive index (RI) and (b) serum creatinine diagnosed with CKD, and five concentration versus pulsatility index (PI) in 50 dogs with renal disease were diagnosed with polycystic kidney disease (PKD) without No differences were found between the right and left kidneys; clinical signs or haematological or biochemical changes consistent therefore, the mean values for both kidneys were used for comparison. with renal failure. In four of the cats with CKD, a histological diagSignificantly higher values were seen for RI (P<0.001), PI (P<0.001) nosis was obtained postmortem; one animal had chronic interstitial (Fig 1) and SBP (P<0.001) in the group with renal disease than in the nephritis, one had chronic interstitial nephritis and glomerulonehealthy dogs. No significant differences were found in heart rate or phritis, and two had neoplasia (one renal carcinoma, one multiple bodyweight between the groups. Age was significantly higher for the myeloma). Values for RI, PI, heart rate, SBP, age and weight for the diseased group. No differences in RI and PI were found between the group with renal disease, together with values for the healthy group two subgroups of the group with renal disease with higher and lower for comparison, are given in Table 1. blood pressure. On the basis of the upper normal limits (0.70 for RI and 1.29 for In the partial correlation tests, a significant low negative correlation PI), 12 cats with renal disease (60 per cent) had a high mean RI, and 11 between RI and red blood cell count (r=0.331, P=0.042) and a positive (55 per cent) had a high mean PI. Eleven cats with CKD (73 per cent) correlation between PI and serum creatinine concentration (r=0.321, had a RI above the upper limits, and 10 (67 per cent) had a PI above the P=0.036) were found (Fig 2). No correlation was found between SBP or upper limits. None of the cats with PKD had increased indices. other haematological or biochemical parameters and the indices. No differences were found between the right and left kidneys; Three of the four dogs with a diagnosis of chronic interstitial therefore, the mean values for both kidneys were used for comparinephritis, one of the two dogs with glomerulonephritis alone and the son. Significantly higher values were found for RI (P=0.0003) and PI dog with both chronic interstitial nephritis and glomerulonephritis (P=0.003) in the group with renal disease compared with the healthy had increased indices. cats (Fig 3). No significant differences were found in SBP or heart rate Dogs with leishmaniosis were compared with other dogs with between the groups. No differences in RI and PI were found between CKD to assess possible differences in the indices associated with the the two subgroups of the renal disease group with higher and lower type of renal damage. The dogs with leishmaniosis showed a tendency blood pressure. towards a lower mean RI (0.71 [0.07] v 0.73 [0.09]) and PI (1.56 [0.40] A significant positive correlation was found between RI and v 1.74 [0.61]), but no significant differences were found between the serum urea (r=0.788, P=0.012), between PI and serum creatinine groups, and the mean values for the animals with leishmaniosis were (r=0.933, P=0.001) and between PI and urea (r=0.893, P=0.001) (Fig still statistically higher than those for the healthy animals. 4), but no correlation was found between SBP or other haematological RI and/or PI higher than the upper normal limits were found in or biochemical parameters and the indices. four of the 13 dogs in the other renal diseases group. In this group, All the animals with a histological diagnosis had increased RI and when the disease was unilateral, differences between the kidneys were PI, except for the cat with chronic interstitial nephritis. considered. The animals with increased indices were one dog with renal cysts, one with bilateral hydronephrosis and two with neoplaDiscussion sia. In another dog, with unilateral hydronephrosis, the indices were The proposed upper normal limits for renal RI in dogs differ slightly within normal limits in both kidneys, but there was a difference in the among previous studies, from 0.70 to 0.73 (Nyland and others 1993, RI of 0.1 between the hydronephrotic kidney and the normal kidney. Morrow and others 1996, Rivers and others 1996a, b, 1997a). In The indices were within normal limits in both kidneys of one dog the present study, values obtained under the same conditions and by
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Values were increased in approximately 50 per cent of the dogs with CKD, and increased RI and 14 3.0 PI, respectively, were found in 67 0.8 per cent and 73 per cent of the 2.5 cats with CKD. Some studies in human 0.7 2.0 patients (Platt and others 1990) and dogs (Morrow and others 1.5 0.6 1996) have suggested that renal 1.0 disease limited to the glomeruli does not present with increased 0.5 0.5 RI. However, other studies have found increased RI in dogs with Renal disease Healthy Renal disease Healthy glomerular disease alone (Rivers FIG 3: Box and whisker plots of the distribution of (a) resistive index (RI) and (b) pulsatility index (PI) in and others 1997b). One of the 10 healthy cats and in 20 cats with renal disease two dogs in the present study with a histopathological diagnosis (a) (b) of glomerulonephritis alone had 0.9 3.5 increased indices. Given the small number of available histopatho3.0 logical diagnoses, no further con0.8 clusions can be drawn; however, it 2.5 should be taken into account that 0.7 2.0 19 of the 36 dogs with CKD had leishmaniosis. In dogs with leish1.5 maniosis, the initial renal lesion is 0.6 due to deposits of immunocom1.0 plexes causing glomerulonephritis. When the dogs with leish0.5 0.5 maniosis were compared with 0 50 100 150 200 0 50 100 150 200 the other animals with CKD, they showed a tendency towards Urea (mmol/l) Urea (mmol/l) lower values of the renal indices (c) (mean RI 0.71 v 0.73 and PI 1.56 3.5 v 1.74), although no statistical dif3.0 ferences were found. This might indicate that the indices were also 2.5 increased in some of the animals with presumptive glomerular 2.0 disease. However, as glomerular disease progresses, tubulointersti1.5 tial disease may also be present 1.0 as a component of renal disease caused by leishmaniosis, although FIG 4: Scatter plots for (a) urea concentration 0.5 it is less common (Costa and othversus resistive index (RI), (b) urea ers 2003, Cortadellas and others concentration versus pulsatility index (PI) and 0 0.2 0.4 0.6 0.8 1.0 1.2 (c) serum creatinine versus PI in 20 cats with 2006). Without histopathological Creatinine (mmol/l) renal disease characterisation of the lesions in the animals with leishmaniosis, it cannot be stated that increased the same authors in healthy non-sedated dogs and cats were used to indices were found in all the animals with glomerulonephritis alone. provide upper normal limits for renal RI and PI (Novellas and others Congenital renal dysplasia has also been reported to increase renal 2007). RI (Morrow and others 1996). Two of the three dogs with presumpRI and PI are used in human and veterinary medicine as indicators tive congenital renal disease had increased values for RI and PI, and the of vascular resistance. When vascular resistance increases as a result of third dog had a PI within the upper normal limit. obstruction or vasoconstriction, diastolic blood flow is reduced to a Higher indices were found in four dogs in the group with other larger degree than systolic blood flow (Rifkin and others 1987). This renal diseases (one with a renal cyst, one with hydronephrosis and is reflected in a higher decrease in end diastolic velocity than in peak two with neoplasia), but none of the cats with other renal diseases systolic velocity and, therefore, in increased RI and PI. had increased indices. Obstruction has been reported to increase RI In human medicine, RI and PI have been related to the severity in human beings (Platt 1992) and dogs (Nyland and others 1993, and progression of chronic renal failure (Petersen and others 1997). A Choi and others 2003). However, increased RI values do not permit positive correlation between RI and end-organ damage of the kidney an unequivocal diagnosis of obstruction (Nyland and others 1993). has also been reported (Pontremoli and others 1999). Increased RI has A difference of 0.10 or more between the RI values of the obstructed been reported in dogs with ureteral obstruction (Nyland and others and non-obstructed kidneys in the same patient may help diagnose 1993) and in cats with obstructive renal disease (Rivers and others obstruction even when the RI is within normal limits (Platt 1992). 1997b), acute and chronic kidney disease (Rivers and others 1997b), In one of the dogs with hydronephrosis, the difference in RI between congenital dysplasia (Morrow and others 1996) and acute tubular the hydronephrotic and normal kidneys was 0.1 (although both valnecrosis (Daley and others 1994). ues were within normal limits). Similarly, very different RI and PI Increased renal RI and PI, in comparison with healthy animals, values between kidneys were found in the dog with unilateral ectopic were found in the present study in the dogs and cats with renal disease. ureter (a difference of 0.17 for RI and 0.52 for PI, both values higher
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in the affected kidney); even in the absence of hydronephrosis, or hydroureter, these values could reflect some degree of obstruction. In the dog with a presumptive renal abscess, the indices in the affected kidney were increased above the normal values, but they decreased to normal values after effective antibiotic treatment. No reports could be found with comparable descriptions, but the increased values both in this dog and in the animals with neoplasia seem to support the conclusion that many renal lesions can cause increased vascular resistance. All five cats in the other renal diseases group had PKD. RI and PI have been used to assess renal function in human patients with autosomal dominant PKD (Kondo and others 2001) and were reported to be higher than in control patients (Brkljacic and others 1997). The five cats with PKD in the present study were young (mean age 2.6 years) and had no signs of renal failure. One older cat (nine years of age) with PKD and renal failure was included in the CKD group and had increased RI and PI. Therefore, it is possible that the disease was not severe enough in the five young cats to show changes in the indices. In human medicine, higher RI and PI were found in children and elderly people (Terry and others 1992). The authors were unable to find studies evaluating the effect of age on renal RI or PI in dogs or cats. Although the median age was similar in the healthy and diseased groups in the present study, an age effect cannot be ruled out, and this represents a limitation of the study. Ideally, reference values for young and older animals should be obtained and used for comparison. The effects of sex on the indices were not considered; however, no sex differences in normal values were found in human beings. A positive correlation between RI and SBP has been reported in human patients (Pontremoli and others 1999). Increased RI has also been reported to be related to increased blood pressure and to the duration of the disease in people with hypertension (Veglio and others 1992). In the present study, no correlation could be found between SBP and either RI or PI. This could reflect differences between species, although other possibilities should be considered. In dogs, many factors cause variations in blood pressure, including age, breed, sex and temperament (Bodey and Michell 1996). Stress is also a factor to consider in both dogs and cats, and can cause values mimicking hypertension. Variations in age, breed and sex were not considered when the upper normal values for SBP were established. The study attempted to control for the effect of stress by allowing the animals to acclimatise to the environment before its blood pressure was measured. However, the authors suspect that the animals were not always relaxed despite the acclimatisation period, even in the animals used to obtain normal values. Therefore, falsely elevated blood pressure as a result of stress cannot be ruled out. Multiple measurements on different days or at different times on the same day would have been more accurate, but this was not possible given the design of the study. Nevertheless, the measurements were performed under the same conditions for all the animals, and the healthy animals did not show clinical signs consistent with secondary hypertension or target organ damage that could indicate sustained (primary) hypertension. Determination of SBP alone, without diastolic and mean blood pressure, is another limitation of the study. Some human studies have found a correlation between RI and mean blood pressure (Boeri and others 1998), so the determination of mean blood pressure would have been of interest. The low number of animals, especially of cats, is also a limitation of the study. Heart rate has also been reported to show a negative correlation with RI (Mostbeck and others 1990). No such correlation was found in the present study, and no differences were observed between the mean heart rates of the healthy animals and those with renal disease. In human patients with renal disease, RI has been reported to be correlated with several indicators of renal function: serum creatinine (Ikee and others 2005), creatinine clearance (Shimizu and others 2001, Ikee and others 2005) and blood urea nitrogen (Mostbeck and others 1991, Shimizu and others 2001). The present study found a negative correlation between RI and red blood cell count in the dogs, similar to the results of a previous study that found a direct association between anaemia and elevated RI (Morrow and others 1996). It was suggested that anaemia may induce a hypoxic state in the kidney that causes constriction of the vessels, resulting in increased vascular resistance and elevation of renal RI. Anaemia may increase cardiac output, and
Veterinary Record | May 15, 2010

chronic anaemia may induce ventricular and arterial remodelling. This pathogenic mechanism may potentially induce diastolic hypertension. No relationship was found among these parameters in cats, but this could reflect differences between species. In the present study, correlations were found between PI and creatinine concentration in dogs, and between RI and urea, PI and serum creatinine, and PI and urea in cats, suggesting some relationship between renal function and the indices. More studies with a larger number of animals are required to evaluate this relationship and the use of RI and PI in prognosis further.

Acknowledgements

This study was supported by a grant from the Departament dEducaci i Universitats de la Generalitat de Catalunya and from the Fons Social Europeu.
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Assessment of renal vascular resistance and blood pressure in dogs and cats with renal disease
R. Novellas, R. Ruiz de Gopegui and Y. Espada Veterinary Record 2010 166: 618-623

doi: 10.1136/vr.b4820

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