Sampaio et al (15) reported that upper infundibulum is almost completely involved, both anteriorly and posteriorly, with segmental or interlobar arteries
in 86.6% of cases, whereas in 62% of the cases, the posterior aspect of the lower major calyceal infundibulum was free from arteries.
In this study, we aim to evaluate effects of terlipressin on renal haemodynamics with the help of resistive index as an indicator of renal interlobar arteries
in patients of hepatorenal syndrome.
An analysis of those studies showed that 35.0% were in the main pulmonary artery, and 31.7% were in the lobar and interlobar arteries
. Such findings "[suggest] that the majority of these embolisms have important clinical consequences," the authors wrote.
When the patient became hemodynamically stable, a selective renal arteriogram was performed (Figure 2) which demonstrated multiple small aneurysms in the segmental and interlobar arteries
of both kidneys but extravasation was not noted.
Blood flow parameters of the main renal artery, intrasinus segmental arteries and bilateral renal interlobar arteries
were determined at about 1 cm of the renal hilum by pulse Doppler ultrasound.
This causes an increase of intrarenal resistance which results in decreased diastolic blood flow as compared to systolic flow which is measurable by colour doppler ultrasonography in form of resistive index (RI) of the arcuate arteries at the corticomedullary junction or the interlobar arteries
.9 Hence an elevated RI likely reflects a significant obstruction; alternatively a normal RI likely reflects an insignificant obstruction without renal hemodynamic changes.
Segmental branches gave off 5-7 interlobar arteries
. It was also seen that the dorsal or ventral branches gave off one or two extra branches in 43 of W's kidneys and 41 of SD's kidneys.
(3,13,15) Spectral waveform findings in the downstream interlobar arteries
will often show a tardus-parvus waveform with prolonged acceleration time (> 0.07 sec) (Figure 12) and low resistive indices (< 0.56).
The arterial vascular tree of the kidney is structured by the renal artery branches into interlobar arteries
, arcuate arteries, and interlobular arteries, which are formed by bifurcation .
The main renal artery, segmental, interlobar arteries
and distal branches were reviewed (Fig.
Three different measurements were obtained from interlobar arteries
from each kidney in its upper, middle and lower poles.
A tardus-parvus waveform may be appreciated in the arcuate and interlobar arteries
of the renal parenchyma.