Background: Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. Methods: The analysis included 1175 patients (mean age: 52 years, IQR: 38–66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. Results: The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. Conclusion: Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.

Hypertensive kidney disease (HKD) represents a significant contributor to chronic kidney disease and end-stage renal failure, yet its early detection remains challenging due to nonspecific clinical and imaging findings. The lack of a noninvasive diagnostic tool, preventing the use of biopsy and diagnosis by exclusion, suggests the underdiagnosis of patients and overestimation of HKD as the cause of renal replacement therapy. Ultrasonography, including Doppler assessment and renal resistive index measurements, provides a widely accessible, noninvasive approach to evaluate renal structure and hemodynamics, aiding in the identification of early renal impairment or renal artery stenosis. Shear-wave elastography (SWE) has emerged as a promising modality for noninvasive assessment of renal stiffness, potentially detecting structural changes prior to functional deterioration. Current evidence demonstrates SWE’s diagnostic potential in chronic kidney disease and early hypertensive renal disease; however, limitations such as inter-device variability, heterogeneous patient populations, and short follow-up periods constrain its clinical applicability. Neither ultrasonography nor SWE can yet serve as standalone diagnostic tools for HKD, emphasizing the need for standardization, further validation, and longitudinal studies to clarify their role in patient management and prediction.

Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non-invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound-visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases.

Introduction: The interactions between ARAS, independent on severity, and cardiovascular risk, and mortality are complex and not fully researched. The aim of this study was the assessment of the risk of cardiovascular events and mortality in patients with hemodynamically non-significant...