MR imaging of nephropathies

Association between congenital defects in papillary outgrowth and functional obstruction in Crim1 mutant mice

Crim1 hypomorphic (Crim1(KST264/KST264)) mice display progressive renal disease characterized by glomerular defects, leaky peritubular vasculature, and progressive interstitial fibrosis. Here we show that 27% of these mice also present with hydronephrosis, suggesting obstructive nephropathy. Dynamic magnetic resonance imaging using Magnevist showed fast development of hypo-intense signal in the kidneys of Crim1(KST264/KST264) mice, suggesting pooling of filtrate within the renal parenchyma. Rhodamine dextran (10 kDa) clearance was also delayed in Crim1(KST264/KST264) mice. Pyeloureteric peristalsis, while present, was less co-ordinated in Crim1(KST264/KST264) mice. However, isolated renal pelvis preparations suggest normal pelvic smooth muscle contractile responses. An analysis of maturation during the immediate postnatal period [postnatal day (P) 0-15] revealed defects in papillary extension in Crim1({KST264/KST264) mice. While Crim1 expression is weak in pelvic smooth muscle, strong expression is seen in the interstitium and loops of Henle of the extending papilla, commencing at the tip of the P1 papilla and disseminating throughout the papilla by P15. These results, as well as implicating Crim1 in papillary extension and pelvic smooth muscle contractility, highlight the previously unrecognized association between defects in papillary development and progression to chronic kidney disease later in life.

Sodium MRI of a human transplanted kidney

RATIONALE AND OBJECTIVES

Sodium magnetic resonance imaging (MRI) of the kidneys has been used to spatially map areas of sodium-concentrating activity and to quantify the corticomedullary sodium gradient in various physiologic and pathophysiologic conditions. In this case study, sodium MRI of a clinically well-functioning transplanted kidney was performed to determine whether its sodium gradient could be detected and quantified using this method.

MATERIALS AND METHODS

Sodium MRI was performed on a 3T scanner with a commercial rectangular sodium surface coil placed on the lower abdomen over the palpable transplanted kidney. A three-dimensional gradient echo sequence, modified for multinuclear imaging, was applied to acquire (23)Na images.

RESULTS

Five main renal pyramids within the medulla were detected, and the corticomedullary sodium gradient was quantified in each renal pyramid by both region of interest-based and pixel-by-pixel analyses, resulting in a mean medulla/cortex signal-to-noise ratio of 1.8 +/- 0.1 (n = 5) and a mean linear increase slope of 1.1 +/- 0.1 relative arbitrary units per mm (n = 5).

CONCLUSIONS

The feasibility and usability of (23)Na MRI of a human renal allograft was demonstrated. Further studies are required to determine the clinical significance of this technique in the follow-up of patients after renal transplantation.

Acute kidney injury: definitions and new paradigms

Changes in terminology and new consensus definitions of acute kidney injury (AKI) and stages of severity have simplified some of the problems in the clinical approach to this complex syndrome. Nevertheless, new proactive approaches to the diagnosis of kidney injury instead of kidney failure are required to allow clinical translation of successful therapies developed for experimental AKI. The recent development of novel urinary and plasma biomarkers, which predict kidney failure, has allowed the development of new paradigms for detection, prevention, and stage-specific treatment.