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Filipov T, Teutsch B, Szabó A, Forintos A, Ács J, Váradi A, Hegyi P, Szarvas T, Ács N, Nyirády P, Deák PÁ. Investigating the role of ultrasound-based shear wave elastography in kidney transplanted patients: correlation between non-invasive fibrosis detection, kidney dysfunction and biopsy results-a systematic review and meta-analysis. J Nephrol 2024:10.1007/s40620-023-01856-w. [PMID: 38427308 DOI: 10.1007/s40620-023-01856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Interstitial fibrosis and tubular atrophy are leading causes of renal allograft failure. Shear wave elastography could be a promising noninvasive method for providing information on the state of the kidney, with specific regard to fibrosis but currently available data in the literature are controversial. Our study aimed to analyze the correlation between shear wave elastography and various kidney dysfunction measures. METHODS This review was registered on PROSPERO (CRD42021283152). We systematically searched three major databases (MEDLINE, Embase, and CENTRAL) for articles concerning renal transplant recipients, shear wave elastography, fibrosis, and kidney dysfunction. Meta-analytical calculations for pooled Pearson and Spearman correlation coefficients (r) were interpreted with 95% confidence intervals (CIs). Heterogeneity was tested with Cochran's Q test. I2 statistic and 95% CI were reported as a measurement of between-study heterogeneity. Study quality was assessed with the QUADAS2 tool. RESULTS In total, 16 studies were included in our meta-analysis. Results showed a moderate correlation between kidney stiffness and interstitial fibrosis and tubular atrophy, graded according to BANFF classification, on biopsy findings for pooled Pearson (r = 0.48; CI: 0.20, 0.69; I2 = 84%) and Spearman correlations (r = 0.57; CI: 0.35, 0.72; I2 = 74%). When compared to kidney dysfunction parameters, we found a moderate correlation between shear wave elastography and resistive index (r = 0.34 CI: 0.13, 0.51; I2 = 67%) and between shear wave elastography and estimated Glomerular Filtration Rate (eGFR) (r = -0.65; CI: - 0.81, - 0.40; I2 = 73%). All our outcomes had marked heterogeneity. CONCLUSION Our results showed a moderate correlation between kidney stiffness measured by shear wave elastography and biopsy results. While noninvasive assessment of kidney fibrosis after transplantation is an important clinical goal, there is insufficient evidence to support the use of elastography over the performance of a kidney biopsy.
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Affiliation(s)
- Teodóra Filipov
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Forintos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Júlia Ács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Metagenomics, University of Debrecen, Debrecen, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Ákos Deák
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary.
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Cè M, Felisaz PF, Alì M, Re Sartò GV, Cellina M. Ultrasound elastography in chronic kidney disease: a systematic review and meta-analysis. J Med Ultrason (2001) 2023; 50:381-415. [PMID: 37186192 DOI: 10.1007/s10396-023-01304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/07/2023] [Indexed: 05/17/2023]
Abstract
Ultrasound elastography (USE) is a noninvasive technique for assessing tissue elasticity, and its application in nephrology has aroused growing interest in recent years. The purpose of this article is to systematically review the clinical application of USE in patients with chronic kidney disease (CKD), including native and transplanted kidneys, and quantitatively investigate differences in elasticity values between healthy individuals and CKD patients. Furthermore, we provide a qualitative analysis of the studies included, discussing the potential interplay between renal stiffness, estimated glomerular filtration rate, and fibrosis. In January 2022, a systematic search was carried out on the MEDLINE (PubMed) database, concerning studies on the application of USE in patients with CKD, including patients with transplanted kidneys. The results of the included studies were extracted by two independent researchers and presented mainly through a formal narrative summary. A meta-analysis of nine study parts from six studies was performed. A total of 647 studies were screened for eligibility and, after applying the exclusion and inclusion criteria, 69 studies were included, for a total of 6728 patients. The studies proved very heterogeneous in terms of design and results. The shear wave velocity difference of - 0.82 m/s (95% CI: - 1.72-0.07) between CKD patients and controls was not significant. This result agrees with the qualitative evaluation of included studies that found controversial results for the relationship between renal stiffness and glomerular filtration rate. On the contrary, a clear relationship seems to emerge between USE values and the degree of fibrosis. At present, due to the heterogeneity of results and technical challenges, large-scale application in the monitoring of CKD patients remains controversial.
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Affiliation(s)
- Maurizio Cè
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, Milan, Italy.
| | - Paolo Florent Felisaz
- Division of Radiology, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Marco Alì
- Centro Diagnostico Italiano, Milan, Italy
- Bracco Imaging S.P.A., Milan, Italy
| | - Giulia Vanessa Re Sartò
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Michaela Cellina
- Division of Radiology, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
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Abstract
Ultrasound imaging is a key investigatory step in the evaluation of chronic kidney disease and kidney transplantation. It uses nonionizing radiation, is noninvasive, and generates real-time images, making it the ideal initial radiographic test for patients with abnormal kidney function. Ultrasound enables the assessment of both structural (form and size) and functional (perfusion and patency) aspects of kidneys, both of which are especially important as the disease progresses. Ultrasound and its derivatives have been studied for their diagnostic and prognostic significance in chronic kidney disease and kidney transplantation. Ultrasound is rapidly growing more widely accessible and is now available even in handheld formats that allow for bedside ultrasound examinations. Given the trend toward ubiquity, the current use of kidney ultrasound demands a full understanding of its breadth as it and its variants become available. We described the current applications and future directions of ultrasound imaging and its variants in the context of chronic kidney disease and transplantation in this review.
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Affiliation(s)
- Rohit K. Singla
- MD and PhD Program, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
- Address for Correspondence: Rohit Singla, MASc, The University of British Columbia, 2332 Main Mall, Vancouver, BC, Canada, V6T 1Z4.
| | - Matthew Kadatz
- Department of Nephrology, University of British Columbia, Vancouver, Canada
| | - Robert Rohling
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - Christopher Nguan
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Gonçalves LM, Forte GC, Holz TG, Libermann LL, Figueiredo CEPD, Hochhegger B. Shear wave elastography and Doppler ultrasound in kidney transplant recipients. Radiol Bras 2022; 55:19-23. [PMID: 35210660 PMCID: PMC8864684 DOI: 10.1590/0100-3984.2020.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the association between shear wave elastography parameters and arterial
resistance in kidney transplant recipients. Materials and Methods This was a prospective cross-sectional study involving consecutive adult kidney transplant
recipients. All patients underwent color Doppler to evaluate the resistive index (RI) and
ultrasound shear wave elastography for the quantification of renal allograft stiffness. Results We evaluated 55 patients, of whom 9 (16.4%) had an RI defined as abnormal (≥ 0.79)
and 46 (83.6%) had an RI defined as normal (< 0.79). The mean age was higher in the
abnormal RI group than in the normal RI group (68.0 ± 8.6 years vs. 42.6 ± 14.1
years; p < 0.001), as was the mean shear wave velocity (2.6 ± 0.4
m/s vs. 2.2 ± 0.4 m/s; p = 0.013). Multivariate analysis identified
two independent predictors of arterial resistance: age (OR = 1.169; 95% CI: 1.056 to 1.294;
p = 0.003) and shear wave velocity (OR = 17.1; 95% CI: 1.137 to 257.83;
p = 0.040). Conclusion We observed an association between rigidity in the cortex of the transplanted kidney, as
evaluated by shear wave elastography, and arterial resistance, as evaluated by color Doppler,
in kidney transplant recipients.
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Affiliation(s)
| | | | - Tiago Garcia Holz
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | | | | | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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Chen S, Li J, Zeng B, Zhu Z, Luo Y, Chen F, Qiu S. The stiffness of transplanted kidneys changes with time after renal transplantation. Acta Radiol 2021; 63:1134-1141. [PMID: 34247516 DOI: 10.1177/02841851211030770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kidney transplantation is one of the most effective ways to treat end-stage kidney disease. However, 5000 renal transplant recipients start or restart dialysis because of chronic allograft nephropathy (CAN) every year in the United States. Detecting changes in the stiffness of transplanted kidneys can help diagnose transplanted kidney disease. PURPOSE To explore changes in the stiffness of transplanted kidneys after renal transplantation using shear wave elastography (SWE). MATERIAL AND METHODS This study conducted consecutive follow-up observations on 10 patients after kidney transplantation. SWE examination was performed in the first week, second week, first month, second month, third month, fourth month, fifth month, and sixth month after surgery. This study also analyzed the graft stiffness of 86 patients with stable renal function recovery one month after surgery. RESULTS The results show that there is a change in the stiffness of the transplanted kidney over time after renal transplantation. It decreases rapidly within one month after renal transplantation and tends to be stable after one month. The mean renal cortical and pyramidal stiffness of patients with stable renal function were 28.48 ± 4.27 kPa and 21.97 ± 3.90 kPa, respectively. CONCLUSION Consecutive stiffness measurement of transplanted kidneys is an effective method for monitoring the function of transplanted kidneys. According to the change in transplanted kidney stiffness, we can designate a more scientific review plan to determine the functional status of the transplanted kidney.
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Affiliation(s)
- Shaona Chen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Jin Li
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Bidan Zeng
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Zhimin Zhu
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Yanhua Luo
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Fei Chen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Shaodong Qiu
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
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Abstract
OBJECTIVES Multiparametric renal magnetic resonance imaging (MRI), including diffusion-weighted imaging, magnetic resonance elastography, and magnetization transfer imaging (MTI), is valuable in the noninvasive assessment of renal fibrosis. However, hemodynamic changes in diseased kidneys may impede their ability to measure renal fibrosis. Because MTI assesses directly tissue content of macromolecules, we test the hypothesis that MTI would be insensitive to renal hemodynamic changes in swine kidneys with acute graded ischemia. MATERIALS AND METHODS Seven domestic pigs underwent placement of an inflatable silicone cuff around the right renal artery to induce graded renal ischemia. Multiparametric MRI was performed at baseline, 50%, 75%, and 100% renal artery stenosis as well as reperfusion. Measurements included regional perfusion, R2*, apparent diffusion coefficient (ADC), stiffness, and magnetization transfer ratio (MTR) using arterial spin-labeled MRI, blood oxygenation-dependent MRI, diffusion-weighted imaging, magnetic resonance elastography, and MTI, respectively. Histology was performed to rule out renal fibrosis. RESULTS During graded ischemia, decreases in renal perfusion were accompanied with elevated R2*, decreased ADC, and stiffness, whereas no statistically significant changes were observed in the MTR. No fibrosis was detected by histology. After release of the obstruction, renal perfusion showed only partial recovery, associated with return of kidney R2*, ADC, and stiffness to baseline levels, whereas cortical MTR decreased slightly. CONCLUSIONS Renal MTI is insensitive to decreases in renal perfusion and may offer reliable assessment of renal structural changes.
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Noninvasive assessment of renal fibrosis by magnetic resonance imaging and ultrasound techniques. Transl Res 2019; 209:105-120. [PMID: 31082371 PMCID: PMC6553637 DOI: 10.1016/j.trsl.2019.02.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
Renal fibrosis is a useful biomarker for diagnosis and guidance of therapeutic interventions of chronic kidney disease (CKD), a worldwide disease that affects more than 10% of the population and is one of the major causes of death. Currently, tissue biopsy is the gold standard for assessment of renal fibrosis. However, it is invasive, and prone to sampling error and observer variability, and may also result in complications. Recent advances in diagnostic imaging techniques, including magnetic resonance imaging (MRI) and ultrasonography, have shown promise for noninvasive assessment of renal fibrosis. These imaging techniques measure renal fibrosis by evaluating its impacts on the functional, mechanical, and molecular properties of the kidney, such as water mobility by diffusion MRI, tissue hypoxia by blood oxygenation level dependent MRI, renal stiffness by MR and ultrasound elastography, and macromolecule content by magnetization transfer imaging. Other MR techniques, such as T1/T2 mapping and susceptibility-weighted imaging have also been explored for measuring renal fibrosis. Promising findings have been reported in both preclinical and clinical studies using these techniques. Nevertheless, limited specificity, sensitivity, and practicality in these techniques may hinder their immediate application in clinical routine. In this review, we will introduce methodologies of these techniques, outline their applications in fibrosis imaging, and discuss their limitations and pitfalls.
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