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Fleischer LT, Ballester L, Dutt M, Howarth K, Poznick L, Darge K, Furth SL, Hartung EA. Evaluation of galectin-3 and intestinal fatty acid binding protein as serum biomarkers in autosomal recessive polycystic kidney disease. J Nephrol 2023; 36:133-145. [PMID: 35980535 DOI: 10.1007/s40620-022-01416-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) causes fibrocystic kidney disease, congenital hepatic fibrosis, and portal hypertension. Serum galectin-3 (Gal-3) and intestinal fatty acid binding protein (I-FABP) are potential biomarkers of kidney fibrosis and portal hypertension, respectively. We examined whether serum Gal-3 associates with kidney disease severity and serum I-FABP associates with liver disease severity in ARPKD. METHODS Cross-sectional study of 29 participants with ARPKD (0.2-21 years old) and presence of native kidneys (Gal-3 analyses, n = 18) and/or native livers (I-FABP analyses, n = 21). Serum Gal-3 and I-FABP were analyzed using enzyme linked immunosorbent assay. Kidney disease severity variables included estimated glomerular filtration rate (eGFR) and height-adjusted total kidney volume (htTKV). Liver disease severity was characterized using ultrasound elastography to measure liver fibrosis, and spleen length and platelet count as markers of portal hypertension. Simple and multivariable linear regression examined associations between Gal-3 and kidney disease severity (adjusted for liver disease severity) and between I-FABP and liver disease severity (adjusted for eGFR). RESULTS Serum Gal-3 was negatively associated with eGFR; 1 standard deviation (SD) lower eGFR was associated with 0.795 SD higher Gal-3 level (95% CI - 1.116, - 0.473; p < 0.001). This association remained significant when adjusted for liver disease severity. Serum Gal-3 was not associated with htTKV in adjusted analyses. Overall I-FABP levels were elevated, but there were no linear associations between I-FABP and liver disease severity in unadjusted or adjusted models. CONCLUSIONS Serum Gal-3 is associated with eGFR in ARPKD, suggesting its value as a possible novel biomarker of kidney disease severity. We found no associations between serum I-FABP and ARPKD liver disease severity despite overall elevated I-FABP levels.
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Affiliation(s)
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mohini Dutt
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Kathryn Howarth
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Laura Poznick
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Dillman JR, Benoit SW, Gandhi DB, Trout AT, Tkach JA, VandenHeuvel K, Devarajan P. Multiparametric quantitative renal MRI in children and young adults: comparison between healthy individuals and patients with chronic kidney disease. Abdom Radiol (NY) 2022; 47:1840-1852. [PMID: 35237897 DOI: 10.1007/s00261-022-03456-x] [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: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiparametric quantitative renal MRI may provide noninvasive radiologic biomarkers of chronic kidney disease (CKD) based on investigations in animal models and adults. We aimed to (1) obtain normative multiparametric quantitative MRI data from the kidneys of healthy children and young adults, (2) compare MRI measurements between healthy control participants and patients with CKD, and (3) determine if MRI measurements correlate with clinical and laboratory data as well as histology. METHODS This was a prospective, case-control study of 20 healthy controls and 12 CKD patients who underwent percutaneous renal biopsy ranging from 12 to 23 years of age between October 2018 and March 2020. Kidney function was documented and pathology assessed for fibrosis/inflammation. Utilizing a field strength of 1.5T, we examined renal T1, T2, and T2* relaxation mapping, MR elastography (MRE), and diffusion-weighted imaging (DWI). A single analyst made all manual measurements for quantitative MRI pulse sequences. Independent measurements from cortex, medulla, and whole kidney were obtained by drawing regions of interest on single slices from the upper, mid, and lower kidney. A weighted average was calculated for each kidney; if two kidneys, the right and left were averaged. Continuous variables were compared with Mann-Whitney U test; bivariate relationships were assessed using Spearman rank-order correlation. RESULTS Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 m2 in controls (n = 20, 10 females) and 55.0 ml/min/m2 in CKD patients (n = 12, 2 females) (p < 0.0001). Whole kidney (1333 vs. 1291 ms; p = 0.018) and cortical (1212 vs 1137 ms; p < 0.0001) T1 values were higher in CKD patients. Cortical T1 values correlated with eGFR (rho = - 0.62; p = 0.0003) and cystatin C (rho = 0.58; p = 0.0007). Whole kidney (1.87 vs. 2.02 10-3 mm2/s; p = 0.007), cortical (1.89 vs. 2.04 10-3 mm2/s; p = 0.008), and medullary (1.87 vs. 1.98 10-3 mm2/s; p = 0.0095) DWI apparent diffusion coefficients (ADC) were lower in CKD patients. Whole kidney ADC correlated with eGFR (rho = 0.45; p = 0.012) and cystatin C (rho = - 0.46; p = 0.009). Cortical histologic inflammation correlated with DWI ADC (rho = - 0.71; p = 0.011). CONCLUSION Renal T1 relaxation and DWI ADC measurements differ between pediatric healthy controls and CKD patients, correlate with laboratory markers of CKD, and may have histologic correlates.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deep B Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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MacAskill CJ, Markley M, Farr S, Parsons A, Perino JR, McBennett K, Kutney K, Drumm ML, Pritts N, Griswold MA, Ma D, Dell KM, Flask CA, Chen Y. Rapid B 1-Insensitive MR Fingerprinting for Quantitative Kidney Imaging. Radiology 2021; 300:380-387. [PMID: 34100680 DOI: 10.1148/radiol.2021202302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background MR fingerprinting (MRF) provides rapid and simultaneous quantification of multiple tissue parameters in a single scan. Purpose To evaluate a rapid kidney MRF technique at 3.0 T in phantoms, healthy volunteers, and patients. Materials and Methods A 15-second kidney MRF acquisition was designed with 12 acquisition segments, a range of low flip angles (5°-12°), multiple magnetization preparation schema (T1, T2, and fat suppression), and an undersampled spiral trajectory. This technique was first validated in vitro using standardized T1 and T2 phantoms. Kidney T1 and T2 maps were then obtained for 10 healthy adult volunteers (mean age ± standard deviation, 35 years ± 13; six men) and three pediatric patients with autosomal recessive polycystic kidney disease (ARPKD) (mean age, 10 years ± 3; two boys) between August 2019 and October 2020 to evaluate the method in vivo. Results Results in nine phantoms showed good agreement with spin-echo-based T1 and T2 values (R2 > 0.99). In vivo MRF kidney T1 and T2 assessments in healthy adult volunteers (cortex: T1, 1362 msec ± 5; T2, 64 msec ± 5; medulla: T1, 1827 msec ± 94; T2, 69 msec ± 3) were consistent with values in the literature but with improved precision in comparison with prior MRF implementations. In vivo MRF-based kidney T1 and T2 values with and without B1 correction were in good agreement (R2 > 0.96, P < .001), demonstrating limited sensitivity to B1 field inhomogeneities. Additional MRF reconstructions using the first nine segments of the MRF profiles (11-second acquisition time) were in good agreement with the reconstructions using 12 segments (15-second acquisition time) (R2 > 0.87, P < .001). Repeat kidney MRF scans for the three patients with ARPKD on successive days also demonstrated good reproducibility (T1 and T2: <3% difference). Conclusion A kidney MR fingerprinting method provided in vivo kidney T1 and T2 maps at 3.0 T in a single breath hold with improved precision and no need for B1 correction. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Laustsen in this issue.
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Affiliation(s)
- Christina J MacAskill
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Michael Markley
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Susan Farr
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Ashlee Parsons
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Jacob R Perino
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Kimberly McBennett
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Katherine Kutney
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Mitchell L Drumm
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Nicole Pritts
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Mark A Griswold
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Dan Ma
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Katherine M Dell
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Chris A Flask
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
| | - Yong Chen
- From the Departments of Radiology (C.J.M., S.F., J.R.P., N.P., M.A.G., D.M., C.A.F., Y.C.), Genetics and Genome Sciences (M.L.D.), Pediatrics (M.L.D., K.M.D., C.A.F.), and Biomedical Engineering (M.A.G., D.M., C.A.F.), Case Western Reserve University, 11100 Euclid Ave, Bowell Building, Room B131, Cleveland, OH 44106; Departments of Radiology (M.M.) and Pediatrics (K.M., K.K.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (A.P., K.M.D.)
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