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Selby NM, Francis ST. Assessment of Acute Kidney Injury using MRI. J Magn Reson Imaging 2024. [PMID: 38334370 DOI: 10.1002/jmri.29281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
There has been growing interest in using quantitative magnetic resonance imaging (MRI) to describe and understand the pathophysiology of acute kidney injury (AKI). The ability to assess kidney blood flow, perfusion, oxygenation, and changes in tissue microstructure at repeated timepoints is hugely appealing, as this offers new possibilities to describe nature and severity of AKI, track the time-course to recovery or progression to chronic kidney disease (CKD), and may ultimately provide a method to noninvasively assess response to new therapies. This could have significant clinical implications considering that AKI is common (affecting more than 13 million people globally every year), harmful (associated with short and long-term morbidity and mortality), and currently lacks specific treatments. However, this is also a challenging area to study. After the kidney has been affected by an initial insult that leads to AKI, complex coexisting processes ensue, which may recover or can progress to CKD. There are various preclinical models of AKI (from which most of our current understanding derives), and these differ from each other but more importantly from clinical AKI. These aspects are fundamental to interpreting the results of the different AKI studies in which renal MRI has been used, which encompass different settings of AKI and a variety of MRI measures acquired at different timepoints. This review aims to provide a comprehensive description and interpretation of current studies (both preclinical and clinical) in which MRI has been used to assess AKI, and discuss future directions in the field. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK
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2
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Wagner MC, Sandoval RM, Yadav SPS, Campos SB, Rhodes GJ, Phillips CL, Molitoris BA. Lrpap1 (RAP) Inhibits Proximal Tubule Clathrin Mediated and Clathrin Independent Endocytosis, Ameliorating Renal Aminoglycoside Nephrotoxicity. KIDNEY360 2023; 4:591-605. [PMID: 36848531 PMCID: PMC10278819 DOI: 10.34067/kid.0000000000000094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
Key Points Proximal tubule endocytosis of toxins often leads to nephrotoxicity. Inhibition of endocytosis with receptor-associated protein may serve as a clinical approach to reduce or eliminate kidney damage from a potential nephrotoxin. Background Proximal tubules (PTs) are exposed to many exogenous and endogenous nephrotoxins that pass through the glomerular filter. This includes many small molecules, such as aminoglycoside and myeloma light chains. These filtered molecules are rapidly endocytosed by the PTs and lead to nephrotoxicity. Methods To investigate whether inhibition of PT uptake of filtered toxins can reduce toxicity, we evaluated the ability of Lrpap1 or receptor-associated protein (RAP) to prevent PT endocytosis. Munich Wistar Frömter rats were used since both glomerular filtration and PT uptake can be visualized and quantified. The injury model chosen was the well-established gentamicin-induced toxicity, which leads to significant reductions in GFR and serum creatinine increases. CKD was induced with a right uninephrectomy and left 40-minute pedicle clamp. Rats had 8 weeks to recover and to stabilize GFR and proteinuria. Multiphoton microscopy was used to evaluate endocytosis in vivo and serum creatinine, and 24-hour creatinine clearances were used to evaluate kidney functional changes. Results Studies showed that preadministration of RAP significantly inhibited both albumin and dextran endocytosis in outer cortical PTs. Importantly, this inhibition was found to be rapidly reversible with time. RAP was also found to be an excellent inhibitor of PT gentamicin endocytosis. Finally, gentamicin administration for 6 days resulted in significant elevation of serum creatinine in vehicle-treated rats, but not in those receiving daily infusion of RAP before gentamicin. Conclusions This study provides a model for the potential use of RAP to prevent, in a reversible manner, PT endocytosis of potential nephrotoxins, thus protecting the kidney from damage.
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Affiliation(s)
- Mark C Wagner
- Indiana Center for Biological Microscopy, Indiana University School of Medicine, Indianapolis, Indiana
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3
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Ramadani AP, Syukri Y, Hasanah E, Syahyeri AW. Acute Oral Toxicity Evaluation of Andrographolide Self-Nanoemulsifying Drug Delivery System (SNEDDS) Formulation. J Pharm Bioallied Sci 2021; 13:199-204. [PMID: 34349480 PMCID: PMC8291106 DOI: 10.4103/jpbs.jpbs_267_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/29/2020] [Accepted: 12/25/2020] [Indexed: 11/20/2022] Open
Abstract
Context: Andrographolide (AND) is an active compound of well-known medicinal plant Andrographis paniculata. It has been widely published for various activities. AND is difficult to develop into dosage form due to its poor solubility and bioavailability. This problem could be solved by using self-nanoemulsifying drug delivery system (SNEDDS) for its formulation. However, the increase of bioavailability might result in potential toxicity as a large amount of drug is absorbed. Aims: The aim of this study is to evaluate the acute potential toxicity using Organization for Economic Cooperation and Development (OECD) test: 401 methods. Subjects and Methods: The OECD 401 method employs groups of animals treated by a single dose or repeated dose (<24 h) of the drug with three variances of doses. In this study, thirty male Wistar rats were divided into five groups which consisted two groups of control and three groups of AND SNEDDS formulation (500, 700, and 900 mg/kg body weight [BW], respectively). Intensive observation of toxicity symptom was performed during the first 30 minutes followed by periodic observation for 14 days. Posttermination, histopathological examination of the liver and kidney was conducted to confirm the toxicity symptoms. To determine the level of toxicity, the lethal dose 50 (LD50) value was calculated at the end of the study. Results: The result showed that all groups presented similar toxicological symptoms such as salivation, lethargy, and cornea reflex. However, based on histopathological examination, there were abnormalities, but still in an early stage. The toxicological symptom that emerged seems related to the SNEDDS formulation with lipophilic properties. Furthermore, the value of LD50 was 832.6 mg/kg BW (po). Conclusions: The AND SNEDDS formulation was slightly toxic in male Wistar rats po.
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Affiliation(s)
| | - Yandi Syukri
- Department of Pharmacy, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Elma Hasanah
- Department of Pharmacy, Universitas Islam Indonesia, Yogyakarta, Indonesia
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Katagiri D, Wang F, Gore JC, Harris RC, Takahashi T. Clinical and experimental approaches for imaging of acute kidney injury. Clin Exp Nephrol 2021; 25:685-699. [PMID: 33835326 PMCID: PMC8154759 DOI: 10.1007/s10157-021-02055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Complex molecular cell dynamics in acute kidney injury and its heterogeneous etiologies in patient populations in clinical settings have revealed the potential advantages and disadvantages of emerging novel damage biomarkers. Imaging techniques have been developed over the past decade to further our understanding about diseased organs, including the kidneys. Understanding the compositional, structural, and functional changes in damaged kidneys via several imaging modalities would enable a more comprehensive analysis of acute kidney injury, including its risks, diagnosis, and prognosis. This review summarizes recent imaging studies for acute kidney injury and discusses their potential utility in clinical settings.
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Affiliation(s)
- Daisuke Katagiri
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA. .,Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Feng Wang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raymond C Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA
| | - Takamune Takahashi
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA. .,Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA.
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Cardiorenal sodium MRI in small rodents using a quadrature birdcage volume resonator at 9.4 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:121-130. [PMID: 31797228 DOI: 10.1007/s10334-019-00810-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/22/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Design, implementation, evaluation and application of a quadrature birdcage radiofrequency (RF) resonator tailored for renal and cardiac sodium (23Na) magnetic resonance imaging (MRI) in rats at 9.4 T. MATERIALS AND METHODS A low pass birdcage resonator (16 rungs, din = 62 mm) was developed. The transmission field (B1+) was examined with EMF simulations. The scattering parameter (S-parameter) and the quality factor (Q-factor) were measured. For experimental validation B1+-field maps were acquired with the double-angle method. In vivo sodium imaging of the heart (spatial resolution: (1 × 1 × 5) mm3) and kidney (spatial resolution: (1 × 1 × 10) mm3) was performed with a FLASH technique. RESULTS The RF resonator exhibits RF characteristics, transmission field homogeneity and penetration that afford 23Na MR in vivo imaging of the kidney and heart at 9.4 T. For the renal cortex and medulla a SNRs of 8 and 13 were obtained and a SNRs of 14 and 15 were observed for the left and right ventricle. DISCUSSION These initial results obtained in vivo in rats using the quadrature birdcage volume RF resonator for 23Na MRI permit dedicated studies on experimental models of cardiac and renal diseases, which would contribute to translational research of the cardiorenal syndrome.
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Gomolka RS, Ciritsis A, Meier A, Rossi C. Quantification of sodium T1 in abdominal tissues at 3 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:439-446. [DOI: 10.1007/s10334-019-00786-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/10/2019] [Accepted: 10/04/2019] [Indexed: 02/02/2023]
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Shin SH, Wendland MF, Zhang B, Tran A, Tang A, Vandsburger MH. Noninvasive imaging of renal urea handling by CEST-MRI. Magn Reson Med 2019; 83:1034-1044. [PMID: 31483529 DOI: 10.1002/mrm.27968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Renal function is characterized by concentration of urea for removal in urine. We tested urea as a CEST-MRI contrast agent for measurement of the concentrating capacity of distinct renal anatomical regions. METHODS The CEST contrast of urea was examined using phantoms with different concentrations and pH levels. Ten C57BL/6J mice were scanned twice at 7 T, once following intraperitoneal injection of 2M 150 µL urea and separately following an identical volume of saline. Kidneys were segmented into regions encompassing the cortex, outer medulla, and inner medulla and papilla to monitor spatially varying urea concentration. Z-spectra were acquired before and 20 minutes after injection, with dynamic scanning of urea handling performed in between via serial acquisition of CEST images acquired following saturation at +1 ppm. RESULTS Phantom experiments revealed concentration and pH-dependent CEST contrast of urea that was both acid- and base-catalyzed. Z-spectra acquired before injection showed significantly higher CEST contrast in the inner medulla and papilla (2.3% ± 1.9%) compared with the cortex (0.15% ± 0.75%, P = .011) and outer medulla (0.12% ± 0.58%, P = .008). Urea infusion increased CEST contrast in the inner medulla and papilla by 2.1% ± 1.9% (absolute), whereas saline infusion decreased CEST contrast by -0.5% ± 2.0% (absolute, P = .028 versus urea). Dynamic scanning revealed that thermal drift and diuretic status are confounding factors. CONCLUSION Urea CEST has a potential of monitoring renal function by capturing the spatially varying urea concentrating ability of the kidneys.
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Affiliation(s)
- Soo Hyun Shin
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | - Michael F Wendland
- Berkeley Preclinical Imaging Core, University of California, Berkeley, Berkeley, California
| | - Brandon Zhang
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | - An Tran
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | - Albert Tang
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | - Moriel H Vandsburger
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
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Abstract
Kidney diseases can be caused by a wide range of genetic, hemodynamic, toxic, infectious, and autoimmune factors. The diagnosis of kidney disease usually involves the biochemical analysis of serum and blood, but these tests are often insufficiently sensitive or specific to make a definitive diagnosis. Although radiologic imaging currently has a limited role in the evaluation of most kidney diseases, several new imaging methods hold great promise for improving our ability to non-invasively detect structural, functional, and molecular changes within the kidney. New methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and blood oxygen level-dependent (BOLD) MRI, allow functional imaging of the kidney. The use of novel contrast agents, such as microbubbles and nanoparticles, allows the detection of specific molecules in the kidney. These methods could greatly advance our ability to diagnose disease and also to safely monitor patients over time. This could improve the care of individual patients, and it could also facilitate the evaluation of new treatment strategies.
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Affiliation(s)
- Joshua Thurman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
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9
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Kierulf-Lassen C, Nielsen PM, Qi H, Damgaard M, Laustsen C, Pedersen M, Krag S, Birn H, Nørregaard R, Jespersen B. Unilateral nephrectomy diminishes ischemic acute kidney injury through enhanced perfusion and reduced pro-inflammatory and pro-fibrotic responses. PLoS One 2017; 12:e0190009. [PMID: 29267404 PMCID: PMC5739457 DOI: 10.1371/journal.pone.0190009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/06/2017] [Indexed: 11/23/2022] Open
Abstract
While unilateral nephrectomy (UNx) is suggested to protect against ischemia-reperfusion injury (IRI) in the remaining kidney, the mechanisms underlying this protection remain to be elucidated. In this study, functional MRI was employed in a renal IRI rat model to reveal global and regional changes in renal filtration, perfusion, oxygenation and sodium handling, and microarray and pathway analyses were conducted to identify protective molecular mechanisms. Wistar rats were randomized to either UNx or sham UNx immediately prior to 37 minutes of unilateral renal artery clamping or sham operation under sevoflurane anesthesia. MRI was performed 24 hours after reperfusion. Blood and renal tissue were harvested. RNA was isolated for microarray analysis and QPCR validation of gene expression results. The perfusion (T1 value) was significantly enhanced in the medulla of the post-ischemic kidney following UNx. UNx decreased the expression of fibrogenic genes, i.a. Col1a1, Fn1 and Tgfb1 in the post-ischemic kidney. This was associated with a marked decrease in markers of activated myofibroblasts (Acta2/α-Sma and Cdh11) and macrophages (Ccr2). This was most likely facilitated by down-regulation of Pdgfra, thus inhibiting pericyte-myofibroblast differentiation, chemokine production (Ccl2/Mcp1) and macrophage infiltration. UNx reduced ischemic histopathologic injury. UNx may exert renoprotective effects against IRI through increased perfusion in the renal medulla and alleviation of the acute pro-inflammatory and pro-fibrotic responses possibly through decreased myofibroblast activation. The identified pathways involved may serve as potential therapeutic targets and should be taken into account in experimental models of IRI.
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Affiliation(s)
- Casper Kierulf-Lassen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Mose Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Haiyun Qi
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Mads Damgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Michael Pedersen
- MR Research Centre, Aarhus University, Aarhus, Denmark
- Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Søren Krag
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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10
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van Eijs MJM, van Zuilen AD, de Boer A, Froeling M, Nguyen TQ, Joles JA, Leiner T, Verhaar MC. Innovative Perspective: Gadolinium-Free Magnetic Resonance Imaging in Long-Term Follow-Up after Kidney Transplantation. Front Physiol 2017; 8:296. [PMID: 28559850 PMCID: PMC5432553 DOI: 10.3389/fphys.2017.00296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/24/2017] [Indexed: 12/23/2022] Open
Abstract
Since the mid-1980s magnetic resonance imaging (MRI) has been investigated as a non- or minimally invasive tool to probe kidney allograft function. Despite this long-standing interest, MRI still plays a subordinate role in daily practice of transplantation nephrology. With the introduction of new functional MRI techniques, administration of exogenous gadolinium-based contrast agents has often become unnecessary and true non-invasive assessment of allograft function has become possible. This raises the question why application of MRI in the follow-up of kidney transplantation remains restricted, despite promising results. Current literature on kidney allograft MRI is mainly focused on assessment of (sub) acute kidney injury after transplantation. The aim of this review is to survey whether MRI can provide valuable diagnostic information beyond 1 year after kidney transplantation from a mechanistic point of view. The driving force behind chronic allograft nephropathy is believed to be chronic hypoxia. Based on this, techniques that visualize kidney perfusion and oxygenation, scarring, and parenchymal inflammation deserve special interest. We propose that functional MRI mechanistically provides tools for diagnostic work-up in long-term follow-up of kidney allografts.
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Affiliation(s)
- Mick J M van Eijs
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Anneloes de Boer
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center UtrechtUtrecht, Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
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11
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Nielsen PM, Szocska Hansen ES, Nørlinger TS, Nørregaard R, Bonde Bertelsen L, Stødkilde Jørgensen H, Laustsen C. Renal ischemia and reperfusion assessment with three-dimensional hyperpolarized 13 C, 15 N2-urea. Magn Reson Med 2016; 76:1524-1530. [PMID: 27548739 DOI: 10.1002/mrm.26377] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/25/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this work was to investigate whether hyperpolarized 13 C,15 N2 -urea can be used as an imaging marker of renal injury in renal unilateral ischemic reperfusion injury (IRI), given that urea is correlated with the renal osmotic gradient, which describes the renal function. METHODS Hyperpolarized three-dimensional balanced steady-state 13 C magnetic resonance imaging (MRI) experiments alongside kidney function parameters and quantitative polymerase chain reaction measurements were performed in rats subjected to unilateral renal ischemia for 60-minute and 24-hour reperfusion. RESULTS We revealed a significant reduction in the intrarenal gradient in the ischemic kidney in agreement with cortical injury markers neutrophil gelatinase-associated lipocalin and kidney injury molecule 1, as well as functional kidney parameters. CONCLUSION Hyperpolarized functional 13 C,15 N2 urea MRI can be used to successfully detect changes in the intrarenal urea gradient post-IRI, thereby enabling in vivo monitoring of the intrarenal functional status in the rat kidney. Magn Reson Med 76:1524-1530, 2016. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Per Mose Nielsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben Søvsø Szocska Hansen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | | | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lotte Bonde Bertelsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Abstract
PURPOSE Transmembrane sodium ((23)Na) gradient is critical for cell survival and viability and a target for the development of anti-cancer drugs and treatment as it serves as a signal transducer. The ability to integrate abdominal (23)Na MRI in clinical settings would be useful to non-invasively detect and diagnose a number of diseases in various organ systems. Our goal in this work was to enhance the quality of (23)Na MRI of the abdomen using a 3-Tesla MR scanner and a novel 8-channel phased-array dual-tuned (23)Na and (1)H transmit (Tx)/receive (Rx) coil specially designed to image a large abdomen region with relatively high SNR. METHODS A modified GRE imaging sequence was optimized for (23)Na MRI to obtain the best possible combination of SNR, spatial resolution, and scan time in phantoms as well as volunteers. Tissue sodium concentration (TSC) of the whole abdomen was calculated from the inhomogeneity-corrected (23)Na MRI for absolute quantification. In addition, in vivo reproducibility and reliability of TSC measurements from (23)Na MRI was evaluated in normal volunteers. RESULTS (23)Na axial images of the entire abdomen with a high spatial resolution (0.3 cm) and SNR (~20) in 15 min using the novel 8-channel dual-tuned (23)Na and (1)H transmit/receive coil were obtained. Quantitative analysis of the sodium images estimated a mean TSC of the liver to be 20.13 mM in healthy volunteers. CONCLUSION Our results have shown that it is feasible to obtain high-resolution (23)Na images using a multi-channel surface coil with good SNR in clinically acceptable scan times in clinical practice for various body applications.
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Bertelsen LB, Nielsen PM, Qi H, Nørlinger TS, Zhang X, Stødkilde-Jørgensen H, Laustsen C. Diabetes induced renal urea transport alterations assessed with 3D hyperpolarized 13 C, 15 N-Urea. Magn Reson Med 2016; 77:1650-1655. [PMID: 27172094 DOI: 10.1002/mrm.26256] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/15/2016] [Accepted: 04/01/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE In the current study, we investigated hyperpolarized urea as a possible imaging biomarker of the renal function by means of the intrarenal osmolality gradient. METHODS Hyperpolarized three-dimensional balanced steady state 13 C MRI experiments alongside kidney function parameters and quantitative polymerase chain reaction measurements was performed on two groups of rats, a streptozotocin type 1 diabetic group and a healthy control group. RESULTS A significant decline in intrarenal steepness of the urea gradient was found after 4 weeks of untreated insulinopenic diabetes in agreement with an increased urea transport transcription. CONCLUSION MRI and hyperpolarized [13 C,15 N]urea can monitor the changes in the corticomedullary urea concentration gradients in diabetic and healthy control rats. Magn Reson Med 77:1650-1655, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Lotte B Bertelsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per M Nielsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Haiyun Qi
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas S Nørlinger
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Xiaolu Zhang
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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14
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Zöllner FG, Konstandin S, Lommen J, Budjan J, Schoenberg SO, Schad LR, Haneder S. Quantitative sodium MRI of kidney. NMR IN BIOMEDICINE 2016; 29:197-205. [PMID: 25728879 DOI: 10.1002/nbm.3274] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/13/2015] [Accepted: 01/25/2015] [Indexed: 05/25/2023]
Abstract
One of the main tasks of the human kidneys is to maintain the homeostasis of the body's fluid and electrolyte balance by filtration of the plasma and excretion of the end products. Herein, the regulation of extracellular sodium in the kidney is of particular importance. Sodium MRI ((23)Na MRI) allows for the absolute quantification of the tissue sodium concentration (TSC) and thereby provides a direct link between TSC and tissue viability. Renal (23)Na MRI can provide new insights into physiological tissue function and viability thought to differ from the information obtained by standard (1)H MRI. Sodium imaging has the potential to become an independent surrogate biomarker not only for renal imaging, but also for oncology indications. However, this technique is now on the threshold of clinical implementation. Numerous, initial pre-clinical and clinical studies have already outlined the potential of this technique; however, future studies need to be extended to larger patient groups to show the diagnostic outcome. In conclusion, (23)Na MRI is seen as a powerful technique with the option to establish a non-invasive renal biomarker for tissue viability, but is still a long way from real clinical implementation.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Simon Konstandin
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany
| | - Jonathan Lommen
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Haneder
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Zöllner FG, Kalayciyan R, Chacón-Caldera J, Zimmer F, Schad LR. Pre-clinical functional Magnetic Resonance Imaging part I: The kidney. Z Med Phys 2014; 24:286-306. [DOI: 10.1016/j.zemedi.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 01/10/2023]
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16
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Inoue T, Kozawa E, Okada H, Suzuki H. Morphological and functional evaluation of chronic kidney disease using magnetic resonance imaging. World J Clin Urol 2014; 3:325-329. [DOI: 10.5410/wjcu.v3.i3.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/07/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
X-ray computed tomography (CT), ultrasonography (US) and radionuclide scanning are important clinical methods for evaluating morphology of the kidney. These modalities are also applicable for estimating kidney function with time lapse analysis using proper contrast-media as may be necessary. In the case of US, it can estimate kidney function based on the measurement of blood flow using the Doppler effect. Formerly, magnetic resonance imaging (MRI) was an inappropriate diagnostic imaging technique for abdominal organs because of their respiratory displacements. However, MRI is now actively used for kidney as well as liver or other parenchymal organs, in tandem with the technological advances. Unlike unenhanced X-ray CT, “conventional” MRI can distinguish the border between cortex and medulla in T1 or T2 weighted images. It was known that the border blurred with decreasing kidney function. Moreover, several other particular imaging methods were introduced in recent years, and these could be called “functional” MRI. In this review, the following are discussed: functional MRI for chronic kidney disease, which include blood oxygenation level-dependent MRI for evaluation of hypoxia, diffusion-weighted imaging for evaluation of fibrosis, diffusion tensor imaging for evaluation of microstructure, and arterial spin labeling to evaluate the amount of organ perfusion, accompanied with several related articles. The ultimate goal of functional MRI is to provide useful in vivo information repeatedly for daily medical treatment non-invasively.
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Moon CH, Furlan A, Kim JH, Zhao T, Shapiro R, Bae KT. Quantitative sodium MR imaging of native versus transplanted kidneys using a dual-tuned proton/sodium (1H/ 23Na) coil: initial experience. Eur Radiol 2014; 24:1320-6. [PMID: 24668008 DOI: 10.1007/s00330-014-3138-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/26/2014] [Accepted: 02/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare sodium ((23)Na) characteristics between native and transplanted kidneys using dual-tuned proton ((1)H)/sodium MRI. METHODS Six healthy volunteers and six renal transplant patients (3 normal function, 3 acute allograft rejection) were included. Proton/sodium MRI was obtained at 3 T using a dual-tuned coil. Signal to noise ratio (SNR), sodium concentration ([(23)Na]) and cortico-medullary sodium gradient (CMSG) were measured. Reproducibility of [(23)Na] measurement was also tested. SNR, [(23)Na] and CMSG of the native and transplanted kidneys were compared. RESULTS Proton and sodium images of kidneys were successfully acquired. SNR and [(23)Na] measurements of the native kidneys were reproducible at two different sessions. [(23)Na] and CMSG of the transplanted kidneys was significantly lower than those of the native kidneys: 153.5 ± 11.9 vs. 192.9 ± 9.6 mM (P = 0.002) and 8.9 ± 1.5 vs. 10.5 ± 0.9 mM/mm (P = 0.041), respectively. [(23)Na] and CMSG of the transplanted kidneys with normal function vs. acute rejection were not statistically different. CONCLUSIONS Sodium quantification of kidneys was reliably performed using proton/sodium MRI. [(23)Na] and CMSG of the transplanted kidneys were lower than those of the native kidneys, but without a statistically significant difference between patients with or without renal allograft rejection. KEY POINTS Dual-tuned proton/sodium RF coil enables co-registered proton and sodium MRI. Structural and sodium biochemical property can be acquired by dual-tuned proton/sodium MRI. Sodium and sodium gradient of kidneys can be measured by dual-tuned MRI. Sodium concentration was lower in transplanted kidneys than in native kidneys. Sodium gradient of transplanted kidneys was lower than for native kidneys.
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Affiliation(s)
- Chan Hong Moon
- Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Presby South tower Suite 3950, Pittsburgh, PA, 15213, USA
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18
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Kalayciyan R, Wetterling F, Neudecker S, Haneder S, Gretz N, Schad LR. Bilateral kidney sodium-MRI: Enabling accurate quantification of renal sodium concentration through a two-element phased array system. J Magn Reson Imaging 2013; 38:564-72. [DOI: 10.1002/jmri.24024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 12/07/2012] [Indexed: 11/06/2022] Open
Affiliation(s)
- Raffi Kalayciyan
- Computer Assisted Clinical Medicine; Heidelberg University; Mannheim; Germany
| | | | - Sabine Neudecker
- Medical Research Center; Heidelberg University; Mannheim; Germany
| | - Stefan Haneder
- Institute of Clinical Radiology and Nuclear Medicine; Heidelberg University; Mannheim; Germany
| | - Norbert Gretz
- Medical Research Center; Heidelberg University; Mannheim; Germany
| | - Lothar R. Schad
- Computer Assisted Clinical Medicine; Heidelberg University; Mannheim; Germany
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Zhang JL, Rusinek H, Chandarana H, Lee VS. Functional MRI of the kidneys. J Magn Reson Imaging 2013; 37:282-93. [PMID: 23355431 PMCID: PMC3558841 DOI: 10.1002/jmri.23717] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 05/02/2012] [Indexed: 12/20/2022] Open
Abstract
Renal function is characterized by different physiologic aspects, including perfusion, glomerular filtration, interstitial diffusion, and tissue oxygenation. Magnetic resonance imaging (MRI) shows great promise in assessing these renal tissue characteristics noninvasively. The last decade has witnessed a dramatic progress in MRI techniques for renal function assessment. This article briefly describes relevant renal anatomy and physiology, reviews the applications of functional MRI techniques for the diagnosis of renal diseases, and lists unresolved issues that will require future work.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA.
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20
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Patel NSA, Kerr-Peterson HL, Brines M, Collino M, Rogazzo M, Fantozzi R, Wood EG, Johnson FL, Yaqoob MM, Cerami A, Thiemermann C. Delayed administration of pyroglutamate helix B surface peptide (pHBSP), a novel nonerythropoietic analog of erythropoietin, attenuates acute kidney injury. Mol Med 2012; 18:719-27. [PMID: 22415011 DOI: 10.2119/molmed.2012.00093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 03/07/2012] [Indexed: 11/06/2022] Open
Abstract
In preclinical studies, erythropoietin (EPO) reduces ischemia-reperfusion-associated tissue injury (for example, stroke, myocardial infarction, acute kidney injury, hemorrhagic shock and liver ischemia). It has been proposed that the erythropoietic effects of EPO are mediated by the classic EPO receptor homodimer, whereas the tissue-protective effects are mediated by a hetero-complex between the EPO receptor monomer and the β-common receptor (termed "tissue-protective receptor"). Here, we investigate the effects of a novel, selective-ligand of the tissue-protective receptor (pyroglutamate helix B surface peptide [pHBSP]) in a rodent model of acute kidney injury/dysfunction. Administration of pHBSP (10 μg/kg intraperitoneally [i.p.] 6 h into reperfusion) or EPO (1,000 IU/kg i.p. 4 h into reperfusion) to rats subjected to 30 min ischemia and 48 h reperfusion resulted in significant attenuation of renal and tubular dysfunction. Both pHBSP and EPO enhanced the phosphorylation of Akt (activation) and glycogen synthase kinase 3β (inhibition) in the rat kidney after ischemia-reperfusion, resulting in prevention of the activation of nuclear factor-κB (reduction in nuclear translocation of p65). Interestingly, the phosphorylation of endothelial nitric oxide synthase was enhanced by EPO and, to a much lesser extent, by pHBSP, suggesting that the signaling pathways activated by EPO and pHBSP may not be identical.
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Affiliation(s)
- Nimesh S A Patel
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, The William Harvey Research Institute, London, UK.
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21
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Heyman SN, Evans RG, Rosen S, Rosenberger C. Cellular adaptive changes in AKI: mitigating renal hypoxic injury. Nephrol Dial Transplant 2012; 27:1721-8. [DOI: 10.1093/ndt/gfs100] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ojeda NB. Low birth weight increases susceptibility to renal injury in a rat model of mild ischemia-reperfusion. Am J Physiol Renal Physiol 2011; 301:F420-6. [PMID: 21613420 DOI: 10.1152/ajprenal.00045.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal injury due to ischemia-reperfusion (I/R) is the major cause of acute kidney injury. Whether enhanced susceptibility to renal injury due to I/R can be programmed during fetal life is unknown. Epidemiological studies indicate that low birth weight (LBW) individuals are more susceptible to renal injury than normal birth weight (NBW) individuals. Thus, the aim of this study was to test the hypothesis that LBW is associated with an increased susceptibility to renal injury induced by mild renal I/R (15-min ischemia). Systemic and renal hemodynamic parameters were determined in NBW and LBW adult male rats after mild renal I/R; renal superoxide production and tubular injury were also assessed. A subgroup was pretreated with tempol, a superoxide dismutase mimetic, initiated 15 min before ischemia. Mild renal I/R did not alter renal hemodynamic parameters, induce tubular injury, or induce superoxide production in NBW rats. However, renal hemodynamic parameters declined, superoxide production increased, and histological indicators of tubular injury were present following mild renal I/R in LBW rats. Acute treatment with tempol prevented these alterations in LBW rats subjected to mild renal I/R. Thus, these findings suggest that adverse conditions during fetal life can compromise the renal response to subtle insults leading to an increased susceptibility to renal injury, suggesting that LBW individuals may be an "at risk" population for renal disease. Additionally, the outcome of tempol treatment proposes a possible mechanistic pathway involved in mediating enhanced susceptibility to renal injury programmed during fetal life.
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Affiliation(s)
- Norma B Ojeda
- Dept. of Pediatrics, Univ. of Mississippi Medical Center, Jackson, 39216-4505, USA.
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Kumar R, Wang ZJ, Forsythe C, Fu Y, Chen YY, Yeh BM. Dual energy CT monitoring of the renal corticomedullary sodium gradient in swine. Eur J Radiol 2011; 81:423-9. [PMID: 21237601 DOI: 10.1016/j.ejrad.2010.12.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility of dual-energy CT (DECT) for monitoring dynamic changes in the renal corticomedullary sodium gradient in swine. MATERIAL AND METHODS This study was approved by our Institutional Animal Care and Use Committee. Four water-restricted pigs were CT-scanned at 80 and 140 kVp at baseline and at 5 min intervals for 30 min during saline or furosemide diuresis. The renal cortical and medullary CT numbers were recorded. A DECT basis material decomposition method was used to quantify renal cortical and medullary sodium concentrations and medulla-to-cortex sodium ratios at each time point based on the measured CT numbers. The sodium concentrations and medulla-to-cortex sodium ratios were compared between baseline and at 30 min diuresis using paired Student t-tests. The medulla-to-cortex sodium ratios were considered to reflect the corticomedullary sodium gradient. RESULTS At baseline prior to saline diuresis, the mean medullary and cortical sodium concentrations were 103.8±8.7 and 65.3±1.7 mmol/l, respectively, corresponding to a medulla-to-cortex sodium ratio of 1.59. At 30 min of saline diuresis, the medullary and cortical sodium concentrations decreased to 72.3±1.0 and 56.0±1.4 mmol/l, respectively, corresponding to a significantly reduced medulla-to-cortex sodium ratio of 1.29 (P<0.05). At baseline prior to furosemide diuresis, the mean medullary and cortical sodium concentrations were 110.5±3.6 and 66.7±4.1 mmol/l, respectively, corresponding to a medulla-to-cortex sodium ratio of 1.66. At 30 min of furosemide diuresis, the medullary and cortical sodium concentrations decreased to 68.5±0.3 and 58.9±4.0 mmol/l, respectively, corresponding to a significantly reduced medulla-to-cortex sodium ratio of 1.16 (P<0.05). One of the 4 pigs developed acute tubular necrosis likely related to prolonged hypoxia during intubation prior to the furosemide diuresis experiment. The medulla-to-cortex sodium ratio for this pig, which was excluded from the mean medulla-to-cortex ratio above, was 1.07 at baseline and 1.15 at 30 min following the administration of furosemide. CONCLUSION DECT monitoring of dynamic changes in the renal corticomedullary sodium gradient after physiologic challenges is feasible in swine.
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Affiliation(s)
- Rahi Kumar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, United States
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Heyman SN, Khamaisi M, Rosen S, Rosenberger C. In vivo models of acute kidney injury. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ddmod.2010.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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