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Rao WT, Jiang S, Shen YH, Wang YH, Liu SN, Tang JD, Xing JF. Myofibroblasts: A New Factor Affecting the Hyperlipidemia-Induced Elastic Abnormality of Corpus Cavernosum in Rabbits Detected by 2-D Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2336-2345. [PMID: 37544829 DOI: 10.1016/j.ultrasmedbio.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Two-dimensional shear wave elastography (2-D SWE) has been proven to detect hyperlipidemia-induced elastic abnormality in the corpus cavernosum. This study investigated cytological factors affecting the elasticity of the corpus cavernosum in rabbits with hyperlipidemia using single-cell RNA sequencing (scRNA-seq). METHODS Male New Zealand white rabbits were randomly divided into a hyperlipidemia group (high-cholesterol diet) and a control group (standard diet). Penile 2-D SWE was performed to detect the elastic abnormality in the corpus cavernosum. ScRNA-seq was performed to observe cellular changes in the corpus cavernosum of rabbits with hyperlipidemia. Immunohistochemistry, immunofluorescence and histological examinations were conducted to verify the results of scRNA-seq. RESULTS Two-dimensional SWE revealed that the Young's modulus of the corpus cavernosum was significantly greater in the hyperlipidemia group than that in the control group (p < 0.001). Histological findings revealed extracellular matrix accumulation within the corpus cavernosum, with stronger staining of collagen types I and Ⅲ. ScRNA-seq revealed that fibroblasts, smooth muscle cells, and endothelial cells were the major cell types in the corpus cavernosum. A novel subtype of fibroblasts (myofibroblast) was discovered in the hyperlipidemia group, which was verified by immunofluorescence staining and gene ontology analysis. Fibroblasts, smooth muscle cells and endothelial cells were three cellular sources for myofibroblasts. CONCLUSION Myofibroblasts are activated and proliferate and secrete large amounts of collagen fibers in the corpus cavernosum during hyperlipidemia, leading to abnormal Young's modulus detected by 2-D SWE and their recognition as a new factor affecting the hyperlipidemia-induced elastic abnormality of the corpus cavernosum.
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Affiliation(s)
- Wan-Ting Rao
- Department of Medical Ultrasound, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Shuai Jiang
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Yi-Hao Shen
- Department of Medical Ultrasound, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Yan-He Wang
- Department of Medical Ultrasound, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Sen-Ning Liu
- Department of Medical Ultrasound, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Jing-Dong Tang
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Jin-Fang Xing
- Department of Medical Ultrasound, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China; Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
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Wu J, Li G, Liu J, Sun W, Liu J, Zou G, Lu H, Zheng M. Utility of shear wave-based ultrasound elastography in chronic kidney disease and related pathological quantitative analysis. Eur Radiol 2023; 33:5625-5633. [PMID: 36847836 DOI: 10.1007/s00330-023-09507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effects of tissue fibrosis and microvessel density on shear wave-based ultrasound elastography (SWUE) of chronic kidney disease (CKD). In addition, we were looking to see whether SWUE could predict stage of CKD, correlating with the histology on kidney biopsy. METHODS Renal tissue sections from 54 patients diagnosed with suspected CKD were subjected to immunohistochemistry (CD31 and CD34), and the degree of tissue fibrosis was assessed using Masson staining. Before renal puncture, both kidneys were examined using SWUE. Comparative analysis was used to assess the correlation between SWUE and microvessel density, and between SWUE and the degree of fibrosis. RESULTS Fibrosis area according to Masson staining (p < 0.05) and integrated optical density (IOD) (p < 0.05) were positively correlated with CKD stage. The percentage of positive area (PPA) and IOD for CD31 and CD34 were not correlated with CKD stage (p > 0.05). When stage 1 CKD was removed, PPA and IOD for CD34 were negatively correlated with CKD stage (p < 0.05). Masson staining fibrosis area and IOD were not correlated with SWUE (p > 0.05), PPA and IOD for CD31 and CD34 were not correlated with SWUE (p > 0.05) and, finally, no correlation between SWUE and CKD stage was found (p > 0.05). CONCLUSION The diagnostic value of SWUE for CKD staging was very low. The utility of SWUE in CKD was affected by many factors and its diagnostic value was limited. KEY POINTS • There was no correlation between SWUE and the degree of fibrosis, or between SWUE and microvessel density among patients with CKD. • There was no correlation between SWUE and CKD stage and the diagnostic value of SWUE for CKD staging was very low. • The utility of SWUE in CKD is affected by many factors and its value was limited.
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Guanghan Li
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jian Liu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Weiliang Sun
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jiang Liu
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Guming Zou
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Haitao Lu
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Min Zheng
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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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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Li H, Men D, Jia M, Wang Z, Xiao W, Xue J, Kang C. Quantitative evaluation of renal tissue changes in patients with liver cirrhosis by shear wave elastography. Abdom Radiol (NY) 2023; 48:2085-2090. [PMID: 36943422 DOI: 10.1007/s00261-023-03881-6] [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: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Hepatocirrhotic nephropathy progresses rapidly and has a poor prognosis, and early detection of renal changes in patients with cirrhosis is particularly important for its prevention and treatment. The objective of this study was to evaluate the value of shear wave elastography (SWE) in the early diagnosis of hepatocirrhotic nephropathy. METHODS 206 hepatic cirrhosis patients with normal conventional renal function were enrolled and divided into Child-Pugh grade A (Group A), Child-Pugh grade B (Group B), and Child-Pugh grade C (Group C) according to the Child-Pugh grading method. Meanwhile, 60 healthy volunteers matched in age and sex were selected as the control group. The maximum Young's modulus (Emax), average Young's modulus (Emean), and minimum Young's modulus (Emin) of the left renal parenchyma were measured by SWE in all subjects. The Emax, Emean, and Emin values of the left renal parenchyma were compared between the cirrhosis and control groups. RESULTS The Emax, Emean, and Emin values of left renal parenchyma in cirrhosis group were higher than those in control group (p = 0.00, 0.00, 0.00). The Emax, Emean, and Emin values of left renal parenchyma in cirrhosis group B and group C were higher than those in control group (p = 0.00, 0.00, 0.00; p = 0.00, 0.00, 0.00), but these values in cirrhosis group A were not significantly different from control group(p = 0.48, 0.52, 0.92). Comparison of the Emax, Emean, and Emin values in left renal parenchyma of three cirrhosis groups, the values of Group B and Group C were higher than those of Group A (p = 0.00, 0.00, 0.00; p = 0.00, 0.00, 0.00), and there was no significant difference between Group B and Group C (p = 0.71, 0.18, 0.39). CONCLUSION SWE can detect renal tissue damage in patients with liver cirrhosis earlier than changes identified during routine laboratory examination by quantitatively measuring the elastic parameters of renal parenchyma and may become a new method for early diagnosis of hepatorenal syndrome.
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Affiliation(s)
- Huizhan Li
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Dianxia Men
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Meihong Jia
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Zhifen Wang
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Wenli Xiao
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Jiping Xue
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Chunsong Kang
- Department of Ultrasonography, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, The Third Hospital of Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China.
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Appleby RB, Vaden SL, Monteith G, Seiler GS. Shear wave elastography evaluation of cats with chronic kidney disease. Vet Radiol Ultrasound 2023; 64:330-336. [PMID: 36324225 DOI: 10.1111/vru.13184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022] Open
Abstract
Chronic kidney disease (CKD) is a major health condition in cats that can lead to poor quality of life and financial implications for therapy. Currently staging and identification of CKD is limited by diagnostic testing such as creatinine and urine-specific gravity, which do not change until late in the disease course. Other methods to evaluate CKD would be valuable in the clinical setting. Shear wave elastography is one novel ultrasound method, which has shown promise in identifying increases in tissue stiffness and identifying CKD in people. As CKD is often histologically characterized by tubulointerstitial fibrosis, shear wave elastography has the potential to identify CKD and differentiate between stages of CKD in cats. This prospective observational case-control study with 78 cats found no difference in shear wave velocities between groups (P = 0.33), a contradictory finding to one prior publication. There was no effect of weight (P = 0.65), nor the presence of mineralization (P = 0.31) or infarction (P = 0.52) on cortical shear wave velocities. There was a significant effect of age on shear wave velocity (P = 0.018) where velocities increased with age. The intraclass correlation coefficient was only moderate (0.62). Possible reasons for the difference in results between our work and that published prior, include differences in methodology and differences in instrumentation. Variability in measurements in our population may be due to the effects of respiratory motion or limitations in shear wave elastography software. As such, shear wave elastography is not currently recommended as a tool to evaluate CKD in cats and further work is necessary.
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Affiliation(s)
- Ryan B Appleby
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Shelly L Vaden
- Department of Clinical Sciences, NC State College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Gabrielle Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Gabriela S Seiler
- Department of Molecular and Biological Sciences, NC State College of Veterinary Medicine, Raleigh, North Carolina, USA
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Chen Z, Chen J, Chen H, Su Z. A nomogram based on shear wave elastography for assessment of renal fibrosis in patients with chronic kidney disease. J Nephrol 2022; 36:719-729. [PMID: 36396847 DOI: 10.1007/s40620-022-01521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Non-invasive evaluation of renal fibrosis is still challenging. This study aimed to establish a nomogram based on shear wave elastography (SWE) and clinical features for the assessment of the severity of renal fibrosis in patients with chronic kidney disease (CKD). METHODS One hundred and sixty-two patients with CKD who underwent kidney biopsy and SWE examination were prospectively enrolled between April 2019 and December 2021. Patients were classified into mildly or moderately-severely impaired group based on pathology results. All patients were randomly divided into a training (n = 113) or validation cohort (n = 49). Least absolute shrinkage and selection operator (LASSO) algorithm was used for data dimensionality reduction and feature selection. Then, a diagnostic nomogram incorporating the selected features was constructed using multivariable logistic regression analysis. Nomogram performance was evaluated for discrimination, calibration, and clinical utility in training and validation cohorts. RESULTS The established SWE nomogram, which integrated SWE value, hypertension, and estimated glomerular filtration rate, showed fine calibration and discrimination in both training (area under the receiver operator characteristic curve (AUC) = 0.94; 95% confidence interval (CI) 0.89-0.98) and validation cohorts (AUC = 0.84; 95% CI 0.71-0.96). Significant improvement in net reclassification and integrated discrimination indicated that the SWE value is a valuable biomarker to assess moderate-severe renal impairment. Furthermore, decision curve analysis revealed that the SWE nomogram has clinical value. CONCLUSION The proposed SWE nomogram showed favorable performance in determining individualized risk of moderate-severe renal pathological impairment in patients with CKD, which will help to facilitate clinical decision-making.
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Affiliation(s)
- Ziman Chen
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jiaxin Chen
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Hui Chen
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
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Islamoglu MS, Gulcicek S, Seyahi N. Kidney tissue elastography and interstitial fibrosis observed in kidney biopsy. Ren Fail 2022; 44:314-319. [PMID: 35166179 PMCID: PMC8856082 DOI: 10.1080/0886022x.2022.2035763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Kidney interstitial fibrosis is an important risk factor for the progression of chronic kidney disease. Kidney elastography is a noninvasive imaging modality that might be used to assess tissue fibrosis. In this study, we aimed to investigate the relationship between tissue stiffness detected in kidney elastography and interstitial fibrosis observed in kidney biopsy. Materials and methods Patients who were hospitalized in a tertiary care university hospital with a kidney biopsy indication were included in this study. In all patients, the transverse and sagittal elastography measurements were made using a sonoelastography device before the biopsy. The total histological score was calculated. Results Fifty-seven native kidney patients with proteinuria were included in the study. Patients were divided into two groups according to the presence (n = 6) and absence of fibrosis (n = 51) as detected by kidney biopsy. A significant correlation was found between the presence of fibrosis detected by biopsy and elastography outcomes (p = .046, r = .192). A significant correlation was found between the urea and creatinine levels and transverse elastography measurements (p = .036, r = .240). No correlation was observed between the transverse elastography measurements and total histological score consisting of glomerular, vascular, and tubular scores (r = .006, p = .967) Conclusion The findings of our study suggest a significant relationship between the elastography measurements and interstitial fibrosis. Because of the high negative predictive value (91%), we suggest that elastography should mainly be used as an exclusion test for the presence of fibrosis. We also believe that elastography may be useful to evaluate the fibrosis status in kidney diseases.
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Affiliation(s)
- Mehmet Sami Islamoglu
- Department of Internal Medicine, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Sibel Gulcicek
- Department of Nephrology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. Shear Wave Elastography: A Review on the Confounding Factors and Their Potential Mitigation in Detecting Chronic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2033-2047. [PMID: 33958257 DOI: 10.1016/j.ultrasmedbio.2021.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Early detection of chronic kidney disease is important to prevent progression of irreversible kidney damage, reducing the need for renal transplantation. Shear wave elastography is ideal as a quantitative imaging modality to detect chronic kidney disease because of its non-invasive nature, low cost and portability, making it highly accessible. However, the complexity of the kidney architecture and its tissue properties give rise to various confounding factors that affect the reliability of shear wave elastography in detecting chronic kidney disease, thus limiting its application to clinical trials. The objective of this review is to highlight the confounding factors presented by the complex properties of the kidney, in addition to outlining potential mitigation strategies, along with the prospect of increasing the versatility and reliability of shear wave elastography in detecting chronic kidney disease.
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Affiliation(s)
- William T H Lim
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Ean H Ooi
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.
| | - Ji J Foo
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Myram S, Venzac B, Lapin B, Battistella A, Cayrac F, Cinquin B, Cavaniol C, Gropplero G, Bonnet I, Demolombe S, Descroix S, Coscoy S. A Multitubular Kidney-on-Chip to Decipher Pathophysiological Mechanisms in Renal Cystic Diseases. Front Bioeng Biotechnol 2021; 9:624553. [PMID: 34124016 PMCID: PMC8188354 DOI: 10.3389/fbioe.2021.624553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a major renal pathology provoked by the deletion of PKD1 or PKD2 genes leading to local renal tubule dilation followed by the formation of numerous cysts, ending up with renal failure in adulthood. In vivo, renal tubules are tightly packed, so that dilating tubules and expanding cysts may have mechanical influence on adjacent tubules. To decipher the role of this coupling between adjacent tubules, we developed a kidney-on-chip reproducing parallel networks of tightly packed tubes. This original microdevice is composed of cylindrical hollow tubes of physiological dimensions, parallel and closely packed with 100-200 μm spacing, embedded in a collagen I matrix. These multitubular systems were properly colonized by different types of renal cells with long-term survival, up to 2 months. While no significant tube dilation over time was observed with Madin-Darby Canine Kidney (MDCK) cells, wild-type mouse proximal tubule (PCT) cells, or with PCT Pkd1 +/- cells (with only one functional Pkd1 allele), we observed a typical 1.5-fold increase in tube diameter with isogenic PCT Pkd1 -/- cells, an ADPKD cellular model. This tube dilation was associated with an increased cell proliferation, as well as a decrease in F-actin stress fibers density along the tube axis. With this kidney-on-chip model, we also observed that for larger tube spacing, PCT Pkd1 -/- tube deformations were not spatially correlated with adjacent tubes whereas for shorter spacing, tube deformations were increased between adjacent tubes. Our device reveals the interplay between tightly packed renal tubes, constituting a pioneering tool well-adapted to further study kidney pathophysiology.
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Affiliation(s)
- Sarah Myram
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Bastien Venzac
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Brice Lapin
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Aude Battistella
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Fanny Cayrac
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Bertrand Cinquin
- Institut Pierre-Gilles de Gennes, IPGG Technology Platform, UMS 3750 CNRS, Paris, France
| | - Charles Cavaniol
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
- Fluigent SA, France
| | - Giacomo Gropplero
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Isabelle Bonnet
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Sophie Demolombe
- Université Côte d’Azur, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Institut de Pharmacologie Moléculaire et Cellulaire, Labex ICST, Valbonne, France
| | - Stéphanie Descroix
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
| | - Sylvie Coscoy
- Institut Curie, Université PSL (Paris Sciences & Lettres), Sorbonne Université, CNRS UMR 168, Laboratoire Physico Chimie Curie, Paris, France
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Fang JX, Chen XY, Yang QM, Xue MH. Factors Influencing Renal Parenchymal Stiffiness in Patients with Diabetic Nephropathy. Int J Gen Med 2021; 14:1911-1917. [PMID: 34040423 PMCID: PMC8140885 DOI: 10.2147/ijgm.s311420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal resilience. The purpose of this study is to determine the factors influencing renal resilience in patients with diabetic nephropathy (DN). Methods We recruited 56 healthy volunteers and 187 patients with DN. All the participants were evaluated using shear-wave elastography (SWE), and the size of their kidneys and Young's modulus values for the parenchyma were recorded. A total of 187 patients with DN are allocated to three groups according to their urinary albumin-to-creatinine ratio: normoalbuminuric (<30 mg/g creatinine), microalbuminuric (30-300 mg/g), and macroalbuminuric (≥300 mg/g) groups. Renal resilience is compared between the stages of diabetic nephropathy and the healthy control group, and the factors affecting the stiffiness of the renal parenchyma in DN are analyzed. Results The renal parenchyma is harder in participants with DN than in healthy participants (P < 0.001), and the stiffiness increases with the progression of the disease (P < 0.001). Multivariate logistic regression analysis shows that disease stage (β = 0.789, P < 0.001), duration of diabetes (β = 0.028, P < 0.001), and serum creatinine (SCr) concentration (β = 0.001, p < 0.001) influence the stiffiness of the renal parenchyma. Conclusion We show that SWE can be used to measure changes in the stiffiness of the renal parenchyma in patients with DN. Furthermore, Young's modulus of the renal parenchyma is related to the duration of diabetes, urinary albumin excretion, and SCr concentration. Thus, SWE can be used to objectively and non-invasively stage DN.
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Affiliation(s)
- Jian-Xiu Fang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Xiao-Yan Chen
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Qing-Mei Yang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Meng-Hua Xue
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
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11
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Caroli A, Remuzzi A, Lerman LO. Basic principles and new advances in kidney imaging. Kidney Int 2021; 100:1001-1011. [PMID: 33984338 DOI: 10.1016/j.kint.2021.04.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
Over the past few years, clinical renal imaging has seen great advances, allowing assessments of kidney structure and morphology, perfusion, function and metabolism, and oxygenation, as well as microstructure and the interstitium. Medical imaging is becoming increasingly important in the evaluation of kidney physiology and pathophysiology, showing promise in management of patients with renal disease, in particular with regard to diagnosis, classification, and prediction of disease development and progression, monitoring response to therapy, detection of drug toxicity, and patient selection for clinical trials. A variety of imaging modalities, ranging from routine to advanced tools, are currently available to probe the kidney both spatially and temporally, particularly ultrasonography, computed tomography, positron emission tomography, renal scintigraphy, and multiparametric magnetic resonance imaging. Given that the range is broad and varied, kidney imaging techniques should be chosen based on the clinical question and the specific underlying pathologic mechanism, taking into account contraindications and possible adverse effects. Integration of various modalities providing complementary information will likely provide the greatest insight into renal pathophysiology. This review aims to highlight major recent advances in key tools that are currently available or potentially relevant for clinical kidney imaging, with a focus on non-oncological applications. The review also outlines the context of use, limitations, and advantages of various techniques, and highlights gaps to be filled with future development and clinical adoption.
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Affiliation(s)
- Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (Bergamo), Italy
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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12
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Qi R, Yang C, Zhu T. Advances of Contrast-Enhanced Ultrasonography and Elastography in Kidney Transplantation: From Microscopic to Microcosmic. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:177-184. [PMID: 33143970 DOI: 10.1016/j.ultrasmedbio.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Kidney transplantation is the best choice for patients with end-stage renal disease. To date, allograft biopsy remains the gold standard for revealing pathologic changes and predicting long-term outcomes. However, the invasive nature of transplant biopsy greatly limits its application. Ultrasound has been a first-line examination for evaluating kidney allografts for a long time. Advances in ultrasound in recent years, especially the growing number of studies in elastography and contrast-enhanced ultrasonography (CEUS), have shed new light on its application in kidney transplantation. Elastography, including strain elastography and shear wave elastography, is used mainly to assess allograft stiffness and, thus, predict renal fibrosis. CEUS has been used extensively in evaluating blood microperfusion, assessing acute kidney injury and detecting different complications after transplantation. Requiring the use of microbubbles also makes CEUS a novel method of gene transfer and drug delivery, enabling promising targeted diagnosis and therapy. In this review, we summarize the advances of elastography and CEUS in kidney transplantation and evaluate their potential efficiency in becoming a better complement to or even substitute for transplant biopsy in the future.
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Affiliation(s)
- Ruochen Qi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.
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13
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Leong SS, Wong JHD, Md Shah MN, Vijayananthan A, Jalalonmuhali M, Chow TK, Sharif NHM, Ng KH. Shear wave elastography accurately detects chronic changes in renal histopathology. Nephrology (Carlton) 2020; 26:38-45. [PMID: 33058334 DOI: 10.1111/nep.13805] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
AIM Renal biopsy is the gold standard for the histological characterization of chronic kidney disease (CKD), of which renal fibrosis is a dominant component, affecting its stiffness. The aim of this study was to investigate the correlation between kidney stiffness obtained by shear wave elastography (SWE) and renal histological fibrosis. METHODS Shear wave elastography assessments were performed in 75 CKD patients who underwent renal biopsy. The SWE-derived estimates of the tissue Young's modulus (YM), given as kilopascals (kPa), were measured. YM was correlated to patients' renal histological scores, broadly categorized into glomerular, tubulointerstitial and vascular scores. RESULTS Young's modulus correlates significantly with tubulointerstitial score (ρ = 0.442, P < .001) and glomerular score (ρ = 0.375, P = .001). Patients with no glomerular sclerosis showed lower mean YM measurements compared to those with glomerular sclerosis. The mean YM increased as the percentage of interstitial fibrosis and tubular atrophy increased. The area under the receiver operating characteristic curve (ROC) for SWE in differentiating between mildly and moderately impaired kidneys was 0.702. CONCLUSION Shear wave elastography accurately detects chronic renal damage resulting from glomerular sclerosis, interstitial fibrosis and tubular atrophy, using the optimal cut-off YM value of ≥5.81 kPa.
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Affiliation(s)
- Sook Sam Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Anushya Vijayananthan
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Tak Kuan Chow
- Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur H M Sharif
- Renal Unit, Faculty of Medicine, Universiti Teknologi Mara, Selangor, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
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14
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Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems. Invest Radiol 2020; 55:191-199. [DOI: 10.1097/rli.0000000000000627] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Leong SS, Wong JHD, Md Shah MN, Vijayananthan A, Jalalonmuhali M, Mohd Sharif NH, Abas NK, Ng KH. Stiffness and Anisotropy Effect on Shear Wave Elastography: A Phantom and in Vivo Renal Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:34-45. [PMID: 31594681 DOI: 10.1016/j.ultrasmedbio.2019.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 05/28/2023]
Abstract
Tissue elasticity is related to the pathologic state of kidneys and can be measured using shear wave elastography (SWE). However, SWE quantification has not been rigorously validated. The aim of this study was to evaluate the accuracy of SWE-measured stiffness and the effect of tissue anisotropy on SWE measurements. Point SWE (pSWE), 2-D SWE and dynamic mechanical analysis (DMA) were used to measure stiffness and evaluate the effect of tissue anisotropy on the measurements. SWE and DMA were performed on phantoms of different gelatin concentrations. In the tissue anisotropy study, SWE and DMA were performed on the outer cortex of sheep kidneys. In the in vivo study, 15 patients with different levels of interstitial fibrosis were recruited for pSWE measurements. Another 10 healthy volunteers were recruited for tissue anisotropy studies. SWE imaging revealed a non-linear increase with gelatin concentration. There was a significant correlation between pSWE and 2-D SWE, leading to the establishment of a linear regression equation between the two SWE ultrasound measurements. In the anisotropy study, the median difference in stiffness between shear waves oriented at 0° and 90° towards the pyramid axis was significant. In the in vivo study, there was a strong positive linear correlation between pSWE and the percentage of interstitial fibrosis. There was a significant difference in the Young's modulus (YM) between severities of fibrosis. The mean YM values were lower in control patients than in patients with mild, moderate and severe fibrosis. YM values were also significantly higher when shear waves were oriented at 0° toward the pyramid axis. Tissue stiffness and anisotropy affects SWE measurements. These factors should be recognized before applying SWE for the interpretation of measured values.
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Affiliation(s)
- Sook Sam Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Anushya Vijayananthan
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Kwan Hoong Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
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16
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Yoon H, Lee YS, Lim BJ, Han K, Shin HJ, Kim MJ, Lee MJ. Renal elasticity and perfusion changes associated with fibrosis on ultrasonography in a rabbit model of obstructive uropathy. Eur Radiol 2019; 30:1986-1996. [PMID: 31858205 DOI: 10.1007/s00330-019-06547-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/24/2019] [Accepted: 10/24/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate elasticity and perfusion change associated with fibrosis in a rabbit model of unilateral ureter obstruction using shear wave elastography (SWE) and contrast-enhanced ultrasonography (CEUS). METHODS Complete unilateral ureter obstruction by ligation was performed in the left kidney of 15 rabbits. Renal elasticity on SWE and perfusion change on CEUS at the renal cortex were measured before and after the operation. Histopathological renal fibrosis was quantified by the stained area ratio with Masson trichrome and Picrosirius red using ImageJ analysis. Renal elasticity and perfusion values were compared by the Mann-Whitney U test and Proc Mixed as a function of time. Spearman's correlation was used to analyze differences between imaging values and fibrosis. RESULTS The duration of imaging follow-up was up to 49 days, with interval imaging performed 1-3 times. Renal elasticity values were higher in obstructed kidneys compared to contralateral kidneys (31.0 kPa vs 16.4 kPa, p < 0.001) and increased according to postoperative time (0.46 kPa/day). With respect to renal fibrosis, SWE values were positively correlated with Masson trichrome (ρ = 0.651, p < 0.001) and Picrosirius red (ρ = 0.514, p = 0.007). Among CEUS parameters, mean transit time was negatively correlated with renal fibrosis by Masson trichrome (ρ = - 0.639, p = 0.001) and Picrosirius red (ρ = - 0.625, p = 0.001). Rise time and time to peak were positively correlated with renal fibrosis. CONCLUSION Obstructive uropathy resulted in changes to both renal elasticity and perfusion. Renal fibrosis was moderately associated with increased renal cortical stiffness and both delayed and decreased cortical perfusion. KEY POINTS • Obstructive uropathy causes changes in elasticity and perfusion in a rabbit model. • Renal fibrosis from obstructive uropathy increases renal cortical stiffness, and both delay and decrease cortical perfusion.
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Affiliation(s)
- Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Seung Lee
- Department of Pediatric Urology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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17
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Kalyoncu Ucar A, Cicek RY, Alis D, Akbas S, Arioz Habibi H, Arslan MU, Eral G, Suleyman A, Caliskan S, Adaletli I. Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:379-385. [PMID: 30027586 DOI: 10.1002/jum.14698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux. METHODS We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results. RESULTS There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers). CONCLUSIONS Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.
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Affiliation(s)
- Ayse Kalyoncu Ucar
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Deniz Alis
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serkan Akbas
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hatice Arioz Habibi
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mine Usta Arslan
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gokalp Eral
- Biostatistics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ayse Suleyman
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Salim Caliskan
- Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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18
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Radulescu D, Peride I, Petcu LC, Niculae A, Checherita IA. Supersonic Shear Wave Ultrasonography for Assessing Tissue Stiffness in Native Kidney. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2556-2568. [PMID: 30154036 DOI: 10.1016/j.ultrasmedbio.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 05/28/2023]
Abstract
Recent years have brought shear wave elastography to the attention of nephrologists as a non-invasive method for detecting kidney fibrosis and, therefore, as a potential tool for reducing the need for kidney biopsy. Few studies are performed on native kidney. We aimed to compare cortical stiffness, assessed by measuring Young's modulus (YM, kPa) with SuperSonic Imaging technology, in patients with various degrees of chronic kidney disease (CKD) compared with healthy individuals. Cortical stiffness was measured by two operators, in different sessions, in 32 patients with CKD stages 3-5 and 20 healthy individuals. Comparison between mean YM values in CKD and those in controls and also between the different stages of CKD was our primary objective. The influence of other possible confounders on YM readings was also investigated and analyzed. Mean YM was significantly greater in CKD patients than in controls. Estimated YM was not able to differentiate the stages of CKD, except stage 5. Intra-subject variability was greater in CKD than in controls. Body mass index was the most important confounder in multiple analyses, in both the CKD and control groups. Our results highlight a positive correlation between increased cortical stiffness and presence of CKD. Further studies are needed to validate this method for implementation in daily clinical practice.
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Affiliation(s)
- Daniela Radulescu
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ileana Peride
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania.
| | - Lucian Cristian Petcu
- Department of Biostatistics and Biophysics, Faculty of Dental Medicine, "Ovidius" University Constanta, Constanta, Romania
| | - Andrei Niculae
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ionel Alexandru Checherita
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
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19
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Hiraki HL, Nagao RJ, Himmelfarb J, Zheng Y. Fabricating a Kidney Cortex Extracellular Matrix-Derived Hydrogel. J Vis Exp 2018:58314. [PMID: 30371659 PMCID: PMC6235530 DOI: 10.3791/58314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Extracellular matrix (ECM) provides important biophysical and biochemical cues to maintain tissue homeostasis. Current synthetic hydrogels offer robust mechanical support for in vitro cell culture but lack the necessary protein and ligand composition to elicit physiological behavior from cells. This manuscript describes a fabrication method for a kidney cortex ECM-derived hydrogel with proper mechanical robustness and supportive biochemical composition. The hydrogel is fabricated by mechanically homogenizing and solubilizing decellularized human kidney cortex ECM. The matrix preserves native kidney cortex ECM protein ratios while also enabling gelation to physiological mechanical stiffnesses. The hydrogel serves as a substrate upon which kidney cortex-derived cells can be maintained under physiological conditions. Furthermore, the hydrogel composition can be manipulated to model a diseased environment which enables the future study of kidney diseases.
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Affiliation(s)
| | - Ryan J Nagao
- Department of Bioengineering, Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington
| | - Jonathan Himmelfarb
- Department of Medicine, Kidney Research Institute, University of Washington;
| | - Ying Zheng
- Department of Bioengineering, Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington;
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20
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Intravoxel incoherent motion MRI-derived parameters and T2* relaxation time for noninvasive assessment of renal fibrosis: An experimental study in a rabbit model of unilateral ureter obstruction. Magn Reson Imaging 2018; 51:104-112. [DOI: 10.1016/j.mri.2018.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/29/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
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21
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Liu X, Li N, Xu T, Sun F, Li R, Gao Q, Chen L, Wen C. Effect of renal perfusion and structural heterogeneity on shear wave elastography of the kidney: an in vivo and ex vivo study. BMC Nephrol 2017; 18:265. [PMID: 28789641 PMCID: PMC5547675 DOI: 10.1186/s12882-017-0679-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the effect of perfusion status on elasticity measurements of different compartments in the kidney using shear wave elastography (SWE) both in vivo and ex vivo. Methods Thirty-two rabbit kidneys were used to observe the elasticity variation caused by renal artery stenosis and vein ligation in vivo, and six beagle kidneys were studied ex vivo to explore the effect of renal perfusion on elasticity. Supersonic SWE was applied to quantify the elasticity values of different renal compartments (cortex, medulla and sinus). Additionally, histopathological examination was performed to explore the possible mechanisms. Results The elasticity of the cortex was higher than that of the medulla, and the elasticity of the sinus was lowest among the compartments in native kidneys. The Young’s modulus (YM) of the cortex, medulla and sinus increased gradually as the duration of renal vein ligation increased, from 16.34 ± 1.01 kPa to 55.06 ± 5.61 kPa, 13.71 ± 1.16 kPa to 39.63 ± 2.91 kPa, and 12.61 ± 0.84 kPa to 29.30 ± 2.04 kPa, respectively. In contrast, the YM of the three compartments respectively decreased with progressive artery stenosis, from 16.34 ± 1.83 kPa to 11.21 ± 1.79 kPa, 13.31 ± 1.67 kPa to 8.07 ± 1.37 kPa, and 12.78 ± 2.66 kPa to 6.72 ± 0.95 kPa. Artery perfusion was the main factor influencing elasticity in ex vivo. The cortical elasticity was more prone to change with renal perfusion both in vivo and ex vivo. Histopathological examination showed progressive changes in the structure and content of the three compartments, consistent with the elasticity variation. Conclusions Both the complex structure/anisotropy and the perfusion of the kidney obviously influence the evaluation of renal elasticity. The measurement of SWE should be performed at a specific location along a certain angle or direction, and renal perfusion status should also be taken into account to ensure reproducible detection.
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Affiliation(s)
- Xiaona Liu
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Na Li
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Auxiliary Diagnosis, The 463rd Hospital of Shenyang Military Region, Shenyang, Liaoning, 110042, People's Republic of China
| | - Tao Xu
- Department of Ultrasound, Chinese PLA Navy General Hospital, Beijing, 100048, People's Republic of China
| | - Fang Sun
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Rui Li
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Qimin Gao
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Lianxiang Chen
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Chaoyang Wen
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China. .,Department of Ultrasound, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, 572013, People's Republic of China.
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Hassan K, Loberant N, Abbas N, Fadi H, Shadia H, Khazim K. Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease. Ther Clin Risk Manag 2016; 12:1615-1622. [PMID: 27853373 PMCID: PMC5106220 DOI: 10.2147/tcrm.s118465] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective The assessment of the grade of renal fibrosis in diabetic kidney disease (DKD) requires renal biopsy, which may be associated with certain risks. To assess the severity of chronic pathologic changes in DKD, we performed a quantitative analysis of renal parenchymal stiffness in advanced DKD, using shear wave elastography (SWE) imaging. Patients and methods Twenty-nine diabetic patients with chronic kidney disease (CKD) grades 3–4 due to DKD, and 23 healthy subjects were enrolled. Combined conventional ultrasound and SWE imaging were performed on all participants. The length, width, and cortical thickness and stiffness were recorded for each kidney. Results Cortical thickness was lower in patients with DKD than in healthy subjects (13.8±2.2 vs 14.8±1.6 mm; P=0.002) and in DKD patients with CKD grade 4 than in those with grade 3 (13.0±3.5 vs 14.7±2.1 mm; P<0.001). Cortical stiffness was greater in patients with DKD than in healthy subjects (23.72±14.33 vs 9.02±2.42 kPa; P<0.001), in DKD patients with CKD grade 4 than in those with grade 3 (30.4±16.2 vs 14.6±8.1 kPa; P<0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (15.7±6.7 vs 11.0±4.2 kPa; P=0.03). Daily proteinuria was higher in DKD patients with CKD grade 4 than in those with grade 3 (5.52±0.96 vs 1.13±0.72; P=0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (1.59±0.59 vs 0.77±0.48; P<0.001). Cortical stiffness was inversely correlated with the estimated glomerular filtration rate (r=−0.65, P<0.001) and with cortical thickness (r=−0.43, P<0.001) in patients with DKD. Conclusions In patients with advanced DKD, SWE imaging may be utilized as a simple and practical method for quantitative evaluation of the chronic morphological changes and for the differentiation between CKD grades.
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Affiliation(s)
- Kamal Hassan
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed; Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center
| | | | - Nur Abbas
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Hassan Fadi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hassan Shadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khaled Khazim
- Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center
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Church CC, Miller DL. A Two-Criterion Model for Microvascular Bio-Effects Induced In Vivo by Contrast Microbubbles Exposed to Medical Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1385-98. [PMID: 27033330 PMCID: PMC4860095 DOI: 10.1016/j.ultrasmedbio.2016.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 05/09/2023]
Abstract
The mechanical index (MI) is a theoretical exposure parameter for cavitational bio-effects of diagnostic ultrasound. The theory for the MI assumed that bubbles of all relevant sizes exist in tissue, a condition that is approximated for tissues that include a microbubble contrast agent. Therefore, the MI should allow science-based safety guidance for contrast-enhanced diagnostic ultrasound. However, theoretical predictions of bio-effects thresholds based on the MI typically do not concur with the frequency dependence of experimentally measured thresholds for bio-effects. For example, experimental thresholds for glomerular capillary hemorrhage in rats infused with contrast microbubbles increased approximately linearly with frequency, whereas the MI predicted a square root dependence. Here, cavitation thresholds were computed for linear versions of the acoustic pulses used in that study assuming bubbles containing either air, C3F8, or a 1:1 mixture of the two and surrounded by either blood or kidney tissue. Although no single threshold criterion was successful, combining results for one criterion that maximized circumferential stress in the capillary wall with another that ensured an inertial collapse produced thresholds that were consistent with experimental data. This suggests that a contrast-specific safety metric may be achieved following validation of this two-criterion model.
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Affiliation(s)
- Charles C Church
- National Center for Physical Acoustics & Department of Physics and Astronomy, University of Mississippi, University, Mississippi, USA.
| | - Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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