Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear-Wave Elastography in Patients With Kidney Transplantation

Chiocchini, Anna Laura Croci; Sportoletti, Camilla; Comai, Giorgia; Brocchi, Stefano; Capelli, Irene; Baraldi, Olga; Bruno, Paolo Ferdinando; Conti, Fabio; Serra, Carla; Meola, Mario; Zompatori, Maurizio; Manna, Gaetano La

doi:10.1177/1526924817731882

Cited by 17 publications

(16 citation statements)

References 28 publications

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“…Our results showed that renal parenchymal stiffness increases as the percentage of glomerular sclerosis, interstitial fibrosis and tubular atrophy increased. These findings were consistent with the results reported by Yang et al and Chiocchini et al, in which kidney stiffness increased with the severity of damage 23,25 . According to López‐Novoa et al, glomerular, tubular, interstitial and vascular pathologies are common pathways in chronic and end‐stage kidney disease 3 .…”

Section: Discussionsupporting

confidence: 92%

“…However, this explanation was based solely on blood pressure and arterial stiffness, with no histopathological correlation. Our results, along with other studies, revealed no such finding, suggesting that vascular sclerosis was not associated with increased renal cortical stiffness 23 …”

Section: Discussioncontrasting

confidence: 64%

“…Several studies have applied SWE imaging to evaluate renal fibrosis, either in transplanted or native kidneys. [23][24][25] Unlike SWE imaging in chronic liver disease, in which liver stiffness increased in advanced stages of the disease due to progressive fibrosis, the results for renal SWE imaging have been contradictory and inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…Our results, along with other studies, revealed no such finding, suggesting that vascular sclerosis was not associated with increased renal cortical stiffness. 23 Renal biopsy is an irreplaceable tool for the diagnosis, prognosis and management of kidney disease. However, such a procedure carries certain limitations.…”

Section: Discussionmentioning

confidence: 99%

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Shear wave elastography accurately detects chronic changes in renal histopathology

et al. 2020

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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 cutoff YM value of ≥5.81 kPa.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Shear wave elastography accurately detects chronic changes in renal histopathology

et al. 2020

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“…The demographic and technical characteristics of the 24 studies (2993 patients) 1,[3][4][5][6][7]11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] are presented in Tables 1-3, respectively. Study populations ranged from healthy subjects to patients with chronic kidney disease, renal allografts, diabetic kidney disease, vesicoureteral reflux, and ureteropelvic junction obstruction.…”

Section: Demographic and Technical Characteristics Of Included Studiesmentioning

confidence: 99%

Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta‐Analysis

Hwang

Kim

et al. 2021

J of Ultrasound Medicine

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Objectives-To estimate the technical performance of acoustic radiation force impulse (ARFI) imaging (two-dimensional shear wave elastography [2D-SWE] and point shear wave elastography [p-SWE]) for measuring renal parenchymal stiffness.Methods-EMBASE and PubMed databases were searched for studies reporting technical performance of ARFI imaging in terms of technical failure, interobserver agreement, and/or intraobserver agreement. The proportion of technical failure and intraclass correlation coefficients (ICCs) for interobserver and intraobserver agreement was pooled. The pooled estimates of native and transplanted kidneys were obtained separately. Meta-regression and subgroup analyses were conducted to explore heterogeneity.Results-Twenty-four studies (2993 patients) were included. The pooled proportions of technical failure were 4.3% (95% confidence interval [CI] 2.2-8.5%) and 6.6% (95% CI 4.0-10.7%) in native and transplanted kidneys, respectively. The pooled ICCs of interobserver agreement were 0.70 (95% CI 0.68-0.83) and 0.81 (95% CI 0.68-0.89), indicating moderate and good agreement in native and transplanted kidneys, respectively. The pooled ICC showed good (0.77; 95% CI 0.49-0.91) intraobserver agreement in native kidneys. Regarding interobserver agreement in transplanted kidneys, ROI location (mid pole only versus others) was a significant factor of heterogeneity (P = .04).Conclusions-The ARFI-based SWE techniques show good technical performance for measuring renal parenchymal stiffness. The wide range of SWE protocols necessitates development of standardized guidelines on the use of renal ARFI imaging.

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Role of Shear Wave Elastography for Assessment of Renal‐Allograft Fibrosis and its Correlation With Histopathology

Ruidas,

Lal,

Prasad

et al. 2024

J of Ultrasound Medicine

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ObjectivesTo investigate whether shear wave elastography (SWE) can accurately identify interstitial fibrosis and tubular atrophy (IFTA) in chronic renal allograft injury (CRAI) and whether it can differentiate between different grades of IFTA.Materials and MethodsProspective observational study on renal transplant recipients who presented with CRAI. Patient selection was done on the basis of clinical presentation, serum creatinine, and eGFR levels. Biopsy and SWE were performed and SWE values were correlated with histopathological findings according to Banff schema. Receiver operating characteristic (ROC) was also analyzed to assess the diagnostic efficacy of SWE.ResultsSxity‐one patients were evaluated. Ten patients had no IFTA, 33 patients had mild IFTA, 16 patients had moderate IFTA, and 2 patients had severe IFTA. Mean parenchymal stiffness values in no IFTA, mild IFTA, moderate IFTA and severe IFTA were 39.86 ± 2.17 kPa (3.64 ± 0.09 m/s), 41.59 ± 3.36 kPa (3.71 ± 0.15 m/s), 47.59 ± 3.34 kPa (3.98 ± 0.14 m/s), and 53.83 ± 1.41 kPa (4.25 ± 0.03 m/s), respectively. SWE values of parenchymal stiffness reached statistical significance to differentiate between mild, moderate, and severe IFTA. ROC analysis revealed cut‐off values of 45.09 kPa (3.89 m/s) to differentiate between mild IFTA and moderate IFTA, 52.06 kPa (4.18 m/s) to differentiate between moderate IFTA and severe IFTA with acceptable sensitivity and specificity.ConclusionSWE is a non‐invasive and cost‐effective imaging tool to evaluate the disease status of renal allografts affected by CRAI. Thus, it can be of paramount importance if added to the regular follow‐up imaging protocol of renal allograft along with grayscale and Doppler imaging.

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Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear-Wave Elastography in Patients With Kidney Transplantation

Abstract: ElastPQ is a noninvasive, reproducible, and sensitive diagnostic tool able to detect moderate/severe chronic lesions. Its routine use during follow-up can identify patients eligible for biopsy, which remains the gold standard exam for detecting chronic allograft dysfunction.

Cited by 17 publications

References 28 publications

Shear wave elastography accurately detects chronic changes in renal histopathology

Shear wave elastography accurately detects chronic changes in renal histopathology

Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta‐Analysis

Role of Shear Wave Elastography for Assessment of Renal‐Allograft Fibrosis and its Correlation With Histopathology

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