Multiparametric magnetic resonance imaging: A robust tool to test pathogenesis and pathophysiology behind nephropathy in humans

Andersen, Ulrik B.; Haddock, Bryan; Asmar, Ali

doi:10.1111/cpf.12818

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…The clinical application of the ASL technique is being increasing favored for the investigation of kidney perfusion that is very sensitive to changes in the renal tissue homeostasis 27 . The use of ASL in the allografts, especially in those with significantly impaired function, is also advantageous in the sense that this modality does not incur radiation or contrast use.…”

Section: Discussionmentioning

confidence: 99%

Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction

Wang

et al. 2023

Magnetic Resonance Imaging

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BackgroundAlthough biopsy is often entailed for managing patients with kidney allograft dysfunction, it is associated with potential complications of severe hemorrhage. Arterial spin labeling (ASL) is a non‐invasive technique that assesses tissue perfusion.PurposeTo assess the utility of ASL for the discrimination of patients with post‐transplant allograft dysfunction who do not need biopsy from those who need.Study TypeProspective.SubjectsForty‐six patients (34 males/12 females, aged 38.8 ± 9.5 years) with kidney allograft dysfunction, including 31 in which biopsy directly lead to changes in management (NECESSARY group) and 15 in which clinical management did not alter after biopsy (UNNECESSARY group).Field Strength/Sequence3.0 T and 3D fast‐spin echo sequence.AssessmentAll patients underwent both ASL scan and biopsies. The serum creatinine, proteinuria, pathologic results, and cortical ASL readings were obtained and compared between the two groups.Statistical AnalysesChi‐square test, independent student t‐test, Mann–Whitney U test, receiver‐operating characteristic curve. A two‐tailed P < 0.05 denoted statistical significance.ResultsThe NECESSARY group presented with significantly elevated serum creatinine as compared with the UNNECESSARY group (1.87 ± 0.56 mg/dL vs. 1.31 ± 0.37 mg/dL). The acute composite score was significantly higher in the NECESSARY group than that in the UNNECESSARY group (7 [4–8] vs. 1 [0–2]). Cortical ASL in the NECESSARY group was significantly decreased as compared with the UNNECESSARY group (108.06 [69.96–134.92] mL/min/100 g vs. 153.48 [113.19–160.37] mL/min/100 g). Serum creatinine differentiated UNNCESSARY group from the NECESSARY group with an area under the curve (AUC) and specificity of 0.79 and 54.84%, respectively. By comparison, the cortical ASL yielded an AUC of 0.75 and a specificity of 70.97%. Notably, the specificity was increased to 90.30% by combined use of serum creatinine and cortical ASL.Data ConclusionThe combined use of ASL and serum creatinine yielded a high specificity for selecting patients who may not need allograft biopsy.Level of Evidence2Technical EfficacyStage 3

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Section: Discussionmentioning

confidence: 99%

Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction

Wang

et al. 2023

Magnetic Resonance Imaging

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“…In murine models of CKD, MRI has shown promise in estimating fibrosis. While in humans the correlation between renal function and MRI evaluation has not always been clearcut, technology is improving rapidly [54,55].…”

Section: Imagingmentioning

confidence: 99%

Fibrosis in Chronic Kidney Disease: Pathophysiology and Therapeutic Targets

Reiss,

Jacob,

Zubair

et al. 2024

JCM

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Chronic kidney disease (CKD) is a slowly progressive condition characterized by decreased kidney function, tubular injury, oxidative stress, and inflammation. CKD is a leading global health burden that is asymptomatic in early stages but can ultimately cause kidney failure. Its etiology is complex and involves dysregulated signaling pathways that lead to fibrosis. Transforming growth factor (TGF)-β is a central mediator in promoting transdifferentiation of polarized renal tubular epithelial cells into mesenchymal cells, resulting in irreversible kidney injury. While current therapies are limited, the search for more effective diagnostic and treatment modalities is intensive. Although biopsy with histology is the most accurate method of diagnosis and staging, imaging techniques such as diffusion-weighted magnetic resonance imaging and shear wave elastography ultrasound are less invasive ways to stage fibrosis. Current therapies such as renin-angiotensin blockers, mineralocorticoid receptor antagonists, and sodium/glucose cotransporter 2 inhibitors aim to delay progression. Newer antifibrotic agents that suppress the downstream inflammatory mediators involved in the fibrotic process are in clinical trials, and potential therapeutic targets that interfere with TGF-β signaling are being explored. Small interfering RNAs and stem cell-based therapeutics are also being evaluated. Further research and clinical studies are necessary in order to avoid dialysis and kidney transplantation.

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“…Interest has turned recently to the use and potential of MRI and the detailed structural and functional readouts it can provide to non-invasively assess and quantify pathophysiological changes in CKD [42][43][44] (Figure 2). As one of the foremost imaging techniques to aid medical diagnoses, MRI is the method of choice for diseased (and normal) soft tissue because the contrast can be "tailored" using multiple "weighting" or "sensitization" techniques.…”

Section: A Potential Role For and Opportunities With Mrimentioning

confidence: 99%

Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease

Friedli

Baid-Agrawal

Unwin

et al. 2023

JCM

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Chronic kidney disease (CKD) associated with diabetes mellitus (DM) (known as diabetic kidney disease, DKD) is a serious and growing healthcare problem worldwide. In DM patients, DKD is generally diagnosed based on the presence of albuminuria and a reduced glomerular filtration rate. Diagnosis rarely includes an invasive kidney biopsy, although DKD has some characteristic histological features, and kidney fibrosis and nephron loss cause disease progression that eventually ends in kidney failure. Alternative sensitive and reliable non-invasive biomarkers are needed for DKD (and CKD in general) to improve timely diagnosis and aid disease monitoring without the need for a kidney biopsy. Such biomarkers may also serve as endpoints in clinical trials of new treatments. Non-invasive magnetic resonance imaging (MRI), particularly multiparametric MRI, may achieve these goals. In this article, we review emerging data on MRI techniques and their scientific, clinical, and economic value in DKD/CKD for diagnosis, assessment of disease pathogenesis and progression, and as potential biomarkers for clinical trial use that may also increase our understanding of the efficacy and mode(s) of action of potential DKD therapeutic interventions. We also consider how multi-site MRI studies are conducted and the challenges that should be addressed to increase wider application of MRI in DKD.

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Multiparametric magnetic resonance imaging: A robust tool to test pathogenesis and pathophysiology behind nephropathy in humans

Cited by 4 publications

References 29 publications

Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction

Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction

Fibrosis in Chronic Kidney Disease: Pathophysiology and Therapeutic Targets

Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease

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