Shear wave elastography accurately detects chronic changes in renal histopathology

Leong, Sook Sam; Wong, Jeannie Hsiu Ding; Shah, Mohammad Nazri Md; Vijayananthan, Anushya; Jalalonmuhali, Maisarah; Chow, Tak Kuan; Sharif, N.H. Mohd; Ng, Kwan Hoong

doi:10.1111/nep.13805

Cited by 37 publications

(19 citation statements)

References 31 publications

(76 reference statements)

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“…In native kidneys, there are studies using different elastography systems (VTQ, ElastPQ ) that show, as expected, that severe histological changes, both glomerular and tubulointerstitial, are associated with a statistically significant increase in kidney SWS [33,52]. Moreover, in a study performed using the 2D-SWE -SSI elastography method, it has been shown that the degree of glomerulosclerosis and tubulointerstitial fibrosis is associated with higher levels of kidney stiffness and that patients with lower kidney SWS showed a better response to corticotherapy [53].…”

Section: Fibrosis and Elastographysupporting

confidence: 61%

Renal Elastography for the Assessment of Chronic Kidney Disease

Bob¹

2022

Elastography - Applications in Clinical Medicine

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For the assessment of chronic kidney disease, point shear wave elastography (pSWE) and shear wave speed imaging (2D-SWE) are suitable, but the use of elastography in the assessment of the kidneys is more difficult compared to the use in other organs, because of the complex architecture of the kidneys, characterized by a high anisotropy and also by the limited size of the renal parenchyma, where the measurements are performed. Despite the difficulties of renal elastography, the reproducibility of the method is good. Kidney shear wave speed values are influenced mainly by age and gender, while in chronic kidney disease, renal stiffness is sometimes decreased in more advanced disease and is not influenced mainly by the progression of fibrosis. There are studies proving that a decreased renal blood flow is associated with a decrease in kidney shear wave speed, the fact that could explain why patients with CKD tend to have lower kidney stiffness. Elastography is a real-time imaging method that could be useful in the assessment of the kidneys, but more extensive studies and even some improvements of the processing algorithms of raw data of elastography machines seem to be needed to implement the use in clinical practice.

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Section: Fibrosis and Elastographysupporting

confidence: 61%

Renal Elastography for the Assessment of Chronic Kidney Disease

Bob¹

2022

Elastography - Applications in Clinical Medicine

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“…One of the causes of this could be anisotropy. The architecture of the renal tissue, which is characterized by a high degree of anisotropy, has an impact on the measured kidney SWS, making the results difficult to interpret [41]. In addition to anisotropy, another problem related to renal elastography is the depth of the kidneys.…”

Section: Discussionmentioning

confidence: 99%

Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

et al. 2022

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Background: We require an quantitative imaging technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in recent years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. Methods: The databases of PubMed, Medscape, Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (SWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results, and outcome data were all collected from each study according to a set protocol. Results: We found 37 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of kidney SWS between studies we found increased heterogeneity Q = 513.133; DF = 10; p < 0001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of −0.216, patients with CKD have a lower kidney SWS than healthy controls. A positive association between kidney SWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, p < 0.001), Q = 73.3, DF = 5, p < 000.1, I2 = 93.18% (95% CI for I2 87.86 to 96.18). The pooled area under the ROC curve for kidney SWS to predict chronic kidney disease was 0.831 (95% CI, p < 0.001), Q = 28.32, DF = 6, p = 0.0001, I2 = 78.8% (95% CI for I2 56.37 to 89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve (AUC) values are used to compare distinct characteristics (differentiating kidney SWS between mildly and moderately impaired kidneys, between non-diabetic/prediabetic/diabetic patients, or kidney SWS between the CKD and control group), therefore not being suitable for further evaluation. Conclusions: The results show that patients with CKD have a lower kidney SWS than healthy controls. However, the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity. Further research is needed to determine which factors actually influence kidney SWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.

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“…It is is calculated according to the equation: E = 3 cs2, where E = Young's modulus (kPa), cs = shear wave velocity (m/s) [43]. In the study performed by Leong et al on the renal patients who underwent renal biopsy, it was demonstrated that the kidney Young's modulus correlated significantly with intrarenal lesions (p < 0.001) [44].…”

Section: Discussionmentioning

confidence: 99%

Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients

et al. 2021

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Objective: Hypertensive nephroangiosclerosis (HN) represents the second most common cause of chronic kidney disease. Kidney damage secondary to high blood pressure favors the appearance of serum and urinary changes, but also imaging, highlighted by ultrasonography (B-mode, Doppler, Acoustic Radiation Force Impulse Elastography). Acoustic Radiation Force Impulse Elastography (ARFI) represents a new imagistic method which characterizes renal stiffness in the form of shear wave velocity (SWV). Aim: This study aims to investigate renal stiffness in HN patients, and to assess the correlations between it and urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intrarenal resistive index (RRI). Material and Methods: This cross-sectional study was performed on a group of 80 HN patients and 50 healthy, sex and age-matched, as controls. UACR (urinary immunoturbidimetry), eGFR (Jaffe method), RRI, and renal SWV (Siemens Acuson 2000) were determined in all patients and controls. Data were expressed as mean ± standard deviation. Statistical analysis was done by means Pearson’s test and t-Student test, p values of less than 0.05 were considered statistically significant. Results: UACR, eGFR, RRI and SWV showed statistically significant differences between the HN patients and controls (p < 0.0001). In the hypertensive patients group, statistically significant correlations were observed between the SWV and UACR (r = −0.7633, p < 0.00001), eGFR (r = 0.7822, p = 0.00001), and RRI (r = −0.7978, p = 0.00001). Conclusions: Kidney sonoelastography characterizes imagistically the existence of intrarenal lesions associated with essential hypertension, offering a new diagnosis method for these patients.

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Shear wave elastography accurately detects chronic changes in renal histopathology

Cited by 37 publications

References 31 publications

Renal Elastography for the Assessment of Chronic Kidney Disease

Renal Elastography for the Assessment of Chronic Kidney Disease

Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients

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