The utility of magnetic resonance imaging for noninvasive evaluation of diabetic
nephropathy.
Authors Brown RS, Sun MRM, Stillman IE, Russell TL, Rosas SE, Wei JL
Submitted By Robert Brown on 8/19/2019
Status Published
Journal Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Year 2019
Date Published 4/1/2019
Volume : Pages Not Specified : Not Specified
PubMed Reference 31329940
Abstract Noninvasive quantitative measurement of fibrosis in chronic kidney disease (CKD)
would be desirable diagnostically and therapeutically but standard radiologic
imaging is too variable for clinical usage. By applying a vibratory force,
tissue shear wave stiffness can be measured by magnetic resonance elastography
(MRE) that may correlate with progression of kidney fibrosis. Since decreased
kidney perfusion decreases tissue turgor and stiffness, we combined newly
available three-dimensional MRE shear stiffness measurements with MR arterial
spin labeling (ASL) kidney blood flow rates to evaluate fibrosis in diabetic
nephropathy., Thirty individuals with diabetes and Stage 0-5 CKD and 13 control
individuals without CKD underwent noncontrast MRE with concurrent ASL blood flow
measurements., MRE cortical shear stiffness at 90?Hz was decreased significantly
below controls in all CKD stages of diabetic nephropathy. Likewise, ASL blood
flow decreased progressively from 480?±?136?mL/min/100?g of cortical tissue in
controls to 302?±?95, 229?±?7 and 152?±?32?mL/min/100?g in Stages 3, 4 and 5
CKD, respectively. A magnetic resonance imaging (MRI) surrogate for the measured
glomerular filtration fraction [surrogate filtration fraction =?estimated
glomerular filtration rate (eGFR)/ASL] decreased progressively from 0.21?±?0.07
in controls to 0.16?±?0.04 in Stage 3 and 0.10?±?0.02 in Stage 4-5 CKD., In this
pilot study, MRI with ASL blood flow rates can noninvasively measure decreasing
kidney cortical tissue perfusion and, with eGFR, a decreasing surrogate
filtration fraction in worsening diabetic nephropathy that appears to correlate
with increasing fibrosis. Differing from the liver, MRE shear stiffness
surprisingly decreases with worsening CKD, likely related to decreased tissue
turgor from lower blood flow rates.

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