Abstract
Background: Superb microvascular imaging (SMI) is an innovative ultrasound image processing technique that provides greater detail and better visualization of small branching vessels. We assume that SMI will provide sufficient information regarding the severity of chronic kidney disease (CKD) and reflecting histological changes. Aims: The aims was to assess the capabilities of SMI imaging regarding the early detection of kidney dysfunction and renal fibrosis in comparison to the reference standard renal biopsy for the early diagnosis of kidney fibrosis. Methods: SMI was performed in patients (n = 52) with CKD stage 2–5, where some of them underwent biopsy proven CKD and fibrosis as part of the diagnosis. In addition, biochemical tests were performed, including kidney function tests, urine collection for proteinuria, and the estimation of GFR by MDRD or CKD-EPI eGFR in CKD patients and healthy controls (n = 17). All subjects underwent SMI, where vascularity is expressed as the SMI index (a low index reflects low vascularity/fibrosis and vice versa). Results: The SMI vascular index was significantly lower in CKD patients as compared with healthy controls (72.2 ± 12.9 vs. 49.9 ± 16.7%, p < 0.01). Notably, a moderate correlation between the SMI index and eGFR was found among the CKD patients (r = 0.56, p < 0.001). Similarly, a strong correlation was found between SCr and the SMI index of the diseased subjects (r = −0.54, p < 0.001). In patients who underwent renal biopsy, the SMI index corresponded with the histological alterations and CKD staging. Conclusions: This study demonstrated that SMI imaging may be utilized in CKD patients of various stages for the evaluation of chronic renal morphological changes and for differentiation between CKD grades.
Highlights
IntroductionChronic kidney disease (CKD) is characterized by a decline in glomerular filtration rate (GFR), a progressive increase in proteinuria, elevated blood pressure, and high risk of advanced kidney failure that requires replacement therapy
Subjects were divided into two groups; chronic kidney disease (CKD) patients and healthy controls
We clearly demonstrated that the Superb microvascular imaging (SMI) index was significantly lower in CKD patients as compared with healthy controls (72.2 ± 12.9 vs. 49.9 ± 16.7%, p < 0.01)
Summary
Chronic kidney disease (CKD) is characterized by a decline in glomerular filtration rate (GFR), a progressive increase in proteinuria, elevated blood pressure, and high risk of advanced kidney failure that requires replacement therapy. Advanced CKD is characterized by morphologic renal changes that include varying degrees of fibrosis [1,2]. The progression of CKD can be assessed using routine biochemical tests, such as the proteinuria and serum creatinine levels, assessment of the grade of renal fibrosis requires renal biopsy. Methods: SMI was performed in patients (n = 52) with CKD stage 2–5, where some of them underwent biopsy proven CKD and fibrosis as part of the diagnosis. Biochemical tests were performed, including kidney function tests, urine collection for proteinuria, and the estimation of GFR by MDRD or CKD-EPI eGFR in CKD patients and healthy controls (n = 17).
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