Abstract
Magnetic resonance imaging (MRI) has great potential to non-invasively assess functional and morphologic changes in the kidney that may improve diagnosis, prognosis and treatment in patients with chronic kidney disease (CKD). We investigated in a diabetic nephropathy (DN) population if non-contrast MRI using multiple techniques could differentiate CKD3-4 stages from healthy controls. The study included T2DM patients of 18-79 years with an established diagnosis of DN, eGFR between 15-60 ml/min/1.73 m2 and urine albumin/creatinine ratio (UACR) of >30 mg/g as well as age- and gender matched healthy controls (HC). GFR was were assessed using iohexol clearance. Multiple MRI measurements were performed, including:•R2* for assessment of renal hypoxia•Apparent Diffusion Coefficient (ADC) as a potential measurement of renal fibrosis•R1 for interstitial water balance•Arterial Spin Labelling (ASL) for cortical perfusion•Renal artery blood flow (peak systolic and end diastolic velocity, mean arterial flow, renal artery resistive index (RARI))•Global perfusion (mean arterial flow/kidney volume)•Kidney volume corrected for body surface area The final analysis included 20 CKD4 and 16 CKD3 patients with DN as well as 20 healthy controls. Demographics and baseline characteristics are shown in Table 1, showing an even age distribution across the DN patients and healthy controls. Several of the assessed MRI variables (highlighted in Table 2) were highly sensitive and specific to differentiate healthy vs CKD3-4. Table 1Demographics and baseline characteristicsVariableDN Patients (n=36)CKD 3 (n=16)CKD 4 (n=20)Healthy controls (n=20)Total (incl CKD 2) (n=58)Age (years)68.6 (5.5)68.9 (5.6)68.3 (5.6)66.7 (6.2)67.9 (5.7)EthnicityCaucasian34 (94.4%)16 (100.0%)18 (90.0%)20 (100.0%)56 (96.6%)Black (African/Afro-American)1 (2.8%)0 (0.0%)1 (5.0%)0 (0.0%)1 (1.7%)Asian1 (2.8%)0 (0.0%)1 (5.0%)0 (0.0%)1 (1.7%)GenderMale30 (83.3%)12 (75.0%)18 (90.0%)15 (75.0%)46 (79.3%)Female6 (16.7%)4 (25.0%)2 (10.0%)5 (25.0%)12 (20.7%)Height174.4 (8.9)175.8 (10.2)173.4 (7.9)176.7 (11.0)175.0 (9.6)Weight85.2 (12.9)86.8 (13.4)84.0 (12.6)80.2 (15.6)83.6 (13.9)BMI27.9 (3.1)28.0 (3.3)27.8 (3.0)25.5 (3.2)27.2 (3.3)Systolic Blood Pressure150.2 (21.2)147.1 (20.9)152.7 (21.6)132.8 (12.4)143.8 (19.9)Diastolic Blood Pressure78.9 (8.5)80.1 (9.4)78.0 (7.9)80.4 (7.3)79.5 (7.9) Open table in a new tab Table 2Imaging Predictors of CKDCKD3 and CKD4 vs Healthy ControlsVariableAUCSensitivitySpecificityCut-offPeak systolic velocity (cm/s)0.620.600.7948.7End diastolic velocity (cm/s)0.940.870.8912.6RARI0.940.900.810.73Mean arterial flow (ml/s)0.960.820.896.85Global perfusion (ml/100g/min)0.960.820.95380R2* medulla (s-1)0.750.720.7524.1ADC cortex (mm2s-1x10-3)0.790.720.842.37ASL perfusion cortex (ml/100g/min)0.940.920.83205Kidney volume (ml) corrected for BSA0.710.610.79108 Open table in a new tab A comprehensive non-contrast MRI protocol was developed, which as a single non-invasive tool could distinguish renal disease in patients with DN
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