Abstract

BackgroundThe renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes.MethodsKidney sonography and biopsy were performed in 112 patients. Histological changes were graded in 0, < 25%, ≥25%, ≤50 and > 50% of the sample. Cortical echogenicity was graded relative to liver or spleen parenchyma: less than, equal to and higher than the liver/spleen. Kidney length, the kidney length/body height ratio (KL/H) and cortical thickness were obtained. Each parameter was multiplied by a cortical echogenicity-weighting arbitrary factor: 1.17, 1 or 0.69 for cortex less than, equal to or higher than the liver, respectively. The GFR was estimated using the CKD-EPI formula. The accuracy of crude and composite parameters to identify patients with a high creatinine, a low GFR and histological changes were evaluated.ResultsThe discriminative power of kidney length and cortical thickness for renal dysfunction and histological changes was improved after weighting for cortical echogenicity. However, the best discriminative was the kidney length to height ratio weighted towards renal echogenicity (w-KL/H).Conclusionw-KL/H exceeded the other parameters as a marker of renal impairment and histological changes in CKD. Calculation of the w-KL/H index may be of help as a non-invasive tool to identify patients with significant renal disease and might be useful to guide therapeutic decisions.

Highlights

  • The renal length and cortical echogenicity have shown correlation to the renal function and histological changes in chronic kidney disease (CKD) patients

  • Increased cortical echogenicity is a marker of renal disease that correlates to severity of interstitial histological changes in renal parenchymal disease [5]

  • Right kidney cortical echogenicity relative to liver echogenicity was obtained in all patients, except in six whose liver was fatty

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Summary

Introduction

The renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes. Some sonographically determined kidney parameters correlate with renal function, including kidney length (KL) [2, 3] and cortical echogenicity, which is the most commonly reported parameter at renal ultrasound [4]. Changes in kidney length/body height ratio (KL/H) [5] and cortical thickness (CT) [6] are believed to show a relationship with renal function in chronic kidney disease (CKD) patients. In adults, a renal cortex more echogenic than the liver is clearly abnormal and indicates renal disease [9]

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