Evaluation Of Chronic Kidney Disease Research Articles

Guidelines for clinical evaluation of chronic kidney disease in early stages

BackgroundFor the development of pharmaceutical products in kidney field, appropriate surrogate endpoints which can predict long-term prognosis are needed as an alternative to hard endpoints, such as end-stage kidney disease. Though international workshop has proposed estimated glomerular filtration rate (GFR) slope reduction of 0.5–1.0 mL/min/1.73 m /year and 30% decrease in albuminuria/proteinuria as surrogate endpoints in early and advanced chronic kidney disease (CKD), it was not clear whether these are applicable to Japanese patients.MethodsWe analyzed J-CKD-DB and CKD-JAC, Japanese databases/cohorts of CKD patients, and J-DREAMS, a Japanese database of patients with diabetes mellitus to investigate the applicability of eGFR slope and albuminuria/proteinuria to the Japanese population. Systematic review on those endpoints was also conducted including the results of clinical trials published after the above proposal.ResultsOur analysis showed an association between eGFR slope and the risk of end-stage kidney disease. A 30% decrease in albuminuria/proteinuria over 2 years corresponded to a 20% decrease in the risk of end-stage kidney disease patients with baseline UACR ≥ 30 mg/gCre or UPCR ≥ 0.15 g/gCre in the analysis of CKD-JAC, though this analysis was not performed on the other database/cohort. Those results suggested similar trends to those of the systematic review.ConclusionThe results suggested that eGFR slope and decreased albuminuria/proteinuria may be used as a surrogate endpoint in clinical trials for early CKD (including diabetic kidney disease) in Japanese population, though its validity and cutoff values must be carefully considered based on the latest evidence and other factors.

Nitrogen doped carbon dots and gold nanoparticles mediated FRET for the detection of creatinine in human urine samples

Serum creatinine (CR) is regarded as one of the most sought out prognostic biomarkers in medical evaluation of chronic kidney disease (CKD). In light of the diagnostic significance of CR, the utility of a fluorescence biosensor for its detection in human urine specimens has been explored based on Förster resonance energy transfer (FRET) across nitrogen-doped carbon dots (N-CDs) and gold nanoparticles (GNPs). A straightforward microwave-assisted synthesis procedure has been adopted to prepare N-CDs (λexcitation = 400 nm, λemission = 540 ± 5 nm) with bright green emissions. On addition of pre-synthesized GNPs, the radiative emanation of the N-CDs is completely suppressed on account of FRET across the N-CDs and the GNPs. About 77 % of their fluorescence intensity is recovered after adding CR to GNPs@N-CDs nanocomposite. The limit of detection for CR sensing is estimated as 0.02 µg•mL−1. This biosensor is selective enough to recognize CR in the existence of potential interfering substances (e.g., ascorbic acid, glucose, glutathione, urea, and electrolytes). Its practical utility for CR detection has been validated further on the basis of satisfactory correlation with the benchmark Jaffe method, as observed in artificial/human urine specimens. Consequently, this manuscript marks a pioneering report on employing CDs and GNPs-based FRET for identifying CR in urine specimens of CKD patients.

#2955 Incidental findings in a renal magnetic resonance imaging study for evaluation of chronic kidney disease in type 2 diabetes population

Abstract Background and Aims Novel Magnetic Resonance Imaging (MRI) techniques are potential methods to non-invasively assess and quantify functional, structural and pathophysiological changes in chronic kidney disease (CKD) that may improve diagnosis, prognosis and treatment of these patients. Advances in imaging techniques are also likely to result in the detection of unexpected and asymptomatic incidental findings. We retrospectively analyzed the overall prevalence of incidental findings in the participants of our previously reported study utilizing a non-contrast multiparametric MRI protocol in patients with type 2 DM (T2DM) as compared to healthy controls. Method The subjects of this sub-study were participants of our original prospective, single-center, observational study, in which several MRI biomarkers were evaluated to differentiate diabetic versus healthy kidneys, and various stages of CKD. A complete medical history and physical examination were performed. The inclusion criteria for the T2DM cohort were: Age 18-70 years, type II DM with CKD staged 3-4 (estimated glomerular filtration rate [eGFR] 15-60 ml/min/1.73 m2, body mass index (BMI) 18-35 and provision of written informed consent. The control group comprised of healthy volunteers who were age- and sex-matched and had the following inclusion criteria: Age 18-70 years, eGFR >80 ml/min/1.73 m2, UACR <30 mmol/g, BMI 18-35 and provision of written informed consent. Exclusion criteria for the diabetic group were any apparent cause/s of CKD other than diabetes, previous kidney transplantation, pregnancy, contraindication for MRI examination, heart failure (NYHA class III or IV), allergies to iodine-based contrast agents. Factors that excluded healthy participants were pregnancy, contraindication for MRI examination, allergy to iodine-based contrast agents and any active or chronic disease/diagnosis. Measured GFR (mGFR) was assessed in all participants using iohexol clearance. An MRI scan using a wide range of non-contrast techniques was performed at baseline. Total scan time for patients did not exceed 45 min per session and no gadolinium-based contrast agents were used in any of the MRI examinations. All patients with incidental findings on MRI were further evaluated and referred to appropriate specialists for management. Results A total of 38 T2DM patients with CKD and 20 age- and gender-matched healthy volunteers who completed the study were included in the analysis. Of the T2DM patients, 2 were found to have CKD stage 2 by mGFR and 36 CKD stages 3–4. Clinically significant incidental findings (excluding 4 cases of renal cysts requiring only follow-up without further intervention) were found in 13 of the 38 (34%) T2DM patients. The most frequent findings were intraductal papillary mucinous neoplasm (IPMN) in 7 patients, followed by 3 cancers (1 case of kidney cancer, 1 bladder cancer and 1 lymphoma) and 3 cases of adrenal gland mass later diagnosed to be benign adenoma on further investigation. In contrast, of the 20 healthy volunteers, 2 (10%) were found to have significant incidental findings, which were IPMN in both. The follow-up duration varied between 2-6 years. The patient with bladder cancer had metastatic disease and died shortly after the diagnosis, the one with kidney cancer is under observation and the one with lymphoma underwent adequate treatment and is under remission. The cases of IPMN are being followed up regularly at our surgical department. Conclusion Clinically important incidental findings on renal MRI appear to be more common in T2DM patients than in healthy volunteers, which would have been missed without MRI examination. Mechanisms for reporting and strategies for dealing with incidental findings need to be taken into account in such investigational imaging studies. The detection of incidental findings also poses various practical and ethical issues. Further larger studies with long-term follow-up are needed to delineate the clinical relevance, natural course and management of such incidental findings.

Application value of real-time shear wave elastography for quantitative evaluation of chronic kidney disease in pediatric patients.

To evaluate the effectiveness of real-time shear wave elastography (SWE) in quantitative evaluation of chronic kidney disease (CKD) in pediatric patients. SWE was conducted on 58 pediatric patients with CKD (CKD group) and 70 healthy volunteers (Control group). Computer-assisted quantitative analysis was utilized to determine the percentage of interstitial fibrosis (IF) in images from the CKD group, categorizing them into mild, moderate, and severe groups according to IF% values. The differences in Young's modulus (YM) and estimated Glomerular Filtration Rate (eGFR) between the renal cortex and medulla in these groups were compared. Additionally, the relationships between YM and IF% as well as YM and eGFR, were analyzed. The YM values in right lower pole cortex and medulla of the CKD group were significantly higher than those in the control group (all P < 0.05). Significant differences were observed in eGFR among mild, moderate, and severe CKD patients (F = 40.882). YM demonstrated a correlation with eGFR in both the renal cortex and medulla (r = -0.329, P = 0.012; r = 0.417, P = 0.001). YM values increased with the severity of renal interstitial fibrosis in a pronounced trend across groups (F = 109.962, F = 72.950, all P < 0.001). Additionally, YM correlated with IF% in both the renal cortex and medulla (r = 0.362, P = 0.006; r = 0.483, P < 0.001). The optimal cut-off value of renal cortex YM for distinguishing between CKD and control group was 4.05 kPa. SWE enables quantitative assessment of kidney YM values, revealing significantly higher values in children with CKD compared to healthy individuals. YM is correlated with the severity of renal interstitial fibrosis, thereby establishing SWE as a valuable non-invasive tool for quantitative evaluation of pediatric CKD.

An alkaline ferrocyanide non-enzymatic electrochemical sensor for creatinine detection

Creatinine is a useful metabolite for the evaluation of Chronic Kidney Disease (CKD). Creatinine concentrations in urine outside of the healthy range of 4 to 15 mM may indicate CKD and other kidney conditions. Early detection and monitoring can provide lifesaving intervention, and as such there is a need to develop rapid, cheap and selective electrochemical creatinine sensors. A simple non-enzymatic creatinine sensing platform enabled by the electrocatalytic response of the metabolite to ferricyanide in alkaline conditions is presented. Studies were made on unmodified glassy carbon (GCE) and screen printed carbon electrodes (SPCE), both giving sensitivity of 21 ± 5 µA mM−1 cm−2 and limit of detection of ca. 60 µM.

Comparison of cystocentesis versus home sampling to determine urinary protein: Creatinine ratio and urine specific gravity in cats.

Urinalysis is necessary for the diagnostic evaluation of chronic kidney disease in cats. Performing cystocentesis is not always feasible, but data comparing urine obtained by cystocentesis in the clinic with voided samples collected at home are lacking in cats. To compare urinary protein:creatinine ratio (UPC) and urine specific gravity (USG) and to detect clinically relevant changes in proteinuria substage or urine concentration between urine collected at home and in-clinic by cystocentesis in cats. Ninety-two healthy and diseased client-owned cats. Prospective study. Owners collected voided urine at home and within 1 to 15 hours, cystocentesis was performed in the clinic. In a subset of motivated owners, 55% succeeded in collecting urine at home. Overall, UPC was higher (mean ±SD difference = 0.09 ±0.22; P < .001) and USG was lower (mean ±SD difference = -0.006 ±0.009; P < .001) in cystocentesis samples than in voided urine. Substantial agreement existed between sampling methods for UPC (weighted к = 0.68) and USG (к = 0.64) categories. A different proteinuria substage (UPC < 0.2, 0.2-0.4, >0.4) was present in paired urine samples from 28% of cats. In 18% of cats, urine concentrating ability (USG < or ≥1.035) differed between both samples. Home sampling of urine is a valid alternative to cystocentesis in cats. However, because clinically relevant differences in UPC and USG were present in 28% and 18% of cats, respectively, by the same collection method for monitoring each cat is advised.

Renal Resistive Index: Revisited.

Introduction Chronic kidney disease (CKD) is universally considered a public health burden and the majority of cases are found to be diabetic at the time of diagnosis. Renal biopsy is the prime modality for the complete evaluation of renal injuriesbut is invasive. Duplex Doppler sonography can help to determine renal resistive index (RRI), which is an excellent marker for demonstrating dynamic or structural changes of intrarenal vessels. In this study, we evaluated the intrarenal hemodynamic abnormalities with RRI in diabetic and non-diabetic kidney disease patients. Also, RRI was correlated with the established parameters of renal dysfunction, i.e., estimated glomerular filtration rate (eGFR) and other biochemical parameters. Results There was a significant correlation of RRI with eGFR and serum creatinine indicating its role as a Doppler parameter, which can be used as complementary to biochemical parameters. A remarkable difference was noted in the RRI values between diabetic and non-diabetic groups in the early stages of CKD, revealing its ability to arrive at etiopathogenesis in the early stages. The renal resistive index increases in a sequential pattern and is an indicator of declining renal function. Conclusions The addition of sonographic parameters like renal resistive index could help in the complete evaluation of chronic kidney disease in diabetic and non-diabetic groups. A sequential increase in renal resistive index is a better indicator of the progressive worsening of renal function as opposed to an absolute cut-off value.

A comparative assessment of artificial intelligence models used for early prediction and evaluation of chronic kidney disease

Chronic Kidney Disease (CKD) is one of the most prevalent and fatal diseases influencing people on a larger that remains dormant until irreversible damage has been done to an individual’s kidney. Progression of CKD is related to a variety of great complications, including increased incidence of various disorders, anemia, hyperlipidemia, nerve damage, pregnancy complication, and even complete kidney failure. Millions of people die from this disease every year. Diagnosing CKD is a cumbersome task as no major symptoms can be used as a benchmark to detect the disease. In cases when diagnosis persists, some results may be interpreted incorrectly. This study proposes using a deep neural network-based Multi-Layer Perceptron Classifier to diagnose CKD in patients. The model was trained using data from 400 people and considered various symptoms and signs, including age, blood sugar, red blood cell count, etc. Experiments reveal that the proposed model achieves perfect testing accuracy in classification tasks. Our goal is to facilitate introducing Deep Learning approaches to learning from the dataset attribute reports and accurately detecting CKD. The paper’s primary contribution is a Deep Neural Network model for chronic kidney disease diagnosis that achieves 100% accuracy, outperforming standard machine learning models such as support vector machines and naive Bayes classifiers. This paper provides a detailed explanation of the multi-layer perceptron classifier, which uses the deep neural network provided by the PyTorch library as its basis. Neural models can be a better alternative for adaption techniques for classifying chronic kidney disease Because they can handle non-linearity in the data, compute complex data heaps fetched from datasets, and adapt and learn on their own about the key information using the layers of neurons present in the structure.

Evaluation of Chronic Kidney Disease in Sudden Death Cases – A One Year Autopsy Study in Tertiary Care Hospital

Autopsy is the ultimate diagnostic test, typically the gold standard with an assumed 100% sensitivity for establishing the causes of death. Medicolegal autopsies are conducted in cases of sudden, suspicious and unnatural deaths. The frequency and spectrum of renal pathologies on medicolegal autopsy specimens are not well documented in the literature. Our study aimed at diseases in sudden death cases based on the histomorphological findings by microscopical examination of renal tissue. Kidney specimens of 120 Medicolegal autopsy cases were received, processed and examined in our department over a period of 2 years. Out of 120 cases chronic kidney cases (CKD) was identified in 45 ( 37.5%) cases. In our study 28 cases were male (62.22%) and 17 cases were female (37.78%). The different lesions suggesting CKD were, glomerulosclerosis 2 cases (4.44%), Chronic pyelonephritis in 6 (13.33%) cases, Vascular sclerosis 32 cases (71.11%) and in 5 cases (11.11%) interstitial nephritis. This study analyzed various entities of chronic kidney disease found in medicolegal autopsies. These entities either contribute or directly responsible for the death of the individuals.

The Use of 99mTc-Labeled Stem Cells for Evaluation of Chronic Kidney Disease.

The labeling of stem cells with radionuclides allows in vivo monitoring of cell migration and homing. Here, we describe the labeling of mononuclear stem cells with 99mTc and show their biodistribution in preclinical models and patients with chronic kidney disease.

Evaluation of serum Cystatin C as an early diagnostic marker in non-dialysis CKD patients as compared to serum creatinine.

Objective: To test the hypothesis that Serum cystatin C is an early diagnostic marker in non-dialysis CKD patients as compared to serum creatinine. Study Design: Descriptive, Cross Sectional OPD/ Hospital Based study. Setting: Department of Biochemistry and Nephrology, Jinnah Postgraduate Medical Centre, Karachi. Period: January 2018 to December 2018. Material &amp; Methods: Study subjects included the diagnosed cases of Chronic Kidney Disease (CKD) up to 4th stage with exclusion of patients on dialysis. A total 90 subjects of age above 18 years who were presenting to the Nephrology clinic of JPMC for screening and evaluation of chronic kidney disease were recruited after applying inclusion and exclusion criteria. Results: There was significant mean difference in all eGFR across studied groups with p-value lower than 0.05. Cystatin C based calculation of GFR is lower in all three groups (86.33±13.08, 18.73±8.44, 73.30±12.23) as compared to GFR calculated based on serum creatinine (102.33±17.84, 30.00±11.59,. Our study was also suggestive that the sensitivity of serum Cystatin C is higher as compared to creatinine for detection of reduced GFR. Conclusion: Our study shows that cystatin C is a reliable indicator of estimating kidney functions as compared to serum creatinine. A possible advantage of cystatin C is that being a large molecule, its blood levels might rise sooner than that of creatinine.

Establishment and Evaluation of Artificial Intelligence-Based Prediction Models for Chronic Kidney Disease under the Background of Big Data.

Objective To establish a prediction model for the risk evaluation of chronic kidney disease (CKD) to guide the management and prevention of CKD. Methods A total of 1263 patients with CKD and 1948 patients without CKD admitted to the Tongde Hospital of the Zhejiang Province from January 1, 2008, to December 31, 2018, were retrospectively analyzed. Spearman's correlation was used to analyze the relationship between CKD and laboratory parameters. XGBoost, random forest, Naive Bayes, support vector machine, and multivariate logistic regression algorithms were employed to establish prediction models for the risk evaluation of CKD. The accuracy, precision, recall, F1 score, and area under the receiver operating curve (AUC) of each model were compared. The new bidirectional encoder representations from transformers with light gradient boosting machine (MD-BERT-LGBM) model was used to process the unstructured data and transform it into researchable unstructured vectors, and the AUC was compared before and after processing. Results Differences in laboratory parameters between CKD and non-CKD patients were observed. The neutrophil ratio and white blood cell count were significantly associated with the occurrence of CKD. The XGBoost model demonstrated the best prediction effect (accuracy = 0.9088, precision = 0.9175, recall = 0.8244, F1 score = 0.8868, AUC = 0.8244), followed by the random forest model (accuracy = 0.9020, precision = 0.9318, recall = 0.7905, F1 score = 0.581, AUC = 0.9519). Comparatively, the predictions of the Naive Bayes and support vector machine models were inferior to those of the logistic regression model. The AUC of all models was improved to some extent after processing using the new MD-BERT-LGBM model. Conclusion The new MD-BERT-LGBM model with the inclusion of unstructured data has contributed to the higher accuracy, sensitivity, and specificity of the prediction models. Clinical features such as age, gender, urinary white blood cells, urinary red blood cells, thrombin time, serum creatinine, and total cholesterol were associated with CKD incidence.

Diagnosis, Classification, and Evaluation of Chronic Kidney Disease

Diagnosis, Classification, and Evaluation of Chronic Kidney Disease

Integrating Point of Care Ultrasound into Nephrology Fellowship Training: Insights from a Pilot Program.

In nephrology, point-of-care ultrasound (POCUS) has multiple applications including the rapid evaluation of acute kidney injury, enhancing the initial evaluation of chronic kidney disease, direct evaluation of vascular access, and improved fluid balance management in acute and chronic settings [1, 2]. Recently, the role of POCUS has been formally acknowledged by the American College of Physicians and curricula specific to nephrology have been proposed [3, 4]. However, the integration of a novel clinical skill into a field comes with its unique set of challenges. Above all, most nephrologists in leadership roles within fellowship training programs lack POCUS experience, which represent a significant barrier for adequate exposure and teaching. Although educational curriculum centered on nephrology have been proposed, the optimal model to ensure adequate POCUS exposure considering the scarcity of expertise among educators is not known.

Features of adipokine status in hypertensive patients with chronic kidney disease

The study aimed at optimization of diagnosis and evaluation of chronic kidney disease (CKD) in hypertensive patients by studying the role of adipokines (leptin, omentin, visfatin, resistin) in patients with hypertension combined with chronic kidney di­sease. Materials and methods. The study enrolled 100 patients with hypertension of II and III degrees of Stage 2, of which 51 patients were diagnosed with chronic kidney disease. The control group consisted of 20 apparently healthy people. Results. Our study showed that leptin, omentin, resistin, and visfatin levels were significantly higher in patients with essential hypertension (EH) combined with CKD, in contrast to patients with EH without CKD and in the control group. The results of the Kraskel-Wallis dispersion analysis demonstrated that in patients with EH combined with CKD, adipokines significantly correlated with systolic blood pressure (BP), diastolic blood pressure, hypertension degree, body mass index, low-density lipoproteins, thyroglobulin, glomerular filtration rate, creatinine, end-diastolic size, relative wall thickness index, left ventricular myocardial mass, left ventricular myocardial mass index, presence of diastolic dysfunction, type of diastolic function. Conclusions. Hypertensive patients with CKD presented with a significant increase in adipokine levels (leptin, omentin, resistin, visfatin) in the blood compared to patients with EH without CKD (p &lt; 0.05) and apparently healthy individuals (p&lt; 0.05). The data obtained indicate that adipokines (leptin, omentin, resistin, visfatin) have a significant pathogenetic role in patients with hypertension combined with chronic kidney disease.

Usefulness of Contrast-enhanced Ultrasound in the Evaluation of Chronic Kidney Disease.

BackgroundContrast-enhanced ultrasound (CEUS) can provide more improved images of renal blood flow and much more information of both macro- and microcirculation of the kidney as compared to Doppler US.ObjectiveTo investigate the usefulness of CEUS by analyzing differences in perfusion-related parameters among the three chronic kidney disease (CKD) subgroups and the control group.MethodsThirty-eight patients with CKD and 21 controls who were age-matched (20−49 years) were included. Included CKD patients were stratified into three groups according to their eGFR: group I, eGFR ≥ 60 ml/min/1.73 m2 (GFR category I and II); group II, 30 ml/min/1.73 m2 ≤ eGFR < 60 ml/min/1.73 m2 (GFR category III); and group III, eGFR < 30 ml/min/1.73 m2 (GFR category IV and V). Comparisons with the controls (eGFR > 90 ml/min/1.73 m2) were performed. Real-time and dynamic renal cortex imaging was performed using CEUS. Time-intensity curves and several bolus model quantitative perfusion parameters were created using the VueBox® quantification software. We compared the parameters among the CKD subgroups and between the CKD and control groups.ResultsEight patients were included in group I, 12 patients in group II, and 18 patients in group III. Significant differences were noted in the wash-in and wash-out rates between the CKD and control groups (p = 0.027 and p = 0.018, respectively), but not between those of the CKD subgroups. There were no significant differences of other perfusion parameters among the CKD subgroups and between the CKD and control groups.ConclusionA few perfusion related CEUS parameters (WiR and WoR) can be used as markers of renal microvascular perfusion relating renal function. CEUS can effectively and quantitatively exhibit the renal microvascular perfusion in patients with CKD as well as normal control participants.

Sonographic Evaluation of Chronic Kidney Disease Correlating with Serum Creatinine Level

Background: Chronic kidney disease is defined as abnormality of urinary system, there is persistent abnormality of structure and upward renal excretory function that is sign of irreversible damage to function of nephron. It is a public health problem world widely and it is 12 th most common cause of mortality and morbidity, respectively. Objective: To evaluate chronic kidney disease (CKD) sonographically in addition correlating echogenicity with the level of serum creatinine. Study Design: An analytical Cross sectional prospective study. Settings: Life Care Hospital, Radiology department Lahore. Period: 20 th December 2020 till 10 th April 2021. Material & Methods: In our study all those patients with age above 18, patients suffering from chronic kidney disease, patient on hemodialysis, diabetic and hypertensive were included. While patient below 18 age, patients on peritoneal dialysis were excluded in which 71 patients were enrolled in the research. All the patient’s data had been composed from indoor of hospital, outdoor of hospital, and emergency department of Life Care Hospital, Lahore. After informed consent, data was composed through ultrasound machine Toshiba Xario Prime. Results: The findings revealed that there were 71 Chronic Renal Failure patients, 45 of whom were male and 26 of whom were female, with ages ranging from 20 to 73. Since the P value is > 0.05 of the relevance indicators, there is no important relationship between the two variables. Conclusion: The ideal sonographic parameter that can be used to correlate the level of serum creatinine with kidney parameter within ultrasound is kidney cortical echogenicity. As kidney cortical echogenicity does not reverses as the disease progress even after the treatment, so it is the most accurate parameter that can be used. Keywords: Chronic kidney disease, Echogenicity grade, Serum creatinine, Ultrasound, estimated Glomerular Filtration rate. DOI: 10.7176/JHMN/90-05 Publication date: June 30 th 2021

Recent advances in medical image processing for the evaluation of chronic kidney disease

Assessment of renal function and structure accurately remains essential in the diagnosis and prognosis of Chronic Kidney Disease (CKD). Advanced imaging, including Magnetic Resonance Imaging (MRI), Ultrasound Elastography (UE), Computed Tomography (CT) and scintigraphy (PET, SPECT) offers the opportunity to non-invasively retrieve structural, functional and molecular information that could detect changes in renal tissue properties and functionality. Currently, the ability of artificial intelligence to turn conventional medical imaging into a full-automated diagnostic tool is widely investigated. In addition to the qualitative analysis performed on renal medical imaging, texture analysis was integrated with machine learning techniques as a quantification of renal tissue heterogeneity, providing a promising complementary tool in renal function decline prediction. Interestingly, deep learning holds the ability to be a novel approach of renal function diagnosis. This paper proposes a survey that covers both qualitative and quantitative analysis applied to novel medical imaging techniques to monitor the decline of renal function. First, we summarize the use of different medical imaging modalities to monitor CKD and then, we show the ability of Artificial Intelligence (AI) to guide renal function evaluation from segmentation to disease prediction, discussing how texture analysis and machine learning techniques have emerged in recent clinical researches in order to improve renal dysfunction monitoring and prediction. The paper gives a summary about the role of AI in renal segmentation.

Applicability of B-mode ultrasonography, ARFI elastography and contrast-enhanced ultrasound in the evaluation of chronic kidney disease in dogs

ABSTRACT: The objective of this study was to verify the applicability of B-mode ultrasonography, ARFI elastography and CEUS in the diagnosis of chronic kidney disease and its Stages in dogs. 24 healthy dogs and 28 with CKD were included. In B-mode, the echogenicity, echotexture and cortico-medullary ratio of the kidneys were verified. By elastography, the shear-wave velocity of the cortical (SWVcort) and medullary (SWVmed) regions were determined and tissue deformity was evaluated. Wash-in, wash-out and peak enhancement (TPic) of the contrast in the renal parenchyma were calculated and homogeneity, presence of filling gaps and distinction of filling phases were evaluated by CEUS. Changes in echogenicity, echotexture and cortico-medullary ratio were observed only in sick patients. There was an increase in SWVcort in CKD, with a cutoff point &gt;2.91m/s. Healthy kidneys were non-deformable and 25% had changes in gray scales. There was an increase in wash-in and TPic, changes in filling characteristics, filling failures and difficulty in distinguishing between the Stages in CEUS in CKD. It was found that dogs with CKD 2, 3 and 4 had greater SWVcort and wash-in values than CKD 1. Elastographic and CEUS changes were observed in dogs with CKD, demonstrating the applicability of ultrasonographic techniques in their diagnosis.

Improving Prognostic and Chronicity Evaluation of Chronic Kidney Disease with Contrast‐Enhanced Ultrasound Index-Derived Peak Intensity

The capability of contrast‐enhanced ultrasound (CEUS) to assess the prognosis and chronicity of chronic kidney disease (CKD) was evaluated in patients diagnosed with CKD in 2014 at Ren Ji Hospital, Shanghai, China. Time–intensity curves and quantitative indexes were created using QLab quantification software. Kidney biopsies were analyzed with α-smooth muscle actin immunohistochemistry. According to the renal chronicity score, patients were divided into four groups: minimal (n = 14), mild (n = 73), moderate (n = 49) and severe (n = 31). Multivariate logistic regression analysis revealed that the derived peak intensity (DPI) was independently associated with the renal chronicity score. Of 167 CKD patients (median follow-up: 30.4 ± 18.7 mo), 31 (18.6%) exhibited CKD progression, with a decline in the glomerular filtration rate of more than 25% or end-stage renal disease. Multivariate Cox regression analysis revealed that a lower DPI was independently associated with CKD progression. This study indicates that DPI is a reliable CEUS parameter for evaluating chronic renal changes and an independent prognostic factor of CKD.