Bhutani Harpreet, Smith Vikram, Rahbari-Oskoui Frederic, Mittal Ankush, Grantham Jared J, Torres Vicente E, Mrug Michal, Bae Kyongtae T, Wu Zhiyuan, Ge Yinghui, Landslittel Doug, Gibbs Patrice, O'Neill W Charles, Chapman Arlene B
Emory University, Atlanta, Georgia, USA.
Kansas University, Lawrence, Kansas, USA.
Kidney Int. 2015 Jul;88(1):146-51. doi: 10.1038/ki.2015.71. Epub 2015 Apr 1.
Autosomal dominant polycystic kidney disease (ADPKD) is marked by gradual renal cyst and kidney enlargement and ultimately renal failure. Magnetic resonance-based, height-adjusted total kidney volume (htTKV) over 600 cc/m predicts the development of CKD stage 3 within 8 years in the Consortium for Radiologic Imaging in Polycystic Kidney Disease cohort. Here we compared simultaneous ultrasound and magnetic resonance imaging to determine whether ultrasound and kidney length (KL) predict future CKD stage 3 over longer periods of follow-up. A total of 241 ADPKD patients, 15-46 years, with creatinine clearance of 70 ml/min and above had iothalamate clearance, magnetic resonance, and ultrasound evaluations. Participants underwent an average of five repeat clearance measurements over a mean follow-up of 9.3 years. Ultrasound and magnetic resonance-based TKV and KL were compared using Bland-Altman plots and intraclass correlations. Each measure was tested to predict future CKD stage 3. Relatively strong intraclass correlations between ultrasound and magnetic resonance were found for both htTKV and KL (0.81 and 0.85, respectively). Ultrasound and magnetic resonance-based htTKV and KL predicted future CKD stage 3 similarly (AUC of 0.87, 0.88, 0.87, and 0.88, respectively). An ultrasound kidney length over 16.5 cm and htTKV over 650 ml/min had the best cut point for predicting the development of CKD stage 3. Thus, kidney length alone is sufficient to stratify the risk of progression to renal insufficiency early in ADPKD using either ultrasound or magnetic resonance imaging.
常染色体显性多囊肾病（ADPKD）的特征是肾囊肿逐渐形成、肾脏增大，最终发展为肾衰竭。在多囊肾病队列放射影像学联盟中，基于磁共振成像的身高校正后的总肾体积（htTKV）超过600 cc/m可预测8年内慢性肾脏病3期的发生。在此，我们比较了同步超声和磁共振成像，以确定超声和肾长（KL）在更长的随访期内是否能预测未来的慢性肾脏病3期。共有241例年龄在15 - 46岁、肌酐清除率在70 ml/min及以上的ADPKD患者接受了碘他拉酸盐清除率、磁共振成像和超声评估。参与者在平均9.3年的随访期间平均接受了5次重复清除率测量。使用布兰德-奥特曼图和组内相关性比较基于超声和磁共振成像的总肾体积和肾长。对每项测量指标进行测试以预测未来的慢性肾脏病3期。在htTKV和KL方面，超声与磁共振成像之间发现了相对较强的组内相关性（分别为0.81和0.85）。基于超声和磁共振成像的htTKV和KL对未来慢性肾脏病3期的预测相似（曲线下面积分别为0.87、0.88、0.87和0.88）。超声肾长超过16.5 cm且htTKV超过650 ml/min对预测慢性肾脏病3期的发生具有最佳切点。因此，单独使用超声或磁共振成像，肾长就足以在ADPKD早期对进展为肾功能不全的风险进行分层。
