Hassan Kamal, Loberant Norman, Abbas Nur, Fadi Hassan, Shadia Hassan, Khazim Khaled
Faculty of Medicine in the Galilee, Bar-Ilan University, Safed; Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center.
Department of Radiology, Galilee Medical Center, Nahariya.
Ther Clin Risk Manag. 2016 Nov 7;12:1615-1622. doi: 10.2147/TCRM.S118465. eCollection 2016.
The assessment of the grade of renal fibrosis in diabetic kidney disease (DKD) requires renal biopsy, which may be associated with certain risks. To assess the severity of chronic pathologic changes in DKD, we performed a quantitative analysis of renal parenchymal stiffness in advanced DKD, using shear wave elastography (SWE) imaging.
Twenty-nine diabetic patients with chronic kidney disease (CKD) grades 3-4 due to DKD, and 23 healthy subjects were enrolled. Combined conventional ultrasound and SWE imaging were performed on all participants. The length, width, and cortical thickness and stiffness were recorded for each kidney.
Cortical thickness was lower in patients with DKD than in healthy subjects (13.8±2.2 vs 14.8±1.6 mm; =0.002) and in DKD patients with CKD grade 4 than in those with grade 3 (13.0±3.5 vs 14.7±2.1 mm; <0.001). Cortical stiffness was greater in patients with DKD than in healthy subjects (23.72±14.33 vs 9.02±2.42 kPa; <0.001), in DKD patients with CKD grade 4 than in those with grade 3 (30.4±16.2 vs 14.6±8.1 kPa; <0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (15.7±6.7 vs 11.0±4.2 kPa; =0.03). Daily proteinuria was higher in DKD patients with CKD grade 4 than in those with grade 3 (5.52±0.96 vs 1.13±0.72; =0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (1.59±0.59 vs 0.77±0.48; <0.001). Cortical stiffness was inversely correlated with the estimated glomerular filtration rate (=-0.65, <0.001) and with cortical thickness (=-0.43, <0.001) in patients with DKD.
In patients with advanced DKD, SWE imaging may be utilized as a simple and practical method for quantitative evaluation of the chronic morphological changes and for the differentiation between CKD grades.
糖尿病肾病（DKD）肾纤维化程度的评估需要进行肾活检，而这可能伴有一定风险。为评估DKD慢性病理改变的严重程度，我们使用剪切波弹性成像（SWE）对晚期DKD患者的肾实质硬度进行了定量分析。
纳入29例因DKD导致慢性肾脏病（CKD）3 - 4级的糖尿病患者以及23名健康受试者。对所有参与者进行了常规超声和SWE成像检查。记录每个肾脏的长度、宽度、皮质厚度及硬度。
DKD患者的皮质厚度低于健康受试者（13.8±2.2 vs 14.8±1.6 mm；P = 0.002），且CKD 4级的DKD患者低于3级患者（13.0±3.5 vs 14.7±2.1 mm；P < 0.001）。DKD患者的皮质硬度高于健康受试者（23.72±14.33 vs 9.02±2.42 kPa；P < 0.001），CKD 4级的DKD患者高于3级患者（30.4±16.2 vs 14.6±8.1 kPa；P < 0.001），CKD 3b级的DKD患者高于3a级患者（15.7±6.7 vs 11.0±4.2 kPa；P = 0.03）。CKD 4级的DKD患者每日蛋白尿高于3级患者（5.52±0.96 vs 1.13±0.72；P = 0.001），CKD 3b级的DKD患者高于3a级患者（1.59±0.59 vs 0.77±0.48；P < 0.001）。DKD患者的皮质硬度与估计肾小球滤过率呈负相关（r = -0.65，P < 0.001），与皮质厚度也呈负相关（r = -0.43，P < 0.001）。
在晚期DKD患者中，SWE成像可作为一种简单实用的方法，用于定量评估慢性形态学改变以及区分CKD分级。
