Zhang Xin, Zhu Xiangyang, Ferguson Christopher Martyn, Jiang Kai, Burningham Tyson, Lerman Amir, Lerman Lilach Orly
Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
MAGMA. 2018 Jun;31(3):375-382. doi: 10.1007/s10334-017-0671-7. Epub 2017 Dec 30.
Low-energy shockwave (SW) therapy attenuates damage in the stenotic kidney (STK) caused by atherosclerotic renal artery stenosis (ARAS). We hypothesized that magnetic resonance elastography (MRE) would detect attenuation of fibrosis following SW in unilateral ARAS kidneys.
Domestic pigs were randomized to control, unilateral ARAS, and ARAS treated with 6 sessions of SW over 3 consecutive weeks (n = 7 each) starting after 3 weeks of ARAS or sham. Four weeks after SW treatment, renal fibrosis was evaluated with MRE in vivo or trichrome staining ex vivo. Blood pressure, single-kidney renal-blood-flow (RBF) and glomerular-filtration-rate (GFR) were assessed.
MRE detected increased stiffness in the STK medulla (15.3 ± 2.1 vs. 10.1 ± 0.8 kPa, p < 0.05) that moderately correlated with severity of fibrosis (R = 0.501, p < 0.01), but did not identify mild STK cortical or contralateral kidney fibrosis. Trichrome staining showed that medullary fibrosis was increased in ARAS and alleviated by SW (10.4 ± 1.8% vs. 2.9 ± 0.2%, p < 0.01). SW slightly decreased blood pressure and normalized STK RBF and GFR in ARAS. In the contralateral kidney, SW reversed the increase in RBF and GFR.
MRE might be a tool for noninvasive monitoring of medullary fibrosis in response to treatment in kidney disease.
低能量冲击波（SW）疗法可减轻动脉粥样硬化性肾动脉狭窄（ARAS）所致狭窄肾脏（STK）的损伤。我们推测磁共振弹性成像（MRE）能够检测单侧ARAS肾脏在接受SW治疗后纤维化的减轻情况。
将家猪随机分为对照组、单侧ARAS组以及在ARAS或假手术3周后开始连续3周接受6次SW治疗的ARAS组（每组n = 7）。SW治疗4周后，采用MRE进行体内肾纤维化评估，或采用三色染色进行体外评估。评估血压、单肾肾血流量（RBF）和肾小球滤过率（GFR）。
MRE检测到STK髓质硬度增加（15.3±2.1 vs. 10.1±0.8 kPa，p < 0.05），其与纤维化严重程度呈中度相关（R = 0.501，p < 0.01），但未识别出轻度STK皮质或对侧肾脏纤维化。三色染色显示，ARAS组髓质纤维化增加，而SW治疗可使其减轻（10.4±1.8% vs. 2.9±0.2%，p < 0.01）。SW可使ARAS组血压略有下降，并使STK的RBF和GFR恢复正常。在对侧肾脏，SW可逆转RBF和GFR的升高。
MRE可能是一种用于无创监测肾脏疾病治疗反应中髓质纤维化的工具。
