Armaly Zaher, Abu-Rahme Munai, Kinaneh Safa, Hijazi Basem, Habbasshi Nayef, Artul Suheil
Department of Nephrology, Nazareth Hospital-EMMS, Nazareth and the Azrieli Faculty of Medicine, Bar Ilan University, Zafed 1330311, Israel.
Administration Department, Azrieli Faculty of Medicine, Bar Ilan University, Zafed 1330311, Israel.
J Clin Med. 2022 Feb 10;11(4):925. doi: 10.3390/jcm11040925.
Superb microvascular imaging (SMI) is an innovative ultrasound image processing technique that provides greater detail and better visualization of small branching vessels. We assume that SMI will provide sufficient information regarding the severity of chronic kidney disease (CKD) and reflecting histological changes.
The aims was to assess the capabilities of SMI imaging regarding the early detection of kidney dysfunction and renal fibrosis in comparison to the reference standard renal biopsy for the early diagnosis of kidney fibrosis.
SMI was performed in patients ( = 52) with CKD stage 2-5, where some of them underwent biopsy proven CKD and fibrosis as part of the diagnosis. In addition, biochemical tests were performed, including kidney function tests, urine collection for proteinuria, and the estimation of GFR by MDRD or CKD-EPI eGFR in CKD patients and healthy controls ( = 17). All subjects underwent SMI, where vascularity is expressed as the SMI index (a low index reflects low vascularity/fibrosis and vice versa).
The SMI vascular index was significantly lower in CKD patients as compared with healthy controls (72.2 ± 12.9 vs. 49.9 ± 16.7%, < 0.01). Notably, a moderate correlation between the SMI index and eGFR was found among the CKD patients (r = 0.56, < 0.001). Similarly, a strong correlation was found between SCr and the SMI index of the diseased subjects (r = -0.54, < 0.001). In patients who underwent renal biopsy, the SMI index corresponded with the histological alterations and CKD staging.
This study demonstrated that SMI imaging may be utilized in CKD patients of various stages for the evaluation of chronic renal morphological changes and for differentiation between CKD grades.
超微血管成像（SMI）是一种创新的超声图像处理技术，能提供更详细的信息并更好地显示小分支血管。我们假设SMI将提供有关慢性肾脏病（CKD）严重程度的充分信息并反映组织学变化。
目的是评估SMI成像在早期检测肾功能障碍和肾纤维化方面的能力，并与用于早期诊断肾纤维化的参考标准肾活检进行比较。
对52例2 - 5期CKD患者进行了SMI检查，其中部分患者作为诊断的一部分接受了活检证实的CKD和纤维化检查。此外，还进行了生化检查，包括肾功能检查、收集尿液检测蛋白尿，以及通过MDRD或CKD - EPI估算肾小球滤过率（eGFR），涉及CKD患者和健康对照者（17例）。所有受试者均接受SMI检查，血管情况用SMI指数表示（低指数反映低血管化/纤维化，反之亦然）。
与健康对照者相比，CKD患者的SMI血管指数显著更低（72.2±12.9%对49.9±16.7%，P<0.01）。值得注意的是，在CKD患者中发现SMI指数与eGFR之间存在中度相关性（r = 0.56，P<0.001）。同样，在患病受试者中发现血清肌酐（SCr）与SMI指数之间存在强相关性（r = -0.54，P<0.001）。在接受肾活检的患者中，SMI指数与组织学改变和CKD分期相符。
本研究表明，SMI成像可用于各阶段CKD患者，以评估慢性肾脏形态学变化并区分CKD分级。
