Kuttancheri Theertha, Krishnan Kavitha, Das Sudha Kiran, Shetty Manjunath Sanjeeva
Department of Radiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India.
Department of Nephrology, JSS medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India.
Pol J Radiol. 2023 Jun 14;88:e286-e293. doi: 10.5114/pjr.2023.128694. eCollection 2023.
Chronic kidney disease (CKD) is recognized as a major worldwide health problem. For all CKD, intra-renal fibrosis is a final common pathway that can be correlated with disease severity. Tissue stiffness can be measured non-invasively using shear wave elastography. This study evaluates the use of Young's modulus derived by SWE as a biomarker that can distinguish normal from diseased kidneys. Also, Young's modulus was correlated with Doppler findings and estimated glomerular filtration rate (eGFR).
This prospective study was performed in 2 phases, in which initially 50 CKD patients and 50 controls were studied to arrive at a median Young's modulus value in both the groups. In the later phase, a cross-sectional comparative study was conducted on 58 diabetic and 56 non-diabetic patients with SWE and renal Doppler, and the findings were correlated in various stages of CKD.
Using Young's modulus, the renal cortex elasticity of CKD patients was shown to be considerably reduced as compared to normal kidneys. There was significant correlation between Young's modulus, eGFR, and renal resistive index. Young's modulus values did not show significant differences between diabetic and non-diabetic groups, revealing its inability to arrive at the aetiopathogenesis of CKD.
Correlation of renal tissue Young's modulus with eGFR suggests that SWE may be used as an indicator of renal tissue injuries in CKD patients. SWE can never replace the gold standard biopsy, but it can be used for staging of CKD. Even though SWE cannot predict the aetiopathogenesis of CKD, it may be a low-cost way to provide additional diagnostic information in CKD.
慢性肾脏病（CKD）被公认为是一个全球性的主要健康问题。对于所有CKD患者而言，肾内纤维化是最终的共同病理途径，且与疾病严重程度相关。组织硬度可通过剪切波弹性成像技术进行无创测量。本研究评估了用剪切波弹性成像（SWE）得出的杨氏模量作为区分正常肾脏与患病肾脏生物标志物的应用情况。此外，还将杨氏模量与多普勒检查结果及估算肾小球滤过率（eGFR）进行了相关性分析。
本前瞻性研究分两个阶段进行，第一阶段对50例CKD患者和50例对照者进行研究，以得出两组的杨氏模量中值。在第二阶段，对58例糖尿病患者和56例非糖尿病患者进行了SWE及肾脏多普勒的横断面比较研究，并将研究结果与CKD的各个阶段进行了相关性分析。
与正常肾脏相比，CKD患者的肾皮质弹性通过杨氏模量显示明显降低。杨氏模量、eGFR和肾阻力指数之间存在显著相关性。糖尿病组和非糖尿病组的杨氏模量值未显示出显著差异，这表明其无法确定CKD的病因发病机制。
肾组织杨氏模量与eGFR的相关性表明，SWE可作为CKD患者肾组织损伤的指标。SWE永远无法取代金标准活检，但可用于CKD的分期。尽管SWE无法预测CKD的病因发病机制，但它可能是一种低成本的方式，可为CKD提供额外的诊断信息。
