Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China.
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong.
Br J Radiol. 2024 Feb 2;97(1154):392-398. doi: 10.1093/bjr/tqad030.
Renal fibrosis is a final common pathological hallmark in the progression of chronic kidney disease (CKD). Non-invasive evaluation of renal fibrosis by mapping renal stiffness obtained by shear wave elastography (SWE) may facilitate the clinical therapeutic regimen for CKD patients.
A cohort of 162 patients diagnosed with CKD, who underwent renal biopsy, was prospectively and consecutively recruited between April 2019 and December 2021. The assessment of renal cortex stiffness was performed using SWE imaging. The patients were classified into different groups based on pathological renal fibrosis (mild group: n = 74; moderate-to-severe group: n = 88). Binary logistic regression model and generalized additive model were conducted to investigate the association of renal elasticity with renal fibrosis.
Compared with the mildly impaired group, the moderate-to-severe group showed a significant decline in renal elasticity (P < .001). In the fully adjusted model, each 10 kPa drop in renal elasticity was associated with a 3.5-fold increment in the risk of moderate-to-severe renal fibrosis (fully adjusted odds ratio, 4.54; 95% CI, 2.41-8.57). Particularly, participants in the lowest elasticity group (≤29.92 kPa) had a 20-fold increased chance of moderate-to-severe renal fibrosis than those in the group with highest elasticity (≥37.93 kPa). An inverse linear association was observed between renal elasticity increment and moderate-to-severe renal fibrosis risk.
There is a negative linear association between increased renal elasticity and moderate-to-severe renal fibrosis risk among CKD patients. Patients with diminished renal stiffness have a higher risk of moderate-to-severe renal fibrosis.
CKD patients with reduced renal stiffness have a higher likelihood of moderate-to-severe renal fibrosis.
肾纤维化是慢性肾脏病（CKD）进展的共同终末病理标志。通过剪切波弹性成像（SWE）获得的肾硬度的无创评估可能有助于制定 CKD 患者的临床治疗方案。
前瞻性连续招募了 2019 年 4 月至 2021 年 12 月期间接受肾活检的 162 例 CKD 患者。使用 SWE 成像评估肾皮质硬度。根据病理肾纤维化将患者分为不同组（轻度组：n=74；中重度组：n=88）。采用二元逻辑回归模型和广义加性模型探讨肾弹性与肾纤维化的关系。
与轻度受损组相比，中重度组肾弹性明显下降（P<0.001）。在完全调整模型中，肾弹性每下降 10kPa，中重度肾纤维化的风险增加 3.5 倍（完全调整比值比，4.54；95%置信区间，2.41-8.57）。特别是，在最低弹性组（≤29.92kPa）的患者中，中重度肾纤维化的风险是最高弹性组（≥37.93kPa）的 20 倍。肾弹性增加与中重度肾纤维化风险之间存在负线性关系。
CKD 患者肾弹性增加与中重度肾纤维化风险呈负线性关系。肾刚度降低的患者中重度肾纤维化的风险更高。
肾硬度降低的 CKD 患者更有可能出现中重度肾纤维化。
