Lakshmana Shivarajkumar K, Koteshwar Prakashini, Kamath Tanushree
Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Int J Nephrol Renovasc Dis. 2024 Dec 6;17:307-317. doi: 10.2147/IJNRD.S480501. eCollection 2024.
Chronic kidney disease (CKD) is a major global public health problem with eventual progression to end-stage renal disease which tends to increase kidney stiffness. Shear wave elastography (SWE) is a recently developed ultrasound based technique which can be used to assess tissue stiffness noninvasively. The aim of this study was to evaluate the potential diagnostic value of SWE to assess renal parenchymal stiffness in CKD and its correlation with estimated glomerular filtration rate (eGFR), which may be used as a marker for detecting and staging CKD.
The study protocol was approved by the Institutional ethics Committee at Kasturba medical college, Manipal and written informed consent was obtained from all participants. The study included 93 control subjects and 108 patients with CKD. SWE imaging was performed to assess renal cortical stiffness, as measured by the Young's modulus (YM). Correlations between SWE and conventional ultrasound parameters with age, serum creatinine, eGFR and serum urea were analysed using Pearson's correlation coefficient (p ≤ 0.05) and receiver operating characteristic (ROC) curves were derived.
The diagnostic performance of SWE correlated with serum creatinine levels and eGFR. We found a statistically significant difference in kidney stiffness values between healthy individuals and CKD patients. The Spearman correlation coefficient revealed moderate negative linear correlation between the YM measurements and eGFR. We obtained a YM measurement cut-off value of 4.43 kPa, a value less than or equal to this suggested a no diseased kidney. This yielded sensitivity and specificity of 92.6% and 80.6%, respectively, with an AUROC of 0.92.
Our results demonstrated that shear wave elastography may provide a low-cost, non-invasive method for the morphological assessment and progression of the disease status in chronic kidney disease patients with CKD.
慢性肾脏病（CKD）是一个重大的全球公共卫生问题，最终会进展为终末期肾病，这往往会增加肾脏硬度。剪切波弹性成像（SWE）是一种最近开发的基于超声的技术，可用于无创评估组织硬度。本研究的目的是评估SWE在评估CKD患者肾实质硬度方面的潜在诊断价值及其与估计肾小球滤过率（eGFR）的相关性，eGFR可作为检测和分期CKD的标志物。
本研究方案经马尼帕尔卡斯图尔巴医学院机构伦理委员会批准，并获得所有参与者的书面知情同意。该研究包括93名对照受试者和108名CKD患者。采用SWE成像评估肾皮质硬度，以杨氏模量（YM）测量。使用Pearson相关系数（p≤0.05）分析SWE与常规超声参数与年龄、血清肌酐、eGFR和血清尿素之间的相关性，并绘制受试者操作特征（ROC）曲线。
SWE的诊断性能与血清肌酐水平和eGFR相关。我们发现健康个体和CKD患者的肾脏硬度值存在统计学显著差异。Spearman相关系数显示YM测量值与eGFR之间存在中度负线性相关。我们获得的YM测量临界值为4.43 kPa，小于或等于该值表明肾脏无疾病。这产生的敏感性和特异性分别为92.6%和80.6%，曲线下面积（AUROC）为0.92。
我们的结果表明，剪切波弹性成像可能为CKD慢性肾脏病患者的疾病状态的形态学评估和进展提供一种低成本、无创的方法。
