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Based on functional and histopathological correlations: is diffusion kurtosis imaging valuable for noninvasive assessment of renal damage in early-stage of chronic kidney disease?

  • Nephrology - Original Paper
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Abstract

Purpose

To evaluate the potential of 3 T magnetic resonance diffusion kurtosis imaging (DKI) in assessing the renal damage in early-stage of chronic kidney disease (CKD) patients with normal or slightly changed functional index, using histopathology as reference standard.

Methods

49 CKD patients and 18 healthy volunteers were recruited in this study. CKD patients were divided into two groups based on estimated glomerular filtration rate (eGFR): Study group I (eGFR ≥ 90 ml/min/1.73 m2 [n = 20]) and Study group II (eGFR < 90 ml/min/1.73 m2 [n = 29]). DKI was performed in all participants. The DKI parameters (mean kurtosis [MK], mean diffusivity [MD], fractional anisotropy [FA]) of renal cortex and medulla were measured. The differences of parenchymal MD, MK and FA values among the different groups were compared. The correlations between DKI parameters and clinicopathological characteristics were assessed. Diagnostic performance of DKI to assess renal damage in early-stage of CKD was analyzed.

Results

The cortex MD and MK showed significant difference among three groups (P < 0.05): trend of cortex MD: Study group II < Study group I < control group; trend of cortex MK: control group < Study group I < Study group II. The cortex MD and MK and medulla FA were correlated with eGFR and Interstitial fibrosis/Tubular atrophy score (0.3 < r < 0.5). Cortex MD and MK yielded an AUC of 0.752 for differentiating healthy volunteers from CKD patients with eGFR ≥ 90 ml/min/1.73 m2.

Conclusion

DKI shows potential in non-invasive and multi-parameter quantitative assessment of renal damage in early-stage of CKD patients and provide additional information for changes in renal function and histopathology.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by grants from the Medical Health Science and Technology Project of Zhejiang Province (Grant no. 2019PY066) and Basic Public Welfare Research Program of Zhejiang Province (Grant no. GF18H180031) and Zhejiang Traditional Chinese Medical Scientific Technology (Grant no. 2020ZA080).

Author information

Authors and Affiliations

  1. Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Number 453, Road Stadium, Hangzhou, 310000, Zhejiang, China

    Jiazhen Lin

  2. Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Number 453, Road Stadium, Hangzhou, 310000, Zhejiang, China

    Caifeng Zhu & Jiazhen Yin

  3. Department of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Number 453, Road Stadium, Hangzhou, 310000, Zhejiang, China

    Feng Cui, Hua Qu, Yongsheng Zhang, Xianjie Le & Youjun Cao

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  1. Jiazhen Lin
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  4. Hua Qu
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  5. Yongsheng Zhang
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Contributions

All authors contributed to the study conception and design. YC designed and performed the research; Jiazhen Lin wrote the original draft; CZ and JY collected the cases and assisted in pathological diagnosis; FC and XL provided technical and financial support; HQ performed the data analysis; YZ revised manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jiazhen Yin or Youjun Cao.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and was approved by the ethics committee of Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (no. 2018KY002). All the patients (or their guardians in the case of minors) provided their written informed consent before data collection.

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Lin, J., Zhu, C., Cui, F. et al. Based on functional and histopathological correlations: is diffusion kurtosis imaging valuable for noninvasive assessment of renal damage in early-stage of chronic kidney disease?. Int Urol Nephrol 56, 263–273 (2024). https://doi.org/10.1007/s11255-023-03632-y

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