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Development and validation of a simple-to-use nomogram for predicting minimal change disease based on quantification of color Doppler sonography data from a region of interest

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objectives

To establish a simple-to-use nomogram based on quantification of color Doppler sonography data from a region of interest (ROI) to diagnose minimal change disease (MCD) promptly and non-invasively, and to evaluate the prediction capability of the nomogram.

Methods

We recruited 564 patients with pathology-proven renal disease who were admitted to our hospital from July 2020 to July 2021 (388 patients in the training dataset and 176 patients in the validation dataset), and their color Doppler sonography data were acquired from a ROI and underwent ipsilateral renal biopsy. The collected clinical features and ultrasonic features were imported into Rstuido and statistically significant features were selected by stepwise regression using the forward–backward method. Multivariate Logistic regression analysis was combined with clinical analysis to obtain the final modeling features. General and dynamic nomogram models were constructed with the selected features, depending on whether they were MCD or not. Bootstrapping and internal validation were used for internal and external validation of the nomogram, respectively. The performance of the nomogram was assessed by C-index, calibration curve, and receiver operating characteristic (ROC) curve.

Results

Age and VI were independent factors in predicting MCD. The value of Age (Best cut-off value: 33.5 years) combined with VI (Best cut-off value: 40.50 points) in the diagnosis of MCD was significantly higher than that of single diagnosis (AUC 0.901, 95% CI 0.863–0.938). The C-index of the nomogram constructed with age and VI in the training and validation datasets was 0.915 [95% confidence interval (CI) 0.874–0.956 and 0.875 95% CI 0.783–0.967], respectively. Calibration curves were fitted well. The sensitivity, specificity, and accuracy were 76.1%, 95.6%, and 78.3%, respectively, in the training dataset, and 74.1%, 94.4%, and 76.1% in the validation dataset, respectively.

Conclusion

The nomogram constructed with age and VI showed a satisfactory degree of differentiation and accuracy, which is of great significance for early, non-invasively, and individually analysis of the risk of MCD.

Graphical abstract

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Abbreviations

ROI:

A region of interest

MCD:

Minimal change disease

ROC:

Receiver operating characteristic

CI:

Confidence interval

NS:

Nephrotic syndrome

MN:

Membranous nephropathy

IgAN:

IgA nephropathy

FSGS:

Focal segmental glomerulosclerosis

MPGN:

Membranoproliferative glomerulonephritis

HSPN:

Henöch–Schönlein purpura nephritis

DN:

Diabetic nephropathy

LN:

Lupus nephritis

AKI:

Acute kidney injury

VI:

Vascular index

FI:

Flow index

VFI:

Vascularization-flow index

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

BMI:

Body mass index

sAlb:

Serum albumin

BUN:

Blood urea nitrogen

sCr:

Serum creatinine

UA:

Uric acid

TC:

Total cholesterol

TG:

Triglyceride

24hTP:

24-h uric total protein

PGN:

Primary glomerulonephritis

SGN:

Secondary glomerulopathy

References

  1. Floege J, Amann K(2016)Primary glomerulonephritides. Lancet 387(10032):2036-2048. https://doi.org/10.1016/s0140-6736(16)00272-5.

    Article  PubMed  Google Scholar 

  2. Vivarelli M, Massella L, Ruggiero B, Emma F(2017) Minimal Change Disease. Clin J Am Soc Nephrol 12(2):332-345. https://doi.org/10.2215/cjn.05000516.

    Article  CAS  PubMed  Google Scholar 

  3. Jefferson JA, Nelson PJ, Najafian B, Shankland SJ(2011) Podocyte disorders: Core Curriculum 2011. Am J Kidney Dis 58(4):666-677. https://doi.org/10.1053/j.ajkd.2011.05.032.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Keskar V, Jamale TE, Kulkarni MJ, Kiggal Jagadish P, Fernandes G, Hase N(2013) Minimal-change disease in adolescents and adults: epidemiology and therapeutic response. Clin Kidney J 6(5):469-472. https://doi.org/10.1093/ckj/sft063.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Takei T, Koike M, Suzuki K, Shirota S, Itabashi M, Ohtsubo S, et al(2007)The characteristics of relapse in adult-onset minimal-change nephrotic syndrome. Clinical and experimental nephrology 11(3):214-217. https://doi.org/10.1007/s10157-007-0484-5.

    Article  PubMed  Google Scholar 

  6. Lee H, Yoo K, Oh Y, Kim D, Oh K, Joo K, et al(2016) Predictors of Relapse in Adult-Onset Nephrotic Minimal Change Disease. Medicine 95(12):e3179. https://doi.org/10.1097/md.0000000000003179.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, et al(2021) Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int 100(4):753-779. https://doi.org/10.1016/j.kint.2021.05.015.

    Article  PubMed  Google Scholar 

  8. AlYousef A, AlSahow A, AlHelal B, Alqallaf A, Abdallah E, Abdellatif M, et al(2020) Glomerulonephritis Histopathological Pattern Change. BMC Nephrol 21(1):186. https://doi.org/10.1186/s12882-020-01836-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lionaki S, Mantios E, Tsoumbou I, Marinaki S, Makris G, Liapis G, et al(2021) Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease. Journal of clinical medicine 10(16). https://doi.org/10.3390/jcm10163632.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Wu F, Zhang Y, Cui W, Dong Y, Geng Y, Liu C, et al(2021)Development and validation of a discrimination model between primary PLA2R-negative membranous nephropathy and minimal change disease confirmed by renal biopsy. Scientific reports 11(1):18064. https://doi.org/10.1038/s41598-021-97517-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Liu L, Wang H, Zhao B, Liu X, Sun Y, Mao Y(2022) Nomogram to predict the progression of patients with primary membranous nephropathy and nephrotic syndrome. International urology and nephrology 54(2):331-341. https://doi.org/10.1007/s11255-021-02859-x.

    Article  CAS  PubMed  Google Scholar 

  12. Cameron J, Hicks J(2002) The origins and development of the concept of a "nephrotic syndrome". American journal of nephrology 22:240-247. https://doi.org/10.1159/000063768.

    Article  PubMed  Google Scholar 

  13. Hu R, Quan S, Wang Y, Zhou Y, Zhang Y, Liu L, et al(2020)Spectrum of biopsy proven renal diseases in Central China: a 10-year retrospective study based on 34,630 cases. Sci Rep 10(1):10994. https://doi.org/10.1038/s41598-020-67910-w.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Xu X, Ning Y, Shang W, Li M, Ku M, Li Q, et al(2016) Analysis of 4931 renal biopsy data in central China from 1994 to 2014. Renal failure 38(7):1021-1030. https://doi.org/10.1080/0886022x.2016.1183443.

    Article  PubMed  Google Scholar 

  15. Yang Y, Zhang Z, Zhuo L, Chen DP, Li WG(2018)The Spectrum of Biopsy-Proven Glomerular Disease in China: A Systematic Review. Chin Med J (Engl) 131(6):731-735. https://doi.org/10.4103/0366-6999.226906.

    Article  PubMed  Google Scholar 

  16. Okpechi I, Swanepoel C, Duffield M, Mahala B, Wearne N, Alagbe S, et al(2011)Patterns of renal disease in Cape Town South Africa: a 10-year review of a single-centre renal biopsy database. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 26(6):1853-1861. https://doi.org/10.1093/ndt/gfq655.

    Article  PubMed  Google Scholar 

  17. Pepe F, Pepe P(2013) Color Doppler ultrasound (CDU) in the diagnosis of obstructive hydronephrosis in pregnant women. Arch Gynecol Obstet 288(3):489-493. https://doi.org/10.1007/s00404-013-2768-1.

    Article  PubMed  Google Scholar 

  18. Scholbach T, Wang H, Yang A, Loong C, Wu T(2013) Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys. BMC nephrology 14:143. https://doi.org/10.1186/1471-2369-14-143.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Scholbach T(1999)Color Doppler sonographic determination of renal blood flow in healthy children. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 18(8):559-564. https://doi.org/10.7863/jum.1999.18.8.559.

    Article  CAS  PubMed  Google Scholar 

  20. Scholbach T(2001)Changes of renal flow volume in the hemolytic-uremic syndrome--color Doppler sonographic investigations. Pediatric nephrology (Berlin, Germany) 16(8):644-647. https://doi.org/10.1007/s004670100638.

    Article  CAS  PubMed  Google Scholar 

  21. Sobh M, El Kannishy G, Moustafa F, Eid R, Hamdy N, Tharwat S(2022) Role of detached podocytes in differentiating between minimal change disease and early focal segmental glomerulosclerosis, can we rely on routine light microscopy? Journal of nephrology 35(9):2313-2324. https://doi.org/10.1007/s40620-022-01456-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. da Silva C, Monteiro M, Araújo L, Urzedo M, Rocha L, Dos Reis M, et al(2020) In situ evaluation of podocytes in patients with focal segmental glomerulosclerosis and minimal change disease. PloS one. 15(11):e0241745. https://doi.org/10.1371/journal.pone.0241745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tang L, Cai Z, Wang S, Zhao W(2022) Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure: A case report. World journal of clinical cases 10(17):5861-5868. https://doi.org/10.12998/wjcc.v10.i17.5861.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author notes

  1. Leiyuan Ma and Yuhan Zhang have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Shinan District, Qingdao, 266003, China

    Leiyuan Ma, Liang Zhang, Changjie Shao & Ning Yu

  2. University of Southern California, Los Angeles, USA

    Yuhan Zhang

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Correspondence to Ning Yu.

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This study was approved in all participating by our Hospital Human Ethics Committee. The ethics number was QYFYWZLL26599. The study followed the ethical principles of the Declaration of Helsinki 1964.

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Ma, L., Zhang, Y., Zhang, L. et al. Development and validation of a simple-to-use nomogram for predicting minimal change disease based on quantification of color Doppler sonography data from a region of interest. Abdom Radiol 48, 1020–1032 (2023). https://doi.org/10.1007/s00261-022-03780-2

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