Contrast-enhanced CT imaging in patients with chronic kidney disease


Renal microvascular rarefaction characterizes chronic kidney disease (CKD). In murine models of CKD, micro-CT imaging reflected capillary rarefaction using quantification of renal relative blood volume (rBV). In addition, micro-CT imaging revealed morphological alterations of the intrarenal vasculature including reduced vascular branching and lumen diameter. Here, we retrospectively quantified rBV in contrast-enhanced CT angiography in patients and found that, compared to non-CKD patients, those with CKD and renal fibrosis had significantly reduced rBV in the renal cortex. rBV values closely mirrored capillary rarefaction in the corresponding nephrectomy specimens. In patients with follow-up CT angiography, reduction of renal function was paralleled by a decline in rBV. Using virtual autopsy, i.e., postmortem CT angiography, morphometry of intrarenal arteries in 3D-rendered CT images revealed significantly reduced arterial diameter and branching in CKD compared to non-CKD cases. In conclusion, in CKD patients, contrast-enhanced CT imaging with quantification of rBV correlates with functional renal vasculature, whereas virtual autopsy allows morphometric analyses of macrovascular changes. Importantly, the observed vascular alterations in CKD patients mirror those in animals with progressive CKD, suggesting a high relevance of animal models for studying vascular alterations in CKD and renal fibrosis.

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This work was supported by grants from the Deutsche Forschungsgemeinschaft (DFG) of the SFB/Transregio 57 “Mechanisms of organ fibrosis” (to PB and JF), by Else-Kröner Fresenius Stiftung (EKFS 2012_A216 to PB), by the German Ministry of Education and Research (BMBF Consortium STOP-FSGS number 01GM1518A to PB) and by the Interdisciplinary Center for Clinical Research within the Faculty of Medicine at the RWTH Aachen University to PB and JF (K7-3).

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Correspondence to Peter Boor.

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Saskia von Stillfried and Jonas C. Apitzsch have contributed equally to this work.

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von Stillfried, S., Apitzsch, J.C., Ehling, J. et al. Contrast-enhanced CT imaging in patients with chronic kidney disease. Angiogenesis 19, 525–535 (2016).

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  • Microvasculature
  • Capillary rarefaction
  • Relative renal blood volume
  • Renal fibrosis
  • Progression of kidney disease
  • Non-invasive imaging