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The role of real-time shear wave elastography in the diagnosis of idiopathic nephrotic syndrome and evaluation of the curative effect

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

Abstract

Purpose

To evaluate the use of real-time shear wave elastography (SWE) in the assessment of renal elasticity and the efficacy of steroid treatment in adult idiopathic nephrotic syndrome (INS).

Methods

This study included 120 patients with INS. Patients were divided into steroid-sensitive and steroid-resistant groups. Renal biopsy was performed. Thirty healthy subjects were recruited as controls. Young’s modulus (YM) of the renal parenchyma was measured by SWE. The YM values in each group were compared using glomerular sclerosis index (GI) and renal interstitial fibrosis (RIF).

Results

The YM values were significantly different between the INS and control groups, as well as between the steroid-sensitive and steroid-resistant groups (P < 0.05). Higher YM values were associated with steroid sensitivity. The area under the receiver operating characteristic curve for the YM value in the INS group vs. control group was 0.871 (95% CI 0.815–0.927) and in the steroid-resistant group vs. control, and steroid-sensitive groups was 0.836 (95% CI 0.765–0.908). The corresponding cut-off values were 7.96 and 10.73 m/s, with 81.7% and 86.0% sensitivities, 93.3% and 77.9% specificities, and Youden index 0.750 and 0.639, respectively. Spearman correlation analysis showed that the YM value in the renal parenchyma was positively correlated with GI (r = 0.631, P < 0.05) and RIF (r = 0.606, P < 0.05).

Conclusion

SWE technology is a potential method for non-invasive quantitative measurement of renal parenchyma stiffness to determine the pathological changes of INS renal parenchyma and evaluate the effectiveness of steroid therapy.

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References

  1. Luks AM, Johnson RJ, Swenson ER (2008) Chronic kidney disease at high altitude. J Am Soc Nephrol 19:2262-2271

    Article  CAS  Google Scholar 

  2. Dumas De La Roque C, Prezelin-Reydit M, Vermorel A, Lepreux S, Deminière C, Combe C, Rigothier C (2018) Idiopathic nephrotic syndrome: characteristics and identification of prognostic factors. J Clin Med 7(9) pii: E265

  3. Audard V1, Lang P, Sahali D (2008) [Minimal change nephrotic syndrome: new insights into disease pathogenesis]. Med Sci (Paris) 24:853-858 (in French)

  4. Kuma A, Tamura M, Otsuji Y (2016) Mechanism of and Therapy for Kidney Fibrosis. J UOEH 38:25-34

    Article  Google Scholar 

  5. Lin HY, Lee YL, Lin KD, Chiu YW, Shin SJ, Hwang SJ, Chen HC, Hung CC (2017) Association of renal elasticity and renal function progression in patients with chronic kidney disease evaluated by real-time ultrasound elastography. Sci Rep 7:43303

    Article  CAS  Google Scholar 

  6. Stock KF, Klein BS, Vo Cong MT et al (2010) ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis. Clin Hemorheol Microcirc 46:139-148

    Article  CAS  Google Scholar 

  7. Mengel M, Chapman JR, Cosio FG et al (2007) Protocol biopsies in renal transplantation: insights into patient management and pathogenesis. Am J Transplant 7:512-517

    Article  CAS  Google Scholar 

  8. Berchtold L, Friedli I, Vallée JP, Moll S, Martin PY, de Seigneux S (2017) Diagnosis and assessment of renal fibrosis: the state of the art. Swiss Med Wkly 147:w14442

    PubMed  Google Scholar 

  9. Dhaun N, Bellamy CO, Cattran DC, Kluth DC (2014) Utility of renal biopsy in the clinical management of renal disease. Kidney Int 85:1039-1048

    Article  Google Scholar 

  10. Yang X, Yu N, Yu J, Wang H, Li X (2018) Virtual Touch Tissue Quantification for Assessing Renal Pathology in Idiopathic Nephrotic Syndrome. Ultrasound Med Biol 44:1318-1326

    Article  Google Scholar 

  11. Kucharska M, Inglot M, Kuliszkiewicz-Janus M, Pazgan-Simon M, Knysz B (2015) Current Possibilities to Assess the Degree of Liver Fibrosis in Patients with Haemophilia Infected with HCV--Review. Adv Clin Exp Med 24:671-677

    Article  Google Scholar 

  12. Frulio N, Trillaud H (2013) Ultrasound elastography in liver. Diagn Interv Imaging 94:515-534

    Article  CAS  Google Scholar 

  13. Grenier N, Poulain S, Lepreux S et al (2012) Quantitative elastography of renal transplants using supersonic shear imaging: a pilot study. Eur Radiol 22:2138-2146

    Article  Google Scholar 

  14. Xu JH, Liu ZH, Sun L, Jin X, Chen H, Fan CZ, An LC, Wang ZL, Wen CY (2011) Application of basic research in kidney by quantitative shear-wave ultrasound elasticity imaging. Chinese Journal of Medical Ultrasound (Electronic Version) 8:1048-1052

    Google Scholar 

  15. Gennisson JL, Grenier N, Combe C, Tanter M (2012) Supersonic shear wave elastography of in vivo pig kidney: influence of blood pressure, urinary pressure and tissue anisotropy. Ultrasound Med Biol 38:1559-1567

    Article  Google Scholar 

  16. Zhong T, Liu Y, Peng L, Chang S, Zhang Y, Fan Q (2017) The related research on quantification evaluation of renal interstitial fibrosis and renal elasticity measured by rea-ltime SWE. Chin J Ultrasonogr 26:58-64

    Google Scholar 

  17. Samir AE, Allegretti AS, Zhu Q et al (2015) Shear wave elastography in chronic kidney disease: a pilot experience in native kidneys. BMC Nephrol 16:119

    Article  Google Scholar 

  18. Chinese Medical Association. (2011) Guidelines for clinical diagnosis and treatment (Fascicle of Nephrology). People’s Medical Publishing House, Beijing. pp 39-43

    Google Scholar 

  19. Chinese adult nephrotic syndrome immunosuppresive treatment group. Immunosuppresive therapy expert consensus of Chinese adults with nephrotic syndrome. Chin J Nephrol (2014) 30: 467-474 (in Chinese).

    Google Scholar 

  20. Kretzler M (2005) Role of podocytes in focal sclerosis: defining the point of no return. J Am Soc Nephrol 16:2830-2832

    Article  Google Scholar 

  21. Solez K, Axelsen RA, Benediktsson H et al (1993) International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 44:411-422

    Article  CAS  Google Scholar 

  22. Goya C, Hamidi C, Ece A, Okur MH, Tasdemir B, Cetincakmak MG, Hattapoglu S, Teke M, Sahin C (2015) Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children. Pediatr Radiol 45:55-61

    Article  Google Scholar 

  23. Hajian-Tilaki K (2013) Receiver Operating Characteristic (ROC) Curve Analysis for Medical Diagnostic Test Evaluation. Caspian J Intern Med 4:627-635

    PubMed  PubMed Central  Google Scholar 

  24. Huang Z, Zheng J, Zheng R, Zeng J, Wu T (2014) The reproducibility study on liver stiffness measurements by two-dimensional real time SWE. Chinese Journal of Medical Ultrasound (Electronic Edition) 11:5-8

    Google Scholar 

  25. Zhi X, Qian L, Geng H, Hu X (2016) Clinical application and progress of SWE technology. Chinese Medical Equipment 13:66-70

    Google Scholar 

  26. Yu N, Zhang Y, Xu Y (2014) Value of virtual touch tissue quantification in stages of diabetic kidney disease. J Ultrasound Med 33:787-792

    Article  Google Scholar 

  27. Yu N, Zhang YY, Niu XY, Xu Y, Ma RX, Zhang W, Jiang XB (2015) Evaluation of shear wave velocity and human bone morphogenetic protein-7 for the diagnosis of diabetic kidney disease. PLoS One 10:e0119713

    Article  Google Scholar 

  28. Ge J, Xu Y. (2013) Nephrology (Version 8). People’s Medical Publishing House, Beijing. pp: 482

  29. D’Agati VD, Kaskel FJ, Falk RJ (2011) Focal segmental glomerulosclerosis. N Engl J Med 365:2398-2411

    Article  Google Scholar 

  30. Shakeel S, Mubarak M, J IK, Jafry N, Ahmed E (2013) Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome. J Nephropathol 2:28-35

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Acknowledgements

We are indebted to the patients that were included in this study, whose participation made this study possible. We would like to thank Yan Xu, of the Department of Nephrology at the Affiliated Hospital of Qingdao University, and Shi-Hong Shao, of the Department of Pathology at the Affiliated Hospital of Qingdao University, for the selection of patients and the assessment of the pathologic results.

Funding

This research was supported by the Natural Science Foundation of Shandong Province (CN), ZR2014HM092.

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Author notes

  1. Xue Yang and Fang-Lin Hou have contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266071, Shandong, China

    Xue Yang, Cheng Zhao, Cai-Yun Jiang, Xiu-Mei Li & Ning Yu

  2. Department of Outpatient, The Qingdao Hiser Medical Center, Qingdao, 266071, Shandong, China

    Fang-Lin Hou

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  1. Xue Yang
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Correspondence to Ning Yu.

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The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the institutional review board of Qingdao University, Shandong Province, P.R. China. All procedures performed in the studies involving human participants were in accordance with the ethics standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards.

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Written informed consent was obtained from all individual participants included in this study.

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Yang, X., Hou, FL., Zhao, C. et al. The role of real-time shear wave elastography in the diagnosis of idiopathic nephrotic syndrome and evaluation of the curative effect. Abdom Radiol 45, 2508–2517 (2020). https://doi.org/10.1007/s00261-020-02460-3

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