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. 2021 Dec 23;12(1):18.
doi: 10.3390/diagnostics12010018.

Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate

Chi Qin  1 , Hailong Jin  2 , Haixiang Zhang  3 , Yun Zhang  3 , Zhaojie Guan  2 , Yongyan Gao  3
Affiliations

Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate

Chi Qin et al. Diagnostics (Basel). .

Abstract

The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0-1 and Grade 2-3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of -1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application.

Keywords: estimated glomerular filtration; interstitial fibrosis and tubular atrophy; point-shear wave elastography; renal transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of all patients.
Figure 2
Figure 2
(a) B-mode image, measurement of renal size including renal length, width, and renal parenchyma thickness. The plus signs mean activating the measurement key after freezing the ultrasound imagine and the green color means focal position.(b) CDFI image, measurement of resistive index (RI).
Figure 3
Figure 3
Measurements of p-SWE in renal transplants with different IF/TA stages: (a) IF/TA Grade 0, median = 17.9 kPa; (b) IF/TA Grade 1, median = 22.5 kPa; (c) IF/TA Grade 2, median = 28.7 kPa and (d) IF/TA Grade 3, median = 38.6 kPa. The line is used to drive operator to select suitable measurement areas. The square showed 3D eWave which is an exclusive tool that provides immediate feedback about the quality of the shear wave produced in the tissue, and is the three-dimensional representation of the shear waves generated by p-SWE. The asterisk showed the cooling indication (2 s in average) which is directly on the measurement site for “eye focus” feedback.
Figure 4
Figure 4
Comparison of renal function markers and p-SWE measurements between IF/TA Grade 0–1 and IF/TA Grade 2–3. The renal cortical stiffness (a), eGFR (b), proteinuria (c), and resistive index (d) were compared. The error bars are the minimum and maximum values. The lines through the middle of the boxes represent the median. The central box represents the interquartile range.
Figure 5
Figure 5
Graph showing receiver operating characteristic curves of p-SWE, eGFR, and p-SWE plus eGFR in the diagnosis of: (a) moderate-to-severe ci, (b) moderate-to-severe ct, and (c) moderate-to-severe IF/TA.
See this image and copyright information in PMC

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References

    1. Kalantar-Zadeh K., Wightman A., Liao S. Ensuring Choice for People with Kidney Failure-Dialysis, Supportive Care, and Hope. N. Engl. J. Med. 2020;383:99–101. doi: 10.1056/NEJMp2001794. - DOI - PubMed
    1. Tong A., Sautenet B., Poggio E.D., Lentine K.L., Oberbauer R., Mannon R., Murphy B., Padilla B., Chow K.M., Marson L., et al. Establishing a Core Outcome Measure for Graft Health: A Standardized Outcomes in Nephrology-Kidney Transplantation (SONG-Tx) Consensus Workshop Report. Transplantation. 2018;102:1358–1366. doi: 10.1097/TP.0000000000002125. - DOI - PubMed
    1. Haas M. Chronic allograft nephropathy or interstitial fibrosis and tubular atrophy: What is in a name? Curr. Opin. Nephrol. Hypertens. 2014;23:245–250. doi: 10.1097/01.mnh.0000444811.26884.2d. - DOI - PubMed
    1. Stegall M.D., Cornell L.D., Park W.D., Smith B.H., Cosio F.G. Renal Allograft Histology at 10 Years After Transplantation in the Tacrolimus Era: Evidence of Pervasive Chronic Injury. Am. J. Transplant. 2018;18:180–188. doi: 10.1111/ajt.14431. - DOI - PubMed
    1. Vanhove T., Goldschmeding R., Kuypers D. Kidney Fibrosis: Origins and Interventions. Transplantation. 2017;101:713–726. doi: 10.1097/TP.0000000000001608. - DOI - PMC - PubMed