Advantages and Controversies in the Era of Intrarenal Volumetry

Abstract

Background/Aims: Ultrasound is the preferred imaging modality in nephrology. In many kidney diseases, however, more accurate methods are needed to distinguish between relevant intrarenal structures. MRI could be a solution, although the use of MRI contrast has caused severe complications in some cases, and invasive kidney biopsies may follow, even though such small specimens traditionally provide inaccurate quantitative data. We evaluated the usefulness of MRI volumetry and quantitative kidney biopsies to assess glomerular number and volume as well as cortical volume. Methods: We specifically highlight an experimental study in which different MRI scans were performed in healthy pigs as well as pigs with unilateral ureteral obstruction to assess intrarenal volume. Single-kidney glomerular filtration rate (GFR) was measured using ureteral cannulation and ⁵¹Cr-EDTA. Kidney biopsies were taken and evaluated employing stereological techniques to measure number and volume of glomeruli. Pigs were sacrificed and kidneys were removed for stereological analysis. Non-contrast-based MRI intrarenal volumes were – without significant difference to intrarenal volumes – obtained using contrast-enhanced MRI and ex vivo techniques. Results: Kidney biopsies gave valid estimates regarding quantitative parameters, such as mean number and volume of glomeruli in the cortex. Different structural parameters correlated with kidney GFR with high, although varying, correlation coefficients. Conclusion: Non-contrast MRI is suitable for estimating intrarenal volumes in healthy and diseased kidneys. We advocate further research in diagnostic modalities combining MRI and biopsies. Major challenges are the cortical architecture and heterogeneous distribution of glomeruli within the kidney.

Renal volumetry with magnetic resonance imaging

“…Another classical method is to measure the kidney with ultrasonographic (US) equipment and insert the values in the ellipsoid formula (height × width × thickness × π/6 = volume). This method, however, has been reported to underestimate renal volume ( 3 ). Furthermore, regional defects, such as scars and partial resections, will hamper the results.…”

The emerging role of MRI in quantitative renal glomerular morphology

“…Both cortical volume and segmental intrarenal volumes have strong associations with renal diseases such as fibrosis, nephritis, and stenosis or urinary obstruction. Recently, Pedersen et al (26) recommended a combined approach of histology with MRI-based volumetry to determine kidney and cortical volume without the use of an imaging contrast agent. However, biopsy carries significant discomfort and risk, so there is still a need for a technique to make direct measurements in vivo.…”

“…This is because nephron endowment is an index of the success or efficiency of nephrogenesis. Nephrogenesis is a complex process involving numerous events (including ureteric budding and branching, mesenchymal condensation, mesenchyme to epithelial conversion, glomerulogenesis, and tubule segmentation) regulated by hundreds of genes and feto-maternal environmental factors (24,26). Whether a specific gene or environmental factor plays a significant role in nephrogenesis can be easily determined by assessing nephron endowment.…”