Clinical study on the use of advanced magnetic resonance imaging in lupus nephritis

Abstract

Objectives To investigate the correlation between the histopathology of the kidney and clinical indicators in patients with lupus nephritis (LN) using magnetic resonance imaging (MRI). Methods A total 50 female participants were enrolled in the study. Thirty patients with LN were divided into types 2, 3, 4, and 5, according to their pathological features. The control group consisted of 20 healthy female volunteers. Serum creatinine, C3, C1q, and anti-ds-DNA were measured. Conventional MRI, DTI, DWI, and BOLD scanning was performed to obtain the FA, ADC, and R2* values for the kidney. Results Compared with the control group, FA and the ADC were decreased in patients with LN, while the R2* value was increased (P < 0.05). The overall comparison of the SLEDAI (Activity index of systemic lupus erythematosus) score, total pathological score, AI, and serum creatinine C3 showed that these were significantly different between the two groups (P < 0.05). FA and the ADC were negatively correlated with urinary, blood ds-DNA, and serum creatinine and positively correlated with C1q (P < 0.05). The R2* value was positively correlated with urinary NGAL, blood ds-DNA, and serum creatinine (P < 0.05). FA and the ADC were negatively correlated with the SLEDAI score, total pathological score, AI, CI, nephridial tissue C3, and C1q. The R2* value was positively correlated with the SLEDAI score, total pathological score, AI, CI, nephridial tissue C3, and C1q (P < 0.05). Conclusions MRI examination in female patients with LN was correlated with pathologic test results, which may have clinical significance in determining the disease’s severity, treatment, and outcome.

Research progress in functional magnetic resonance imaging assessment of lupus nephritis kidney injury

“…Shi et al 42 conducted a BOLD study on 23 LN and 18 healthy volunteer kidneys, and the mean renal R2* values were higher in LN patients than in healthy volunteers, with higher R2* values in class V patients than in class IV and class III patients. Similar findings were obtained by Chen et al, 9 who showed an increase in R2* values in LN patients compared to controls ( p < 0.05), but the most significant increase was found in the class IV group. In addition, the R2* values were positively correlated with SLE disease activity index score, total pathological score, activity index (AI), CI, renal tissue C3, and C1q ( p < 0.05).…”

“…Their study also found statistically significant differences in mean cortical and medullary FA in stage 1 and 2 chronic kidney disease (CKD) compared to controls, which contributes to the early detection of LN cases. 5 Similar findings were obtained by Chen et al, 9 who showed that FA decreased in both cortical and medullary areas in the LN group compared to the control group, and the greatest decrease was observed in the class IV group. Hassan et al speculated that these changes in FA values may be related to changes in tubular injury, tubular flow, microcirculation, and interstitial fibrosis, which reduce the number of radially oriented structures and thus FA values, and are more reflected in the medulla.…”

“…In addition, the R2* values were positively correlated with SLE disease activity index score, total pathological score, activity index (AI), CI, renal tissue C3, and C1q ( p < 0.05). 9 Both Shi et al and Chen et al showed that renal hypoxia was more severe in LN patients than in healthy volunteers. 9,42 However, contrary results were obtained by Li et al, 6 who found that LN R2* values in the renal cortex and medullary were significantly lower than those in the control group, and that medullary R2* values were negatively correlated with 24-h albuminuria and the degree of tubulointerstitial disease in the kidney.…”

“…9 Both Shi et al and Chen et al showed that renal hypoxia was more severe in LN patients than in healthy volunteers. 9,42 However, contrary results were obtained by Li et al, 6 who found that LN R2* values in the renal cortex and medullary were significantly lower than those in the control group, and that medullary R2* values were negatively correlated with 24-h albuminuria and the degree of tubulointerstitial disease in the kidney. They hypothesized that chronic hypoxic injury could further induce glomerulosclerosis, interstitial fibrosis, and tubular atrophy, leading to decreased intrarenal metabolism and reduced oxygen consumption, ultimately resulting in lower R2* values.…”

“…Zheng et al speculated that this may be due to increased cell density. 8 Chen et al 9 and shi et al 7 speculated that the proliferative lesions of the kidney were an important cause, while the proliferative classes (class III and class IV) were controversial and needed further study. Hassan et al 5 and Li et al 6 believe that chronic pathological processes in LN ultimately lead to glomerulosclerosis, interstitial fibrosis, and tubular atrophy, all of which can lead to a decrease in glomerular filtration rate and limited water molecule movement.…”