Contrast-Enhanced Ultrasound for Assessing Renal Perfusion Impairment and Predicting Acute Kidney Injury to Chronic Kidney Disease Progression

Cao, Wei; Cui, Shuang; Yang, Li; Wu, Chunyi; Liu, Jian; Yang, Fang; Liu, Youhua; Bin, Jianping; Hou, Fan Fan

doi:10.1089/ars.2017.7006

Cited by 48 publications

(44 citation statements)

References 47 publications

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“…The significant reduction in the refilling of the vessels is most likely due to compression, caused by the interstitial edema and accumulated red blood cells. Even though MBs returned to the renal vascular bed after 60 min of reperfusion, the MB velocity and perfusion index were lower compared with baseline; this is also in accordance with previous studies [8]- [10] and with our power Doppler scans. Despite the differences in reperfusion immediately after clamp release and the differences between the H&E stains, a direct distinction between the 60 min SRI scans of the two rats could not be made.…”

Section: Discussionsupporting

confidence: 93%

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Super-Resolution Ultrasound Imaging of Rat Kidneys before and after Ischemia-Reperfusion

Andersen

Hoyos²,

Taghavi

et al. 2019

2019 IEEE International Ultrasonics Symposium (IUS)

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In vivo visualization of the microvasculature is feasible with super-resolution ultrasound imaging (SRI), but the method needs more affirmative data before clinical use. The kidneys have a rich vasculature, and microvascular dysfunction decreases the kidney function. Therefore, detection of subtle renal microvascular changes could benefit patients with renal disease. We hypothesized that our SRI setup can visualize the microvascular network of two healthy rat kidneys and subsequently demonstrate microvascular flow changes immediately after ischemiareperfusion. The left kidney of two male Sprague-Dawley rats was scanned during laparotomy using a customized BK5000 scanner, an X18L5s transducer, and interleaved contrast and B-mode sequences with focused beam transmission. Images were acquired over 10 min using SonoVue (1:10) as the contrast agent. After a baseline scan, one rat had the renal vein clamped, while the other rat had the renal artery clamped, both for 45 min. The kidneys were rescanned immediately after clamp release and after 60 min of reperfusion. Motion correction was applied before microbubble (MB) detection. The characteristic renal microvascular structure was visualized with anatomical distinction between the dense cortical vascular network and the straight vessels of the medulla. Immediately after vein clamp release, almost no MBs perfused the medullary vessels. After 60 min of reperfusion, MBs refilled the renal vascular bed, but with a slower velocity compared with the baseline scan. The results after artery clamping were subtler, with more MBs perfusing the medulla immediately after clamp release compared with the vein clamping. The results imply that this SRI setup can evaluate different stages of ischemic kidney disease in rats as it can visualize the entire renal vascular bed and differentiate the pattern of reperfusion in two types of ischemic injury.

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Section: Discussionsupporting

confidence: 93%

“…The renal vein clamp causes the severest tissue damage [7]. Is has been shown that the blood flow in the kidneys is reduced after ischemia with subsequent reperfusion [8]- [10].…”

Section: Introductionmentioning

confidence: 99%

Super-Resolution Ultrasound Imaging of Rat Kidneys before and after Ischemia-Reperfusion

Andersen

Hoyos²,

Taghavi

et al. 2019

2019 IEEE International Ultrasonics Symposium (IUS)

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“…Because the reproducibility of RT was poor, and the sensitivity and specificity of medullary AUC were low, based on their consistent reliability, we suggest MTT and WIS at the renal cortex and PI at the renal medulla for diagnosing the severity and predicting the renal prognosis in patients with AKI. Previous studies have shown that renal microcirculatory perfusion is impaired in animal models of AKI [12][13][14], and in humans with septic shock [15]. One animal study showed that perfusion impairment correlated with renal histological injury and CKD progression [14].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that renal microcirculatory perfusion is impaired in animal models of AKI [12][13][14], and in humans with septic shock [15]. One animal study showed that perfusion impairment correlated with renal histological injury and CKD progression [14]. However, previous literature lacked any assessment of the association between CEUS-driven parameters and the clinical outcomes of human AKI, which is vital for the validity of CEUS for use in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

A pilot trial to evaluate the clinical usefulness of contrast-enhanced ultrasound in predicting renal outcomes in patients with acute kidney injury

Yoon

Kim

et al. 2020

PLoS ONE

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Objectives Contrast-enhanced ultrasound (CEUS) enables the assessment of real-time renal microcirculation. This study investigated CEUS-driven parameters as hemodynamic predictors for renal outcomes in patients with acute kidney injury (AKI). Methods Forty-eight patients who were diagnosed with AKI were prospectively enrolled and underwent CEUS at the occurrence of AKI. Parameters measured were the wash-in slope (WIS), time to peak intensity, peak intensity (PI), area under the time-intensity curve (AUC), mean transit time (MTT), time for full width at half maximum, and rise time (RT). The predictive performance of the CEUS-driven parameters for Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, initiation of renal replacement therapy (RRT), AKI recovery, and chronic kidney disease (CKD) progression was assessed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of CEUS. Results Cortical RT (Odds ratio [OR] = 1.21) predicted the KDIGO stage 3 AKI. Cortical MTT (OR = 1.07) and RT (OR = 1.20) predicted the initiation of RRT. Cortical WIS (OR = 76.23) and medullary PI (OR = 1.25) predicted AKI recovery. Medullary PI (OR = 0.78) and AUC (OR = 1.00) predicted CKD progression. The areas under the ROC curves showed reasonable performance for predicting the initiation of RRT and AKI recovery. The sensitivity and specificity of the quantitative CEUS parameters were 60-83% and 62-77%, respectively, with an area under the curve of 0.69-0.75.

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“…It has been shown to be a cost-effective modality for evaluating renal function impairment (RFI) [6]. Studies have shown that contrast-enhanced US is almost as sensitive as radioisotope renography in the quantitative diagnosis of chronic renal insufficiency, and correspondingly, contrast-enhanced US could be a useful tool for the assessment of renal function in children with UPJO [7][8][9]. Ionizing radiation exposure is a known risk factor for patients with leukaemia and brain tumours, especially for children with a higher radiation sensitivity and longer life expectancy [10,11].The European Federation of Societies for Ultrasound in Medicine and Biology( EFSUMB)release guidelines state that intravenous CEUS is safe and effective in paediatric populations and can be used effectively to avoid ionizing radiation exposure [11].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Assessment of Renal Function In Children with UPJO By Contrast-enhanced Ultrasound ： A Pilot Study

Chen

Lin

Liu

et al. 2020

Preprint

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Background: Contrast-enhanced ultrasonography (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of renal parenchyma.Objective: To prospectively evaluate the diagnostic value of CEUS in assessing renal function in patients with ureteropelvic junction obstruction (UPJO).Methods: The study protocol was approved by the ethics committee of Beijing Children’s Hospital (Beijing,China), and written informed consent was obtained from the patients’ parents or guardians. Ultrasonography (US), CEUS, and radioisotope renography were performed in 51 children (42 boys, 9 girls; mean age, 6.75 ± 4.14 years) with unilateral UPJO. The slope of the ascending curve (A), time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were recorded during CEUS; the quantitative data were calculated by the QLAB system (semiautomated border tracking, Philips Healthcare) software. Sensitivity and specificity values were determined for CEUS and compared with radioisotope renography.Results: A total of 102 kidneys in 51 patients were depicted by CEUS and the perfusion time-intensity curve (TIC).CEUS depicted 102 kidneys in 51 patients, in whom the perfusion time-intensity curve（TIC）was determined. The TIC of renal cortical perfusion in all groups showed an asymmetrical single-peak curve, which could be clearly distinguished between the experimental group and the control group. Compared to the control group, the TTP was markedly prolonged but A was significantly decreased in the experimental group (P < 0.05). There was no significant correlation between AUC, PI and DFR，but the correlation coefficient between TTP, A and DFR remained significant (p<0.001).The receiver operating characteristic （ROC）curve drawn to differentiate the differential renal function (DRF) using the TTP value provided an area under the ROC curve (AUROC) of 0.86. The diagnostic performance of contrast-enhanced US was better than that of US, as the sensitivity and specificity values were 92.86% and 76.14%, respectively.Conclusions: This preliminary experience represents the first report of evaluating the diagnostic value of CEUS in assessing renal function in children with UPJO. CEUS is a highly sensitive, rapid, and diagnostic imaging modality for detecting and monitoring renal function noninvasively.

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Contrast-Enhanced Ultrasound for Assessing Renal Perfusion Impairment and Predicting Acute Kidney Injury to Chronic Kidney Disease Progression

Abstract: These results indicate that CEUS enables the evaluation of renal perfusion impairment associated with CKD after ischemic AKI and may serve as a noninvasive technique for assessing AKI-CKD progression. Antioxid. Redox Signal. 27, 1397-1411.

Cited by 48 publications

References 47 publications

Super-Resolution Ultrasound Imaging of Rat Kidneys before and after Ischemia-Reperfusion

Super-Resolution Ultrasound Imaging of Rat Kidneys before and after Ischemia-Reperfusion

A pilot trial to evaluate the clinical usefulness of contrast-enhanced ultrasound in predicting renal outcomes in patients with acute kidney injury

Quantitative Assessment of Renal Function In Children with UPJO By Contrast-enhanced Ultrasound ： A Pilot Study

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