Kidney Disease (CKD): evidence to date Prof. Sophie de Seigneux, - - PowerPoint PPT Presentation

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Kidney Disease (CKD): evidence to date Prof. Sophie de Seigneux, - - PowerPoint PPT Presentation

Apr 28, 2023 347 likes •631 views

Application of MRI to Chronic Kidney Disease (CKD): evidence to date Prof. Sophie de Seigneux, MD, PhD Service de Nphrologie, Genve Nottingham 2019 Current evidence for MRI in CKD Recognize a sick kidney Evaluate non invasively the

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Application of MRI to Chronic Kidney Disease (CKD): evidence to date

  • Prof. Sophie de Seigneux, MD, PhD

Service de Néphrologie, Genève Nottingham 2019

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Current evidence for MRI in CKD

  • Recognize a sick kidney
  • Evaluate non invasively the histology
  • Ct in lung/fibroscan in liver, MRI in heart
  • Follow non invasively the evolution of a disease
  • Predict prognosis
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Diffusion MRI in healthy and sick kidneys

Eisenberg, 2006; Thoeny, Radiology 2005 and 2006

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22 patients G3/4, 22 healthy volunteers

Multiparametric MRI in CKD

Buchanan, NDT, 2019

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  • Recognize a sick kidney
  • Evaluate non invasively the histology
  • Ct in lung/fibroscan in liver, MRI in heart
  • Follow non invasively the evolution of a disease
  • Predict prognosis

Current evidence for MRI in CKD

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Why should we evaluate fibrosis in the kidney?

  • IF associates to eGFR
  • If predicts the evolution of

renal disease

  • Treatment choice in selected

cases

Srivastava, JASN, 2018

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Histological evaluation of IF

  • Standard stainings:

trichrome Masson, sirius red, silver

  • Visually most of the

time

  • Automatization in

developpment

  • Focal and bleeding risk
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Diffusion MRI and fibrosis

Inoue, JASN, 2011 142 Patients with diabetic nephropathy (43), AKI (23), CKD non diabetic (76)

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Correcting for the medulla: ∆ADC

∆ADC = (ADC cortex) – (ADC medulla)

Friedli I et al. Sci Rep. 2016 Jul Fridli et al., JMRI, 2017

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∆ADC external validation

r= -0.52 p< 0.001

Berchtold et al., NDT 2019 164 patients 72% allograft 28% native, better results

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Combining ∆T1 and ∆ADC

Berchtold et al., NDT 2019

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Bold, diffusion and aterial spin labelling

Wang CJASN 2019 103 kidney allograft recipients

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Arterial spin labeling and capillary rarefaction

Wang CJASN 2019

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Multiparametric MRI in CKD

22 patients G3/4, 22 healthy volunteers Different fibrosis cutoff Buchanan, NDT, 2019

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Diffusion tensor MRI

  • Diffusion in selected directions( 10-20

directions)

  • Measures fractional anisotropy (FA),

Hartung, JMRI, 2016

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MRI elastography

16 allograft recipients with biopsy Kirpalani, CJASN, 2017

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  • Recognize a sick kidney
  • Evaluate non invasively the histology
  • Ct in lung/fibroscan in liver, MRI in heart
  • Follow non invasively the evolution of a disease
  • Predict prognosis

Current evidence for MRI in CKD

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Can MRI be used to follow a patient?

Nine allograft patients, first imaging at 7 +/- 3 months, second at 32+/-2 months Vermathen, JMRI 2012

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Can MRI be used to follow a patient?

  • L. Berchtold et al, accepted in NDT

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fici

fici

+ +

fici

+ +

2 yers in median

First biopsy: 12.4 months (IQR: 12.0-49.1)

  • Protocol biopsy(53%)
  • Indication biopsy(47%).

Second biopsy: 38.4 months (IQR: 23.7-75.5)

  • Protocol (11%)
  • Indication (89%)

Augmentation créatinine 27% Albuminurie 5% DSA 18% Contrôle après traitemen t de rejet 41% Autres 9%

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Diffusion MRI detects fibrosis aggravation before creatinine elevation

  • L. Berchtold et al, accepted
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  • Recognize a sick kidney
  • Evaluate non invasively the histology
  • Ct in lung/fibroscan in liver, MRI in heart
  • Follow non invasively the evolution of a disease
  • Predict prognosis

Current evidence for MRI in CKD

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Can MRI predict CKD evolution?

Pruijm et al., KI, 2018 BOLD MRI in 112CKD patients, 47 with HBP, 24 controls patients followed 3 years in median Worst renal

  • utcome :

RRT, +30% creatinine Image analyzed 12 layers, Slope and abolute R2* of cortex associated to worse

  • utcome
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Can MRI predict eGFR slope?

92 patients, native kidneys, 42% diabetes, mean eGFR 49 ml/min/1.73 m2, followed mean 5.13 years. Correlation to eGFR slope Sugiyama, NDT, 2018

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Summary

  • Large improvement in MRI methodology for the

evaluation of CKD patients:

  • Better assessment of renal fibrosis, perfusion and
  • xygenation
  • Follow up of patients
  • Prognosis assessment
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The challenges remaining are among others

  • Use multiparametric MRI and combine complementary

sequences

  • Homogenize the technologies used
  • Homogenize and automatize the quantification
  • Apply it in everyday practice?

vasculitis w/o biopsy ( anca, pla2r?) before liver/heart transplantation diabetic patients ….

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Thank you for your attention

Nephrology Lena Berchtold Chantal Martinez Pierre-Yves Martin Pathology Solange Moll Collaborators Hariett Thoeny Menno Pruijm Radiology Jean-Paul Vallée Iris Friedli Lindsey Crowe

European the Cooperation in Science and Technology (COST) Action PARENCHIMA (www.renalmri.org)

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