What does the nephrologist expect from functional renal imaging ? - - PowerPoint PPT Presentation

What does the nephrologist expect from functional renal imaging ?

K.-U. Eckardt

Nephrology and Medical Intensive Care Charité, University Medicine Berlin, Germany

Expectations from renal imaging

Better patient care through improved assessment of

• Kidney disease risk
• Early diagnosis of kidney disease
• Differential diagnosis of kidney disease
• Underlying pathomechanisms
• Therapeutic responsiveness

My hypothesis: In nephrology we are underutilizing the

• pportunities of modern imaging.

Better patient care through improved assessment of

• Kidney disease risk
• Early diagnosis of kidney disease
• Differential diagnosis of kidney disease
• Structure / function correlations
• Underlying pathomechanisms
• Risk for kidney disease progression
• Therapeutic responsiveness

My hypothesis: In nephrology we are underutilizing the

• pportunities of modern imaging.

Expectations from renal imaging

Better patient care through improved assessment of

• Kidney disease risk
• Early diagnosis of kidney disease
• Differential diagnosis of kidney disease
• Structure / function correlations
• Underlying pathomechanisms
• Risk for kidney disease progression
• Therapeutic responsiveness

My hypothesis: In nephrology we are underutilizing the

• pportunities of modern imaging.

Expectations from renal imaging

Ways forward ….

Standardized imaging protocol that allows qualitative and quantitative, objective assessment and analysis of structural (and functional) parameters

To be correlated with…..

• Clinical parameters (cross sectional)
• Course of disease (retro- and prospective)
• Other imaging parameters (ultrasound, CT)
• Histology on biopsy specimens
• Other parameters in specific settings (e.g. after nephrectomy)

Other

• utcomes

c a r d i

• v

a s c u l a r d i s e a s e Cardiovascular complications, death progressive loss of function

Kidney failure (dialysis) CKD

• Diabetes mellitus
• Hypertension
• Glomerulonephritis
• Vasculitis
• others
• Polycystic Kidney

Disease

? ? ?

5000 Patients

• CKD stage 3 (eGFR 30-60) or overt albuminuria
• under care of nephrologists

German Chronic Kidney Disease Study

prospective follow-up (up to 10 years) Biomaterials

• DNA
• Serum, Plasma
• Urine

Outcome

Eckardt et al., NDT 2011

Clinical Phenotype

?

Baseline eGFR and Albuminuria

A1 A2 A3 < 30 mg/g 30-300 mg/ g > 300 mg/g G1 > 90 1 2 G2 60-89 6 3 4 G3 a 45-59 20 8 6 G3 b 30-44 19 13 8 G4 15-29 3 3 4 G5 < 15 Proportions of patients in different categories (%)

24 6 33 33 4

Risk categories

Based on Levey et al., Kidney Int 2010 Titze et al., NDT 2014

Recruitment and Follow-Up

FU 1 FU 2 2 years

N= 5217

FU 3 FU 4 FU 5 October 2017 Loss to follow-up: N=91 (1.55%) Consent withdrawn: N=2 (0.04%) Left study: N=266 (5.10%) Death: N=568 (10.89%) FU 6 BL FU 5

Ways forward ….

Standardized imaging protocol that allows qualitative and quantitative, objective assessment and analysis of structural (and functional) parameters

To be correlated with…..

• Clinical parameters (cross sectional)
• Course of disease (retro- and prospective)
• Other imaging parameters (ultrasound, CT)
• Histology on biopsy specimens
• Other parameters in specific settings (e.g. after nephrectomy)

Department of Nephrology & Intensive Care

Possible seetings in which MRI could be integrated into routine care (with protocols and ethic approval):

• Patients with AKI / CKD prior to kidney biopsy
• Healthy kidney donors prior to nephrectomy
• Patients with specific etiologies of CKD

Largest Nephrology Center in Germany

Ways forward ….

Standardized imaging protocol that allows qualitative and quantitative, objective assessment and analysis of structural (and functional) parameters

To be correlated with…..

• Clinical parameters (cross sectional)
• Course of disease (retro- and prospective)
• Other imaging parameters (ultrasound, CT)
• Histology on biopsy specimens
• Other parameters in specific settings (e.g. after nephrectomy)