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Zhong L, Lian D, Zhang Y, Ding Y, Rao S, Guo J, Lin W, Qu X, Zhou J. Identification of benign from malignant small renal tumors: is there a possible role of T1 mapping? Discov Oncol 2025; 16:808. [PMID: 40388025 PMCID: PMC12089541 DOI: 10.1007/s12672-025-02609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 05/07/2025] [Indexed: 05/20/2025] Open
Abstract
PURPOSE Differentiating benign from malignant small renal tumors (SRMs) can help to guide clinical decision-making. T1 mapping enables quantitative assessment of T1 relaxation time and may help to evaluate SRMs properties. This study aimed to investigate the possible utility of T1 mapping for identification of SRMs. METHODS The data set used in this retrospective study, consisted of 104 patients with SRMs (≤ 4 cm). 78 malignant and 25 benign ones respectively. Calculated and compared the quantitative variables (including T1 mapping) between different renal tumors. The clinical features qualitative characteristics were subsequently documented. Finally, the logistic regression models were used to identify independent influencing factors. The diagnostic accuracy of independent influencing factors was represented with the area under the receiver operating characteristic curve (AUC). RESULTS The pre-contrast T1 mapping (T1) and the ratio of T1 reduction in malignance were higher than those in benign SRMs, while post-contrast T1 mapping was lower (all P < 0.025). In multivariable logistic regression, the tumor necrosis (odds ratio (OR) = 20.636, P = 0.005) and T1 (OR = 2.982, P = 0.002) were independent predictors. For the identification of SRMs, the performance of the model achieving an AUC of 0.793 (95% CI 0.701-0.866) when combining two factors. CONCLUSION Quantitative T1 mapping parameters may be a new potential biomarker for noninvasively distinguishing SRMs.
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Affiliation(s)
- Lianting Zhong
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen, 361015, China
| | - Danlan Lian
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen, 361015, China
| | - Ying Zhang
- Department of Nuclear Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiefeng Guo
- Department of Microelectronics and Integrated Circuit, Xiamen University, Xiamen, 361102, China
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361102, China
| | - Weifeng Lin
- Department of Information, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Xiaobo Qu
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361102, China.
- Department of Electronic Science, Xiamen University, Xiamen, 361102, China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, 668 Jinhu Road, Huli District, Xiamen, 361015, China.
- Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, 361015, China.
- Fujian Province Key Clinical Specialty for Medical Imaging, Xiamen, 361015, China.
- Xiamen Key Laboratory of Clinical Transformation of Imaging Big Data and Artificial Intelligence, Xiamen, 361015, China.
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Bhattacharya S, Nagaraju SP, Prabhu RA, Rangaswamy D, Rao IR, Bhojaraja MV, Shenoy SV. Sonological predictors of complications of percutaneous renal biopsy-a prospective observational study. Ir J Med Sci 2024; 193:2537-2544. [PMID: 38995486 PMCID: PMC11450080 DOI: 10.1007/s11845-024-03753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters-kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications. METHODS This was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted. RESULTS Out of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis. CONCLUSION The incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.
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Affiliation(s)
- Shruti Bhattacharya
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Bhadauria D, Jose L, Kushwaha R, Kaul A, Nandan R, Singh V, Prasad N. Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed? Acta Radiol 2022; 63:261-267. [PMID: 33497275 DOI: 10.1177/0284185120988812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. PURPOSE To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. MATERIAL AND METHODS We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. RESULTS Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. CONCLUSION A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.
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Affiliation(s)
- Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Leena Jose
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Raghu Nandan
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vivek Singh
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Liang P, Li S, Yuan G, He K, Li A, Hu D, Li Z, Xu C. Noninvasive assessment of clinical and pathological characteristics of patients with IgA nephropathy by diffusion kurtosis imaging. Insights Imaging 2022; 13:18. [PMID: 35092495 PMCID: PMC8800983 DOI: 10.1186/s13244-022-01158-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To explore the diagnostic performance of diffusion kurtosis imaging (DKI) in evaluating the clinical and pathological characteristics of patients with immunoglobulin A nephropathy (IgAN) compared with conventional DWI. Materials and methods A total of 28 IgAN patients and 14 healthy volunteers prospectively underwent MRI examinations including coronal T2WI, axial T1WI, T2WI, and DWI sequences from September 2020 to August 2021. We measured mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) by using MR Body Diffusion Toolbox v1.4.0 (Siemens Healthcare). Patients were divided into three groups according to their estimated glomerular filtration rate (eGFR) (Group1, healthy volunteers without kidney disease or other diseases that affect renal function; Group2, IgAN patients with eGFR > 60 mL/min/1.73 m2; Group3, IgAN patients with eGFR < 60 mL/min/1.73 m2). One-way analysis of variance, Pearson or Spearman correlation, and receiver operating characteristic curves were applied in our statistical analysis. Results MKCortex and ADCCortex showed significant differences between the Group1 and Group2. MKCortex, MDCortex, ADCCortex, MKMedulla, and ADCMedulla showed significant differences between Group2 and Group3. MKCortex had the highest correlation with CKD stages (r = 0.749, p < 0.001), and tubulointerstitial lesion score (r = 0.656, p < 0.001). MDCortex had the highest correlation with glomerular lesion score (r = − 0.475, p = 0.011). MKCortex had the highest AUC (AUC = 0.923) for differentiating Group1 from Group2, and MDCortex had the highest AUC (AUC = 0.924) for differentiating Group2 from Group3, followed by MKMedulla (AUC = 0.923). Conclusions DKI is a feasible and reliable technique that can assess the clinical and pathological characteristics of IgAN patients and can provide more valuable information than conventional DWI, especially MKCortex.
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Radovic T, Jankovic MM, Stevic R, Spasojevic B, Cvetkovic M, Pavicevic P, Gojkovic I, Kostic M. Detection of impaired renal allograft function in paediatric and young adult patients using arterial spin labelling MRI (ASL-MRI). Sci Rep 2022; 12:828. [PMID: 35039571 PMCID: PMC8764097 DOI: 10.1038/s41598-022-04794-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022] Open
Abstract
The study aimed to discriminate renal allografts with impaired function by measuring cortical renal blood flow (cRBF) using magnetic resonance imaging arterial spin labelling (ASL-MRI) in paediatric and young adult patients. We included 18 subjects and performed ASL-MRI on 1.5 T MRI to calculate cRBF on parameter maps. cRBF was correlated to calculated glomerular filtration rate (GFR) and compared between patient groups with good (GFR ≥ 60 mL/min/1.73 m2) and impaired allograft function (GFR < 60 mL/min/1.73 m2). Mean cRBF in patients with good allograft function was significantly higher than in patients with impaired allograft function (219.89 ± 57.24 mL/min/100 g vs. 146.22 ± 41.84 mL/min/100 g, p < 0.008), showing a highly significant correlation with GFR in all subjects (r = 0.75, p < 0.0001). Also, the diffusion-weighted imaging (DWI-MRI) apparent diffusion coefficient (ADC) and Doppler measurements of peak-systolic and end-diastolic velocities and the resistive index (PS, ED, RI) were performed and both methods showed no significant difference between groups. ADC implied no correlation with GFR (r = 0.198, p = 0.464), while PS indicated moderate correlation to GFR (r = 0.48, p < 0.05), and PS and ED moderate correlation to cRBF (r = 0.58, p < 0.05, r = 0.56, p < 0.05, respectively). Cortical perfusion as non-invasively measured by ASL-MRI differs between patients with good and impaired allograft function and correlates significantly with its function.
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Affiliation(s)
- Tijana Radovic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.
| | - Milica M Jankovic
- Department of Signals and Systems, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Ruza Stevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Radiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Brankica Spasojevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Cvetkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Polina Pavicevic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Gojkovic
- Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Kostic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
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6
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Bonani M, Seeger H, Weber N, Lorenzen JM, Wüthrich RP, Kistler AD. Safety of Kidney Biopsy when Performed as an Outpatient Procedure. Kidney Blood Press Res 2021; 46:310-322. [PMID: 34077930 DOI: 10.1159/000515439] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kidney biopsy remains the gold standard for the diagnosis of most renal diseases. A major obstacle to performing a biopsy is safety concerns. However, many safety measures are not evidence based and therefore vary widely between centers. We sought to determine the rate and timing of kidney biopsy complications in our center, to compare the complication rate between native and transplant kidney biopsies, to evaluate the feasibility of performing kidney biopsies as an outpatient procedure and the value of a postbiopsy ultrasound before discharge, and to identify risk factors for complications. METHODS We performed a single-center, retrospective, observational study at the Division of Nephrology of the University Hospital Zurich including all patients who underwent renal biopsy between January 2005 and December 2017. Major bleeding (primary outcome) and any other bleeding or nonbleeding complications (secondary outcomes) were compared between native and transplant kidney biopsies and between inpatient and outpatient procedures and correlated with clinical factors possibly affecting bleeding risk. RESULTS Overall, 2,239 biopsies were performed in 1,468 patients, 732 as inpatient and 1,507 as outpatient procedures. Major bleeding was observed in 28 (3.8%) inpatient and in 15 (1.0%) outpatient procedures, totaling to 43 (1.9%) of all biopsies. Major bleeding requiring intervention amounted to 1.0% (0.5% of outpatient procedures). Rate of major bleeding was similar between native and transplant kidneys. 13/15 (87%) bleeding episodes in planned outpatient procedures were detected during the 4-h surveillance period. Risk factors for bleeding were aspirin use, low eGFR, anemia, cirrhosis, and amyloidosis. Routine postbiopsy ultrasound did not change management. CONCLUSIONS Kidney biopsy is an overall safe procedure and can be performed as an outpatient procedure in most patients with an observation period as short as 4 h. The value of routine postbiopsy ultrasound is questionable.
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Affiliation(s)
- Marco Bonani
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Nina Weber
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Johan M Lorenzen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas D Kistler
- Division of Nephrology, Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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Mao W, Ding Y, Ding X, Wang Y, Fu C, Zeng M, Zhou J. Pathological assessment of chronic kidney disease with DWI: Is there an added value for diffusion kurtosis imaging? J Magn Reson Imaging 2021; 54:508-517. [PMID: 33634937 DOI: 10.1002/jmri.27569] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide health problem, precise functional and pathological assessment is beneficial to better treatment. Diffusion kurtosis imaging (DKI) can evaluate non-Gaussian diffusion and may help to assess renal pathology and function. PURPOSE To assess pathological and functional alterations in CKD using DKI compared with diffusion-weighted imaging (DWI). STUDY TYPE Prospective study. POPULATION 70 CKD patients and 20 healthy volunteers. FIELD STRENGTH 1.5 T. ASSESSMENT All participants underwent DKI, and apparent diffusion coefficient (ADC), mean diffusivity (MD), and mean kurtosis (MK) of renal parenchyma were acquired. Correlation between renal parenchymal ADC, MD, MK, and estimated glomerular filtration rate (eGFR), pathological scores were assessed. The diagnostic efficacy of ADC, MD, and MK for assessing the degree of renal pathological injury were compared. STATISTICAL TESTS ANOVA, Spearman correlation analysis, and ROC curve analysis. RESULTS The cortical ADC, MD were significantly higher than medulla for all participants, whereas medullary MK was significantly higher than cortex (P < 0.01). Whether eGFR reduced or not, renal parenchymal MK were significantly higher in patients than controls (P < 0.05). Positive correlation was found between eGFR and ADC (cortex, r = 0.562; medulla, r = 0.527), and negative correlation between eGFR and MK (cortex, r = -0.786; medulla, r = -0.709) (all P < 0.001). There was positive correlation between MK and glomerular injury (cortex, r = 0.681; medulla, r = 0.652), tubulointerstitial lesion (cortex, r = 0.650; medulla, r = 0.599) (all P < 0.001). For discrimination between mild and m-s renal injury group, the AUC values of ADC, MD, MK were cortex: 0.723, 0.655, 0.864 and medulla: 0.718, 0.581, 0.829. The AUC values of ADC, MD, MK were cortex: 0.708, 0.679, 0.770 and medulla: 0.713, 0.830, 0.780 for differentiating control group from mild renal injury group. DATA CONCLUSION DKI is practicable for noninvasive assessment of renal pathology and function of CKD, DKI offer better diagnostic performance than DWI. Evidence Level 1 Technical Efficacy 2.
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Affiliation(s)
- Wei Mao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yaqiong Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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8
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Cheng ZY, Feng YZ, Liu XL, Ye YJ, Hu JJ, Cai XR. Diffusional kurtosis imaging of kidneys in patients with hyperuricemia: initial study. Acta Radiol 2020; 61:839-847. [PMID: 31610679 DOI: 10.1177/0284185119878362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND At present, there remains a lack of a reliable indicator for monitoring renal function in patients with hyperuricemia. PURPOSE This study aimed to evaluate the feasibility of diffusion kurtosis imaging in the assessment of renal function in patients with hyperuricemia. MATERIAL AND METHODS A total of 75 male participants, including 25 with asymptomatic hyperuricemia, 25 with gouty arthritis, and 25 age-matched male healthy controls, were enrolled in this study. Diffusion kurtosis imaging data were acquired to derive axial (Ka), radial (Kr), and mean kurtosis (MK), fractional anisotropy, axial (Da), radial (Dr), and mean diffusivity (MD) for comparisons among the three groups. They were also correlated with estimated glomerular filtration rate (eGFR). RESULTS The MK values of the renal cortex and medulla and Kr value of the renal medulla in patients with asymptomatic hyperuricemia and gouty arthritis significantly increased compared with those in the controls (P < 0.05). Patients with gouty arthritis showed significant higher cortical and medullary Ka values compared with the other two groups (P < 0.05). The cortical Kr values of the asymptomatic hyperuricemia and gouty arthritis patients were significantly higher than that of the controls (P < 0.05). The medullary fractional anisotropy value showed a significant difference between the control and gouty arthritis groups (P < 0.05). No correlation was found between any diffusion kurtosis imaging parameters and eGFR value. CONCLUSION Diffusion kurtosis imaging is feasible in the assessment of the early changes of renal cortex and medulla in patients with hyperuricemia.
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Affiliation(s)
- Zhong-Yuan Cheng
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
- *Equal contributors
| | - You-Zhen Feng
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
- *Equal contributors
| | - Xiao-Ling Liu
- Medical Imaging Center, Guangdong Provincial Hospital of Traditional Chinese Medicine Zhuhai Branch, Guangdong, PR China
| | - Yao-Jiang Ye
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
| | - Jun-Jiao Hu
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
| | - Xiang-Ran Cai
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, PR China
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Schorr M, Roshanov PS, Weir MA, House AA. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Can J Kidney Health Dis 2020; 7:2054358120923527. [PMID: 32547772 PMCID: PMC7251654 DOI: 10.1177/2054358120923527] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives: The risk and timing of bleeding events following ultrasound-guided
percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: We performed a retrospective study of 617 consecutive adult patients who
underwent kidney biopsy between 2012 and 2017 at a tertiary academic
hospital in London, Canada. We assessed frequency and timing of minor (not
requiring intervention) and major (requiring blood transfusion, surgery, or
embolization) bleeds and developed a personalized risk calculator for
these. Results: Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]:
10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI:
8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI:
1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%)
and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three
of 79 events were identified immediately on post-procedure ultrasound (92.4%
of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor
event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients
(0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not
recognized immediately; both required blood transfusions only. There were no
deaths or nephrectomies. A risk calculator using age, body mass index,
platelet count, hemoglobin concentration, size of the target kidney, and
whether the kidney is native, or an allograft predicted minor (C-statistic,
0.70) and major bleeding (C-statistic, 0.83). Conclusions: This retrospective study of 617 patients who had percutaneous
ultrasound-guided renal biopsies supports the safety of short post-biopsy
monitoring for most patients. A risk calculator can further personalize
estimates of complication risk (http://perioperativerisk.com/kbrc).
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Affiliation(s)
- Melissa Schorr
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
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10
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Abuelo JG. How long should patients be observed after percutaneous kidney biopsies? Nephrol Dial Transplant 2019; 34:1979-1981. [PMID: 31377770 DOI: 10.1093/ndt/gfz157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julian Gary Abuelo
- Department of Medicine, Division of Hypertension and Kidney Diseases, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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11
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Lewis JI, Patel NJ, Williams EA, Bowman AW. Prophylactic Intravenous Access: Is It Necessary for Renal Transplant Biopsies? Curr Probl Diagn Radiol 2019; 50:156-158. [PMID: 31611010 DOI: 10.1067/j.cpradiol.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Percutaneous renal transplant biopsies have long been a safe and effective procedure with bleeding being the most common significant complication. Only a few studies, however, have addressed the need for intravenous access prior to the procedure. OBJECTIVES We postulate that the number of patients requiring intravenous resuscitation after a routine renal transplant biopsy is sufficiently low enough to prove that eliminating pre-procedural peripheral IV placement will have no negative impact on patient safety and could improve departmental efficiency. METHODS This is a retrospective analysis of complications that occurred in patients who underwent routine percutaneous renal transplant biopsies at an academic center. Patients were divided into two groups: the IV cohort that had peripheral IV access placed before the procedure (n=1318) and the no-IV cohort that did not (n=492). RESULTS This is a retrospective analysis of complications that occurred in patients who underwent routine percutaneous renal transplant biopsies at an academic center. Patients were divided into two groups: the IV cohort that had peripheral IV access placed before the procedure (n=1318) and the no-IV cohort that did not (n=492). CONCLUSIONS Placement of prophylactic peripheral IV access in patients undergoing routine renal transplant biopsies does not significantly impact the rate of biopsy complications.
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Affiliation(s)
- Jacob I Lewis
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Neema J Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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12
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Palmucci S, Mammino L, Caltabiano DC, Costanzo V, Foti PV, Mauro LA, Farina R, Profitta ME, Sinagra N, Ettorre GC, Veroux M, Basile A. Diffusion-MR in kidney transplant recipients: is diuretic stimulation a useful diagnostic tool for improving differentiation between functioning and non-functioning kidneys? Clin Imaging 2019; 53:97-104. [PMID: 30317137 DOI: 10.1016/j.clinimag.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of diuretic stimulation on Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI) techniques in transplanted kidneys. METHODS 33 transplanted kidney recipients underwent DWI and DTI sequences before and after furosemide. Cortical and medullary Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) values were calculated in transplanted kidneys. Patients were divided into two groups according to their estimated glomerular rate filtration (Group A ≥ 60 ml/min and Group B < 60 ml/min). Wilcoxon matched pairs signed rank test was applied to compare pre- and post-furosemide values. ADC and FA values were compared between the 2 groups using a Mann-Whitney U test. Receiver Operating Curves (ROC) analysis was performed to predict normal renal function. RESULTS Wilcoxon test revealed a statistically significant difference for all pre- and post- ADC and FA values in group B. For group A, a significant difference was found comparing pre- and post-medullary ADC and FA values (p = 0.0151 and p = 0.0054). In the comparison between group A and group B, cortical and medullary mean ADC values were significantly different before and after furosemide. With regard to medullary FA values, a significant difference was found between groups before and after diuretic stimulation (p respectively of 0.004 and 0.042). Comparing cortical FA mean values, no statistical difference was observed between groups before and after furosemide. The highest Area Under Curve values were reported for cortical ADC (0.878) and medullary ADC (0.863) before diuretic bolus. CONCLUSIONS In transplanted kidneys, furosemide did not improve the differentiation between normal and reduced function.
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Affiliation(s)
- Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy.
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Daniele Carmelo Caltabiano
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Letizia Antonella Mauro
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Renato Farina
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Maria Elena Profitta
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
| | - Nunziata Sinagra
- Vascular Surgery Unit - University Hospital "Policlinico-Vittorio Emanuele", 95123 Catania, Italy
| | | | - Massimiliano Veroux
- Department of Medical Surgical Sciences and Advanced Technologies - Vascular Surgery and Organ Transplant Unit, University Hospital "Policlinico-Vittorio Emanuele", 95123 Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies - Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, Catania 95123, Italy
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13
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Dave CN, Seifman B, Chennamsetty A, Frontera R, Faraj K, Nelson R, Lucido C, Schervish EW. Office-based Ultrasound-guided Renal Core Biopsy Is Safe and Efficacious in the Management of Small Renal Masses. Urology 2017; 102:26-30. [DOI: 10.1016/j.urology.2016.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/08/2023]
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Ren T, Wen CL, Chen LH, Xie SS, Cheng Y, Fu YX, Oesingmann N, de Oliveira A, Zuo PL, Yin JZ, Xia S, Shen W. Evaluation of renal allografts function early after transplantation using intravoxel incoherent motion and arterial spin labeling MRI. Magn Reson Imaging 2016; 34:908-14. [PMID: 27114341 DOI: 10.1016/j.mri.2016.04.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/25/2016] [Accepted: 04/17/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate renal allografts function early after transplantation using intravoxel incoherent motion (IVIM) and arterial spin labeling (ASL) MRI. METHODS This prospective study was approved by the local ethics committee, and written informed consent was obtained from all participants. A total of 82 participants with 62 renal allograft recipients (2-4weeks after kidney transplantation) and 20 volunteers were enrolled to be scanned using IVIM and ASL MRI on a 3.0T MR scanner. Recipients were divided into two groups with either normal or impaired function according to the estimated glomerular filtration rate (eGFR) with a threshold of 60ml/min/1.73m(2). The apparent diffusion coefficient (ADC) of pure diffusion (ADCslow), the ADC of pseudodiffusion (ADCfast), perfusion fraction (PF), and renal blood flow (RBF) of cortex were compared among three groups. The correlation of ADCslow, ADCfast, PF and RBF with eGFR was evaluated. The receiver operating characteristic (ROC) curve and binary logistic regression analyses were performed to assess the diagnostic efficiency of using IVIM and ASL parameters to discriminate allografts with impaired function from normal function. P<0.05 was considered statistically significant. RESULTS In allografts with normal function, no significant difference of mean cortical ADCslow, ADCfast, and PF was found compared with healthy controls (P>0.05). Cortical RBF in allografts with normal function was statistically lower than that of healthy controls (P<0.001). Mean cortical ADCslow, ADCfast, PF and RBF were lower for allografts with impaired function than that with normal function (P<0.05). Mean cortical ADCslow, ADCfast, PF and RBF showed a positive correlation with eGFR (all P<0.01) for recipients. The combination of IVIM and ASL MRI showed a higher area under the ROC curve (AUC) (0.865) than that of ASL MRI alone (P=0.02). CONCLUSION Combined IVIM and ASL MRI can better evaluate the diffusion and perfusion properties for allografts early after kidney transplantation.
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Affiliation(s)
- Tao Ren
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Cheng-Long Wen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Li-Hua Chen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Shuang-Shuang Xie
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Yue Cheng
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Ying-Xin Fu
- Department of Transplantation Surgery, Tianjin First Center Hospital, 300192, Tianjin, China.
| | | | | | - Pan-Li Zuo
- Siemens Healthcare, MR Collaborations NE Asia, 100010,Beijing, China.
| | - Jian-Zhong Yin
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Shuang Xia
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Wen Shen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
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Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB. Complications of Ultrasound-Guided Renal Transplant Biopsies. Am J Transplant 2016; 16:1298-305. [PMID: 26601796 DOI: 10.1111/ajt.13622] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023]
Abstract
Renal transplant biopsies to diagnose transplant pathology are routinely performed using ultrasound guidance. Few large studies have assessed the rate and risk factors of major biopsy complications. This study is a single-center 5-year retrospective cohort analysis of 2514 biopsies. Major complications occurred in 47 of 2514 patients (1.9%) and included hospitalization, transfusion of blood products, operative exploration and interventional radiology procedures. The complication rate among "cause" biopsies was significantly higher than in "protocol" biopsies (2.7% vs. 0.33%, p < 0.001). Complications presented on postbiopsy days 0-14, with the majority diagnosed on the same day as the biopsy and manifested by hematocrit drop, although the presence of such delayed presentation of complications occurring >24 h after the biopsy on days 2-14 is previously unreported. Specific patient characteristics associated with increased risk of a complication were increased age and blood urea nitrogen, decreased platelet count, history of prior renal transplant, deceased donor transplant type and use of anticoagulant medications but not aspirin.
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Affiliation(s)
- T A Morgan
- Department of Radiology and Biomedical Imaging, Univeristy of California San Francisco, San Francisco, CA
| | - S Chandran
- Kidney Transplant Service, Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - I M Burger
- Department of Radiology, Kaiser Permanente Los Angeles/VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - C A Zhang
- Department of Radiology and Biomedical Imaging, Univeristy of California San Francisco, San Francisco, CA
| | - R B Goldstein
- Department of Radiology and Biomedical Imaging, Univeristy of California San Francisco, San Francisco, CA
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16
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Dutta R, Okhunov Z, Vernez SL, Kaler K, Gulati AT, Youssef RF, Nelson K, Lotan Y, Landman J. Cost Comparisons Between Different Techniques of Percutaneous Renal Biopsy for Small Renal Masses. J Endourol 2016; 30 Suppl 1:S28-33. [PMID: 26915901 DOI: 10.1089/end.2016.0015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs). METHODS We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology. RESULTS A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were $3449, $3280, and $1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologist's and radiologist's professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were $4598, $4470, and $2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001). CONCLUSION For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.
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Affiliation(s)
- Rahul Dutta
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Simone L Vernez
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kamaljot Kaler
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Anjalie T Gulati
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Ramy F Youssef
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kari Nelson
- 2 Department of Radiology, University of California , Irvine, Orange, California
| | - Yair Lotan
- 3 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jaime Landman
- 1 Department of Urology, University of California , Irvine, Orange, California
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The Timing and Presentation of Major Hemorrhage After 18,947 Image-Guided Percutaneous Biopsies. AJR Am J Roentgenol 2015; 205:190-5. [DOI: 10.2214/ajr.14.13002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Fan WJ, Ren T, Li Q, Zuo PL, Long MM, Mo CB, Chen LH, Huang LX, Shen W. Assessment of renal allograft function early after transplantation with isotropic resolution diffusion tensor imaging. Eur Radiol 2015; 26:567-75. [PMID: 26017738 DOI: 10.1007/s00330-015-3841-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/02/2015] [Accepted: 05/11/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the value of diffusion tensor imaging (DTI) and tractography in renal allografts at the early stage after kidney transplantation. METHODS This study was approved by the institutional ethical review committee, and written informed consent was obtained. A total of 54 renal allograft recipients 2-3 weeks after transplantation and 26 age-matched healthy volunteers underwent renal DTI with a 3.0-T magnetic resonance imaging (MRI) system. Recipients were divided into three groups according to the estimated glomerular filtration rate (eGFR). Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the cortex and medulla were measured and compared among the groups. Whole-kidney tractography was performed. Correlation of eGFR with diffusion parameters was evaluated. RESULTS In allografts with stable function, the medullary ADC was higher and the cortical FA was lower (p < 0.001) than in healthy kidneys. The cortical ADC, medullary ADC and FA decreased as the allograft function declined, and with a positive correlation with eGFR (p < 0.001); cortical FA did not. Tractography demonstrated a decrease of tract density in impaired functional allografts. CONCLUSIONS Renal DTI produces reliable results to assess renal allograft function at the early stage after transplantation. KEY POINTS • DTI and tractography can evaluate renal allograft function at an early stage • Medullary FA, cortical and medullary ADC can effectively evaluate allograft function • Medullary FA, cortical and medullary ADC are correlated with eGFR in renal allografts • Medullary ADC increased and cortical FA decreased in stable allografts compared to control subjects • Medullary FA, cortical and medullary ADC decreased and allograft function declined.
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Affiliation(s)
- Wen-jun Fan
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China.,Medical Department, Armed Police Corps Hospital of Henan Province, Zhengzhou, 450052, China
| | - Tao Ren
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China
| | - Qiong Li
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China
| | - Pan-li Zuo
- Siemens Healthcare, MR Collaboration NE Asia, Beijing, 100102, China
| | - Miao-miao Long
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China
| | - Chun-bai Mo
- Department of Transplantation Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Li-hua Chen
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China
| | - Li-xiang Huang
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin Medical University First Central Hospital, Tianjin, 300192, China.
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Brachemi S, Bollée G. Renal biopsy practice: What is the gold standard? World J Nephrol 2014; 3:287-294. [PMID: 25374824 PMCID: PMC4220363 DOI: 10.5527/wjn.v3.i4.287] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/22/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Renal biopsy (RB) is useful for diagnosis and therapy guidance of renal diseases but incurs a risk of bleeding complications of variable severity, from transitory haematuria or asymptomatic hematoma to life-threatening hemorrhage. Several risk factors for complications after RB have been identified, including high blood pressure, age, decreased renal function, obesity, anemia, low platelet count and hemostasis disorders. These should be carefully assessed and, whenever possible, corrected before the procedure. The incidence of serious complications has become low with the use of automated biopsy devices and ultrasound guidance, which is currently the “gold standard” procedure for percutaneous RB. An outpatient biopsy may be considered in a carefully selected population with no risk factor for bleeding. However, controversies persist on the duration of observation after biopsy, especially for native kidney biopsy. Transjugular RB and laparoscopic RB represent reliable alternatives to conventional percutaneous biopsy in patients at high risk of bleeding, although some factors limit their use. This aim of this review is to summarize the issues of complications after RB, assessment of hemorrhagic risk factors, optimal biopsy procedure and strategies aimed to minimize the risk of bleeding.
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Chronic kidney disease: pathological and functional assessment with diffusion tensor imaging at 3T MR. Eur Radiol 2014; 25:652-60. [PMID: 25304821 DOI: 10.1007/s00330-014-3461-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/09/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Our objective was to evaluate pathological and functional changes in chronic kidney disease (CKD) using diffusion tensor imaging (DTI) at 3 T. METHODS There were fifty-one patients with CKD who required biopsy and 19 healthy volunteers who were examined using DTI at 3 T. The mean values of fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) were obtained from the renal parenchyma (cortex and medulla). Correlations between imaging results and the estimated glomerular filtration rate (eGFR), as well as pathological damage (glomerular lesion and tubulointerstitial injury), were evaluated. RESULTS The renal cortical FA was significantly lower than the medullary in both normal and affected kidneys (p < 0.001). The parenchymal FA was significantly lower in patients than healthy controls, regardless of whether eGFR was reduced. There were positive correlations between eGFR and FA (cortex, r = 0.689, p = 0.000; and medulla, r = 0.696, p = 0.000), and between eGFR and ADC (cortex, r = 0.310, p = 0.017; and medulla, r = 0.356, p = 0.010). Negative correlations were found between FA and the glomerular lesion (cortex, r = -0.499, p = 0.000; and medulla, r = -0.530, p = 0.000), and between FA and tubulointerstitial injury (cortex, r = -0.631, p = 0.000; and medulla, r = -0.724, p = 0.000). CONCLUSION DTI is valuable for noninvasive assessment of renal function and pathology in patients with CKD. A decrease in FA could identify the glomerular lesions, tubulointerstitial injuries, and eGFR.
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Peters B, Andersson Y, Stegmayr B, Mölne J, Jensen G, Dahlberg P, Holm-Gunnarsson I, Ekberg J, Bjurström K, Haux SB, Hadimeri H. A study of clinical complications and risk factors in 1,001 native and transplant kidney biopsies in Sweden. Acta Radiol 2014; 55:890-6. [PMID: 24068748 DOI: 10.1177/0284185113506190] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In Sweden, native and transplant kidney biopsies are usually performed in major renal medical centers. PURPOSE To clarify risk factors in native and transplant kidney biopsies to improve patient safety. MATERIAL AND METHODS A total of 1001 biopsies (in 352 women and 565 men) were included. The median age was 54 years (range, 16-90 years). Data were derived from 826 native kidney biopsies (640 prospective and 186 retrospective) and 175 transplant kidney biopsies (170 prospective and 5 retrospective). Various factors and complications were registered while performing native and transplant kidney biopsies, focusing on major (e.g. blood transfusions, invasive procedures) and minor complications. The prospective protocol was used at six centers and at one center data were obtained retrospectively. RESULTS Women were at greater risk of overall complications than men (12.2% vs. 6.5%; P = 0.003; odds ratio [OR], 2.0; confidence interval [CI], 1.3-3.1) as well as of major complications (9.6% vs. 4.5%; P = 0.002; OR, 2.2, CI 1.3-3.7). Major complications occurred more commonly after biopsies from the right kidney, in women than in men (10.8% vs. 3.1%; P = 0.005; OR, 3.7; CI, 1.5-9.5), and in patients with lower BMI (25.5 vs. 27.3, P = 0.016) and of younger age (45 years vs. 52.5 years; P = 0.001). Lower mean arterial pressure in transplant kidney biopsies indicated a risk of major complications (90 mmHg vs. 98 mmHg; P = 0.039). Factors such as needle size, number of passes, serum creatinine, and eGFR did not influence complication rates. CONCLUSION The present findings motivate greater attention being paid to the risk of major side-effects after right-side biopsies from women's kidneys, as well as after biopsies from younger patients and patients with lower BMI.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | | | - Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Sweden
| | - Johan Mölne
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gert Jensen
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Dahlberg
- Medicine, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | | | - Jana Ekberg
- Transplantation Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
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Breyer MD, Coffman TM, Flessner MF, Fried LF, Harris RC, Ketchum CJ, Kretzler M, Nelson RG, Sedor JR, Susztak K. Diabetic nephropathy: a national dialogue. Clin J Am Soc Nephrol 2013; 8:1603-5. [PMID: 23788618 DOI: 10.2215/cjn.03640413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The National Institute of Diabetes and Digestive and Kidney Diseases-supported Kidney Research National Dialogue (KRND) asked the scientific community to formulate and prioritize research objectives that would improve our understanding of kidney function and disease. Several high-priority objectives for diabetic nephropathy were identified in data and sample collection, hypothesis generation, hypothesis testing, and translation promotion. The lack of readily available human samples linked to comprehensive phenotypic, clinical, and demographic data remains a significant obstacle. With data and biological samples in place, several possibilities exist for using new technologies to develop hypotheses. Testing novel disease mechanisms with state-of-the-art tools should continue to be the foundation of the investigative community. Research must be translated to improve diagnosis and treatment of people. The objectives identified by the KRND provide the research community with future opportunities for improving the prevention, diagnosis, and treatment of diabetic nephropathy.
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Affiliation(s)
- Matthew D Breyer
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Boulevard, Bethesda, MD 20892, USA
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Spanjol J, Celic T, Markic D, Djordjevic G, Maric I, Fuckar Z, Racki S, Bobinac D. Expression of receptor activator of nuclear factor-kappa B ligand in leukocytes during acute kidney rejection after transplantation in rats. Transplant Proc 2013; 45:1766-1770. [PMID: 23769040 DOI: 10.1016/j.transproceed.2012.10.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/11/2012] [Accepted: 10/09/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute cellular rejection of the transplanted kidney is an important cause of impaired graft function. One of the basic characteristics of acute cellular rejection according to the latest Banff classification of renal allograft pathology is the presence of a large number of T lymphocytes in the allografted tissue. Osteoprotegerin, receptor activator of nuclear factor-kappa B (RANK) and RANK ligand (RANKL), three relatively novel members of the tumor necrosis factor superfamily, have crucial roles not only in physiologic and pathologic bone metabolism but also in immunologic processes. The aim of our study was to determine the expression of RANKL and RANK by T lymphocytes and macrophages in acute cellular kidney allograft rejection in rats. METHODS The study included 15 male Wistar rats of 3 months old and 250-300 g as recipients and 15 male DA rats donors of 3 months old; and weight 250-300 g. When animals were sacrificed at 3 weeks to extract the transplanted kidney for pathohistologic analysis and immunoflorescence. all samples showed acute cellular rejection. Kidney sections were examined by dual-labeled immunofluorescence to detect CD4, CD8, or CD68 (red) and RANK or RANKL (green) with coexpressing cells as orange. RESULTS RANKL-positive expression colocalized with CD4(+) and CD8(+) T lymphocytes in acutely rejected kidney tissue. There was no association between CD4(+) and CD8(+) T cells with RANK expression, which was evident by infiltrating CD68-positive macrophages in the kidney tissue interstitium. CONCLUSION RANK and RANKL were expressed by T lymphocytes and macrophages in acute cellular kidney rejection after transplantation in rats.
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Affiliation(s)
- J Spanjol
- Department of Urology, University Hospital of Rijeka, Rijeka, Croatia.
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Gaudiano C, Clementi V, Busato F, Corcioni B, Orrei MG, Ferramosca E, Fabbri E, Berardi P, Santoro A, Golfieri R. Diffusion tensor imaging and tractography of the kidneys: assessment of chronic parenchymal diseases. Eur Radiol 2013; 23:1678-85. [PMID: 23300038 DOI: 10.1007/s00330-012-2749-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/15/2012] [Accepted: 11/17/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess renal dysfunction in chronic kidney diseases using diffusion tensor imaging (DTI). METHODS Forty-seven patients with impaired renal function (study group) and 17 patients without renal diseases (control group) were examined using DTI sequences. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and the fractional anisotropy (FA). The mean values of the ADC and FA, for each ROI site, were obtained in each group and were compared. Furthermore, the correlations between the diffusion parameters and the estimated glomerular filtration rate (eGFR) were determined. RESULTS In both the normal and affected kidneys, we obtained the cortico-medullary difference of the ADC and the FA values. The FA value in the medulla was significantly lower (P = 0.0149) in patients with renal function impairment as compared to patients with normal renal function. A direct correlation between DTI parameters and the eGFR was not found. Tractography visualised disruption of the regular arrangement of the tracts in patient with renal function alteration. CONCLUSION DTI could be a useful tool in the evaluation of chronic kidney disease and, in particular, the medullary FA value seems to be the main parameter for assessing renal damage. KEY POINTS • Magnetic resonance diffusion tensor imaging (MRDTI) provides new information about renal problems. • DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media. • DTI could become useful in the management of chronic parenchymal disease. • DTI seems more appropriate for renal evaluation than diffusion-weighted imaging.
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Affiliation(s)
- Caterina Gaudiano
- Radiology Unit, Department of Digestive Diseases and Internal Medicine, University of Bologna, Via Albertoni, 15, 40138 Bologna, Italy.
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Khalifeh A, Autorino R, Hillyer SP, Kaouk JH. Reply. Urology 2012. [DOI: 10.1016/j.urology.2012.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Coppo R. How early renal biopsy has to be performed in children with isolated asymptomatic proteinuria? Nephrol Dial Transplant 2012; 27:3016-7. [PMID: 22645322 DOI: 10.1093/ndt/gfs147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosanna Coppo
- Department of Nephrology, Dialysis and Transplantation, Regina Margherita University Hospital, Torino, Italy.
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Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012; 19:179-87. [PMID: 22578678 DOI: 10.1053/j.ackd.2012.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/04/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022]
Abstract
Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.
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