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Scientific article
Open access
English

Diffusion-magnetic resonance imaging predicts decline of kidney function in chronic kidney disease and in patients with a kidney allograft

Published inKidney international, vol. 101, no. 4, p. 804-813
Publication date2022-04
First online date2022-01-11
Abstract

Kidney cortical interstitial fibrosis is highly predictive of kidney prognosis and is currently assessed by evaluation of a biopsy. Diffusion-weighted magnetic resonance imaging is a promising non-invasive tool to evaluate kidney fibrosis. We recently adapted diffusion-weighted imaging sequence for discrimination between the kidney cortex and medulla and found that the cortico-medullary difference in apparent diffusion coefficient (ΔADC) correlated with histological interstitial fibrosis. Here, we assessed whether ΔADC as measured with diffusion-weighted magnetic resonance imaging is predictive of kidney function decline and dialysis initiation in chronic kidney disease (CKD) and patients with a kidney allograft in a prospective study encompassing 197 patients. We measured ΔADC in 43 patients with CKD (estimated GFR (eGFR) 55ml/min/1.73m2) and 154 patients with a kidney allograft (eGFR 53ml/min/1.73m2). Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of biopsy; median follow-up of 2.2 years with measured laboratory parameters. The primary outcome was a rapid decline of kidney function (eGFR decline over 30% or dialysis initiation) during follow up. Significantly, patients with a negative ΔADC had 5.4 times more risk of rapid decline of kidney function or dialysis (95% confidence interval: 2.29-12.58). After correction for kidney function at baseline and proteinuria, low ADC still predicted significant kidney function loss with a hazard ratio of 4.62 (95% confidence interval 1.56-13.67) independent of baseline age, sex, eGFR and proteinuria. Thus, low ΔADC can be a predictor of kidney function decline and dialysis initiation in patients with native kidney disease or kidney allograft, independent of baseline kidney function and proteinuria.

eng
Keywords
  • Chronic kidney disease
  • Magnetic resonance imaging (MRI)
  • Prognostic tool
  • Allografts / diagnostic imaging
  • Allografts / pathology
  • Diffusion Magnetic Resonance Imaging / methods
  • Female
  • Fibrosis
  • Glomerular Filtration Rate
  • Humans
  • Kidney / pathology
  • Male
  • Prospective Studies
  • Proteinuria / diagnostic imaging
  • Proteinuria / etiology
  • Proteinuria / pathology
  • Renal Insufficiency, Chronic / diagnostic imaging
  • Renal Insufficiency, Chronic / pathology
  • Renal Insufficiency, Chronic / surgery
Citation (ISO format)
BERCHTOLD, Lena et al. Diffusion-magnetic resonance imaging predicts decline of kidney function in chronic kidney disease and in patients with a kidney allograft. In: Kidney international, 2022, vol. 101, n° 4, p. 804–813. doi: 10.1016/j.kint.2021.12.014
Main files (2)
Article (Accepted version)
Article (Published version)
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Secondary files (1)
Identifiers
ISSN of the journal0085-2538
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Creation08/01/2022 2:54:00 PM
First validation08/01/2022 2:54:00 PM
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