Can measurement of the foetal renal parenchymal thickness with ultrasound be used as an indirect measure of nephron number?

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Sonja Brennan ◽  
David Watson ◽  
Michal Schneider ◽  
Donna Rudd ◽  
Yogavijayan Kandasamy
Keyword(s):  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Kidney Disease ◽  
Renal Artery ◽  
Artery Blood Flow ◽  
Nephron Number ◽  
Foetal Growth ◽  
Significant Difference ◽  
Prospective Longitudinal ◽  
Parenchymal Thickness

Abstract Chronic kidney disease continues to be under recognised and is associated with a significant global health burden and costs. An adverse intrauterine environment may result in a depleted nephron number and an increased risk of chronic kidney disease. Antenatal ultrasound was used to measure the foetal renal parenchymal thickness (RPT), as a novel method to estimate nephron number. Foetal renal artery blood flow was also assessed. This prospective, longitudinal study evaluated the foetal kidneys of 102 appropriately grown and 30 foetal growth-restricted foetuses between 20 and 37 weeks gestational age (GA) to provide vital knowledge on the influences foetal growth restriction has on the developing kidneys. The foetal RPT and renal artery blood flow were measured at least every 4 weeks using ultrasound. The RPT was found to be significantly thinner in growth-restricted foetuses compared to appropriately grown foetuses [likelihood ratio (LR) = 21.06, P ≤ 0.0001] and the difference increases with GA. In foetuses with the same head circumference, a growth-restricted foetus was more likely to have a thinner parenchyma than an appropriately grown foetus (LR = 8.9, P = 0.0028), supporting the principle that growth-restricted foetuses preferentially shunt blood towards the brain. No significant difference was seen in the renal arteries between appropriately grown and growth-restricted foetuses. Measurement of the RPT appears to be a more sensitive measure than current methods. It has the potential to identify infants with a possible reduced nephron endowment allowing for monitoring and interventions to be focused on individuals at a higher risk of developing future hypertension and chronic kidney disease.

Fetal renal artery blood flow – Normal ranges

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110224
Author(s):  
Sonja Brennan ◽  
David Watson ◽  
Michal Schneider ◽  
Donna Rudd ◽  
Yogavijayan Kandasamy
Keyword(s):  
Blood Flow ◽  
Renal Artery ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Renal Arteries ◽  
Artery Blood Flow ◽  
Flow Measurements ◽  
Prospective Longitudinal Study ◽  
Normal Ranges ◽  
Prospective Longitudinal

Introduction The study objectives were to develop standard charts for fetal renal artery blood flow to define normal ranges and to assess the reliability of the measurements. Methods This prospective, longitudinal study reviewed 72 low-risk singleton pregnancies who had serial ultrasound examinations. Pulse wave Doppler was used to obtain the resistivity and pulsatility indices of the fetal renal arteries. Standard charts of the fetal renal arteries were created using mixed effects modelling and the intra- and interobserver reliability for the renal blood flow measurements was analysed. Results Standard charts of the normal ranges of the renal artery resistive index (RI) and pulsatility index (PI) of the fetal renal arteries were created. The 3rd, 5th, 10th, 50th, 90th, 95th and 97th centiles were calculated. The intraclass correlation coefficient was acceptable for intraobserver reliability (RI = 0.66, PI = 0.88) and poor for interobserver reliability (RI = 0.11, PI = −0.56). Conclusions These novel charts demonstrate the change of the fetal renal artery blood flow during pregnancy. These may be used in clinical practice to detect variations from these normal ranges and be useful in future studies of kidney function projection.

scholarly journals Quantitative assessment of renal structural and functional changes in chronic kidney disease using multi-parametric magnetic resonance imaging

2019 ◽  
Vol 35 (6) ◽  
pp. 955-964 ◽  
Author(s):  
Charlotte E Buchanan ◽  
Huda Mahmoud ◽  
Eleanor F Cox ◽  
Thomas McCulloch ◽  
Benjamin L Prestwich ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Magnetic Resonance ◽  
Kidney Disease ◽  
Renal Artery ◽  
Response To Therapy ◽  
Resonance Imaging ◽  
Artery Flow ◽  
Cortical Perfusion

Abstract Background Multi-parametric magnetic resonance imaging (MRI) provides the potential for a more comprehensive non-invasive assessment of organ structure and function than individual MRI measures, but has not previously been comprehensively evaluated in chronic kidney disease (CKD). Methods We performed multi-parametric renal MRI in persons with CKD (n = 22, 61 ± 24 years) who had a renal biopsy and measured glomerular filtration rate (mGFR), and matched healthy volunteers (HV) (n = 22, 61 ± 25 years). Longitudinal relaxation time (T1), diffusion-weighted imaging, renal blood flow (phase contrast MRI), cortical perfusion (arterial spin labelling) and blood-oxygen-level-dependent relaxation rate (R2*) were evaluated. Results MRI evidenced excellent reproducibility in CKD (coefficient of variation <10%). Significant differences between CKD and HVs included cortical and corticomedullary difference (CMD) in T1, cortical and medullary apparent diffusion coefficient (ADC), renal artery blood flow and cortical perfusion. MRI measures correlated with kidney function in a combined CKD and HV analysis: estimated GFR correlated with cortical T1 (r = −0.68), T1 CMD (r = −0.62), cortical (r = 0.54) and medullary ADC (r = 0.49), renal artery flow (r = 0.78) and cortical perfusion (r = 0.81); log urine protein to creatinine ratio (UPCR) correlated with cortical T1 (r = 0.61), T1 CMD (r = 0.61), cortical (r = −0.45) and medullary ADC (r = −0.49), renal artery flow (r = −0.72) and cortical perfusion (r = −0.58). MRI measures (cortical T1 and ADC, T1 and ADC CMD, cortical perfusion) differed between low/high interstitial fibrosis groups at 30–40% fibrosis threshold. Conclusion Comprehensive multi-parametric MRI is reproducible and correlates well with available measures of renal function and pathology. Larger longitudinal studies are warranted to evaluate its potential to stratify prognosis and response to therapy in CKD.

SONOGRAPHIC FINDINGS OF PATIENTS WITH CHRONIC KIDNEY DISEASE

2017 ◽  
pp. 109-113
Author(s):  
Ba Lai Luu ◽  
Thanh Thao Nguyen
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Artery ◽  
Glomerular Filtration ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Kidney Size ◽  
Healthy Group ◽  
Diastolic Velocity ◽  
Significant Difference

Objective: To describe the morphologic and hemodynamic changes of renal interlobar artery on ultrasonography, and to evaluate the relationship between RI and kidney size, glomerular filtration rate, and causes of chronic kidney disease. Materials and methods: A cross-sectional study of 50 chronic kidney disease patients from stage 3, and 50 healthy individuals. RI, peak systolic velocity (PSV), end diastolic velocity (EDV) of renal interlobar artery, renal size was measured. Results: The mean RI in chronic kidney disease group and healthy group was 0.68 ± 0.05 and 0.57 ± 0.04 (p <0.05), respectively. RI increases with the stage of chronic kidney disease. There were statistically significant differences in RI of renal lobar arteries between chronic pyelonephritis and chronic glomerulonephritis (p <0.05). There was strong negative correlation and a statistically significant difference between renal lobar renal artery RI with kidney size (horizontal, vertical and thickness) and glomerular filtration level. Conclusion: Renal artery resistance index in patients with chronic kidney disease was higher than in the healthy group. The greater the kidney failure is, the more reduction in size and renal function, and the more increase in renal artery resistance index. Key words: morphologic, hemodynamic, chronic kidney disease, ultrasonography

Abstract 33: Combination of Allogeneic Mesenchymal and Kidney-derived Stem Cells Promotes Kidney Repair in a Swine Model of Chronic Kidney Disease

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Angela C Rieger ◽  
Bryon A Tompkins ◽  
Makoto Natsumeda ◽  
Victoria Florea ◽  
Jose Rodriguez ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Stem Cells ◽  
Kidney Disease ◽  
Cell Therapy ◽  
Renal Artery ◽  
Swine Model ◽  
Creatinine Ratio ◽  
Urine Protein ◽  
Increased Risk ◽  
Significant Difference

Background: Chronic kidney disease (CKD) has a high prevalence (~14% of the population) and is associated with a significantly increased risk of cardiovascular disease and a 15-fold higher rate of mortality than the general population. Current therapies slow disease progression but do not repair organ damage, leading to end-stage renal disease. Stem cell therapy has the potential to promote repair via neovascularization and antifibrotic effects. We tested the renal reparative capacity of allogeneic mesenchymal stem cells (MSCs) and kidney ckit+ stem cells (c-kit) in an established swine model of CKD. Methods: Yorkshires pigs (n=27) underwent 5/6 nephrectomy via renal artery embolization and 4-weeks later received either: MSC (10х10 6 ), c-kit (10х10 6 ), combination (MSC+c-kit; 1:1 ratio [5х10 6 each]), or placebo (each n=5). Allogeneic cell therapy was delivered via the patent renal artery of the remnant kidney. Kidney functional parameters and renal MRI were measured at baseline, and at 4- and 12-weeks (euthanasia) post-embolization. Results: The CKD model was validated from baseline to 4 weeks by an increased creatinine: (Δ1.1 ± 0.15 mg/dl; p<0.0001), BUN (Δ13.50 ± 2.99mg/dl; p=0.0003), and urine protein/creatinine ratio (Δ0.311mg/g; p=0.018), and decreased GFR (Δ49.82 ±6.41 ml/min; p=0.0002). Mean arterial pressure (MAP) was not different between groups from baseline to 4 weeks. After 12 weeks, there was a significant difference in MAP between groups (p=0.04), with an increase in the placebo group (19.97± 8.65 mmHg, p=0.08). BUN and creatinine levels improved in all of the groups from 4-12 weeks. GFR also improved in all the groups, but with the greatest effect in the combination group (76± 23.83ml/min; p= 0.03) from 4-12 weeks. Urine protein/creatinine ratio did not change in placebo but decreased in cell treated groups. There was no evidence of immune rejection as evaluated in a complete body necropsy. Conclusion: Allogeneic MSCs and kidney-derived stem cells are safe in a CKD swine model. The combination of stem cells was shown to be more efficacious in improving kidney function. These novel findings have important implications for the advancement of cell therapy for CKD.

scholarly journals SP723INTRA ABDOMINAL PRESSURE AND RENAL ARTERY BLOOD FLOW IN THE EARLY POST TRANSPLANTATION PERIOD

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i589-i590
Author(s):  
Armando Coca ◽  
Ana Lucia Valencia ◽  
Cristina Ferrer ◽  
Pablo Gonzalez ◽  
Miriam Martinez ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Artery ◽  
Abdominal Pressure ◽  
Artery Blood Flow ◽  
Post Transplantation

scholarly journals The Copenhagen chronic kidney disease echo study (COInCYDE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Landler ◽  
S Bro ◽  
B Feldt-Rasmussen ◽  
D Hansen ◽  
A.L Kamper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

scholarly journals MicroRNA-451 as an Early Predictor of Chronic Kidney Disease in Diabetic Nephropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mostafa Abdelsalam ◽  
A. M. Wahab ◽  
Maysaa El Sayed Zaki ◽  
Mohamad Motawea
Keyword(s):  
Chronic Kidney Disease ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Early Diagnosis ◽  
Serum Creatinine ◽  
High Sensitivity ◽  
Urinary Albumin ◽  
Significant Difference ◽  
Plasma Microrna ◽  
Stage Renal Disease

Background. Diabetes mellitus is the leading cause of end-stage renal disease worldwide. Microalbuminuria is the cornerstone for the diagnosis of diabetic nephropathy. However, it is an inadequate marker for early diagnosis. MicroRNAs are not only new and promising markers for early diagnosis but also, but they may also play a role in the prevention of disease progression. Methods. This study included ninety patients with type 2 DM in addition to 30 control subjects. MicroRNA-451 expression in blood and plasma using real-time PCR was evaluated in addition to the classic diabetic nephropathy markers (serum creatinine, urinary albumin, and eGFR). Results. There was a significant difference between the studied groups versus control regarding serum creatinine, eGFR, urinary, and plasma microRNA-451 with p=0.0001. Patients with eGFR 60 ml/min/1.73 m2 showed a significantly higher plasma microRNA-451 (29.6 ± 1.6) and significantly lower urinary microRNA-451 (21 ± 0.9) in comparison to patients with eGFR >60 ml/min/1.73 m2 and p=0.0001. eGFR showed a positive correlation with urinary microRNA-451 and negative correlation with both plasma microRNA-451 and urinary albumin. Both plasma and urinary microRNA-451 are highly sensitive and specific markers for chronicity in diabetic nephropathy patients with sensitivity of 90.9% and 95.5% and specificity of 67.6% and 95.6%, respectively. Conclusion. MicroRNA-451 is a promising early biomarker for chronic kidney disease in diabetic nephropathy with high sensitivity and specificity.

scholarly journals Safety and efficacy of iron isomaltoside 1000/ferric derisomaltose versus iron sucrose in patients with chronic kidney disease: the FERWON-NEPHRO randomized, open-label, comparative trial

2020 ◽  
Vol 36 (1) ◽  
pp. 111-120 ◽  
Author(s):  
Sunil Bhandari ◽  
Philip A Kalra ◽  
Mario Berkowitz ◽  
Diogo Belo ◽  
Lars L Thomsen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Single Dose ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Iron Sucrose ◽  
Hypersensitivity Reactions ◽  
Open Label ◽  
Pronounced Increase ◽  
Safety And Efficacy ◽  
Significant Difference

Abstract Background The optimal intravenous (IV) iron would allow safe correction of iron deficiency at a single infusion over a short time. The FERWON-NEPHRO trial evaluated the safety and efficacy of iron isomaltoside 1000/ferric derisomaltose (IIM) in patients with non-dialysis-dependent chronic kidney disease and iron deficiency anaemia. Methods In this randomized, open-label and multi-centre trial conducted in the USA, patients were randomized 2:1 to a single dose of 1000 mg IIM or iron sucrose (IS) administered as 200 mg IV injections up to five times within a 2-week period. The co-primary endpoints were serious or severe hypersensitivity reactions and change in haemoglobin (Hb) from baseline to Week 8. Secondary endpoints included incidence of composite cardiovascular adverse events (AEs). Results A total of 1538 patients were enrolled (mean estimated glomerular filtration rate 35.5 mL/min/1.73 m2). The co-primary safety objective was met based on no significant difference in the incidence of serious or severe hypersensitivity reactions in the IIM and IS groups [0.3% versus 0%; risk difference: 0.29% (95% confidence interval: –0.19; 0.77; P &gt; 0.05)]. Incidence of composite cardiovascular AEs was significantly lower in the IIM versus IS group (4.1% versus 6.9%; P = 0.025). Compared with IS, IIM led to a more pronounced increase in Hb during the first 4 weeks (P ≤ 0.021), and change in Hb to Week 8 showed non-inferiority, confirming that the co-primary efficacy objective was met. Conclusions Compared with multiple doses of IS, a single dose of IIM induced a non-inferior 8-week haematological response, comparably low rates of hypersensitivity reactions, and a significantly lower incidence of composite cardiovascular AEs.

scholarly journals P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Renal Function ◽  
Kidney Disease ◽  
Urinary Protein ◽  
Dietary Phosphorus ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p&lt;0.001), s albumin (p&lt;0.001), FGF-23 (p&lt;0.001), klotho (p&lt;0.001), urinary protein (p&lt;0.001) and Nephron Index (p&lt;0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p&lt;0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p&lt;0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p&lt;0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

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