Evaluation On Early Renal Function And Pathology Injury In Chronic Glomerulonephritis With Diffusion Tensor Imaging

Objective:We investigated the value that MR diffusion tensor imaging estimated early renal function and pathology of chronic glomerulonephritis.Methods:We chose 25 healthy volunteers and 63 chronic glomerulonephritis patients(eGFR≥60ml/min/1.73m~2).All the subjects were tested creatinine.According to creatinine level,we used MDRD equation to estimate glomerular filtration rate.All patients were tested cystatin C,24-hour proteinuria,urinaryα1-microglobulin and urinaryβ2-microglobulin at the same time.Renal biopsy was performed in all patients.According to the Katafuchi’s semi-quantitative evaluation method,we estimated the pathological score.According to the e GFR,all the patients were divided into two group,which were CKDⅠgroup(eGFR≥90ml/min/1.73m~2,38 cases)and CKDⅡgroup(eGFR 60-89ml/min/1.73m~2,25 cases).While according to the pathological score,all the patients were divided intoⅠgroup(pathological score≤5,15 cases),Ⅱgroup(pathological score6-9,16 cases),Ⅲgroup(pathological score10-14,17 cases),Ⅳgroup(pathological score≥15,15 cases).The cortical and medullary FA value was measured in all subjects who underwent DTI.The differences in the cortical,medullary FA value of healthy female and male were assessed.The differences in the cortical,medullary FA value of left and right side kidney were assessed.The differences in the cortical,medullary FA value of different renal regions were assessed.The difference in the cortical,medullary FA value of the matched group and all CKD groups was assessed;The difference in the cortical,medullary FA value of the matched group and all pathological score groups was assessed;The difference in the cortical,medullary FA value of various pathological types was assessed;The correlation of the cortical,medullary FA value and 24-hour proteinuria,eGFR,creatinine,cystatin C,urinaryα1-microglobulin,urinaryβ2-microglobulin,total pathological score,glomerular pathology score,renal tubulointerstitial pathology score,small vascular pathology score was analysed.Results:1.The difference in the cortical,medullary FA value of healthy female and male was not statistically significant(P>0.05).The difference in the cortical,medullary FA value of left and right kidney was not statistically significant(P>0.05).the medullary FA value of the renal upper pole was higher than the renal mid and under pole,the difference was statistically significant(p<0.05).2.The differences in the cortical FA value of the matched group and CKDⅠ-Ⅱgroup was not statistically significant(P>0.05).The difference in the medullary FA value of the matched group and CKDⅠ-Ⅱgroup was statistically significant(P<0.05).With the higher classification of CKD,the medullary FA values was on the decline gradually.The medullary FA value of all subjects was higher than the cortical FA value,the difference was statistically significant(P<0.05).3.For all the patients,the cortical and medullary FA value was not correlated with24-hour proteinuria(r=-0.040,-0.069,P>0.05).the cortical FA value was not correlated with eGFR,creatinine,cystatin C,urinaryα1-microglobulin and urinaryβ2-microglobulin(r=0.103,-0.188,0.070,-0.187,0.088,P>0.05).the medullary FA value was correlated with eGFR,creatinine,cystatin C,urinaryα1-microglobulin and urinaryβ2-microglobulin(r=0.692,-0.582,-0.386,-0.341,-0.270,P<0.05).4.The difference in the cortical FA value of the matched group and all pathological score groups was not statistically significant(P>0.05).The difference in the medullary FA value of the matched group and all the pathological score groups was statistically significant(P<0.05).With the higher pathology classification,the medullary FA values was on the decline gradually.5.For all the patients,The cortical FA value was not correlated with total pathological score,glomerular pathology score,renal tubulointerstitial pathology score and small vascular pathology score(r=-0.116,-0.085,-0.195,-0.036,P>0.05).The medullary FA value was correlated with total pathological score,glomerular pathology score,renal tubulointerstitial pathology score and small vascular pathology score(r=-0.774,-0.741,-0.788,-0.663,P<0.05).6.The difference in the pathology score of various pathological types was statistically significant(P<0.05).The difference in the cortical FA value of various pathological types was not statistically significant(P>0.05).The difference in the medullary FA value of various pathological types was statistically significant(P<0.05).Conclusion:1.Compared to the cortical FA value,the medullary FA value can be sensitive to estimate renal function at early stage of chronic glomerulonephritis.2.Compared to the cortical FA value,the medullary FA value can be sensitive to estimate the pathological damage at early stage of chronic glomerulonephritis.3.Diffusion tensor imaging does not distinguish between various pathological types.