Ultrasonography Imagings Combined With Histopathological Scoring Criteria For The Assessment Of Early Chronic Kidney Disease

Background:Chronic kidney disease is a worldwide clinical and public health problem.As a risk factor of cardiovascular diseases,it has gradually become one of the causes of morbidity and mortality.Treatment of early CKD is important to delay the progression of renal failure.However,traditional indicators of CKD diagnosis,such as serum cre,urea nitrogen,and proteinuria,are not highly sensitive to CKD diagnosis and may result in a long time interval before successful intervention.In imaging examination,CT and PET-CT can not be used for routine examination because the use of contrast media increases the burden of kidneys and costs.Therefore,as a routine means of renal disease examination,ultrasound is necessary to improve the early detection rate and accuracy of chronic kidney disease.Objective: To evaluate the early chronic kidney disease combined with renal histopathology score by multiple ultrasound imaging methods,including acoustic radiation force pulse imaging(ARFI),two-dimensional ultrasound(US)and three-dimensional ultrasound(3D US).Materials and Methods: The study included 118 patients with chronic kidney disease who met the CKD diagnostic criteria of K/DOQI,among whom 31,39 and 48 patients were mild,moderate and severe pathological findings.Meanwhile,36 people as a healthy control group.For all the participants,conventional two-dimensional ultrasound for the left kidney scan was completed,observed carefully the kidney size,shape,the internal echo and the thickness of cortex and medulla,and calculated the acceleration time(AT)and resistance Index(RI).Then started the 3D scan of the left kidney,the volume of kidney were calculated automatically by the software.Lastly,all the kidneys were examined by acoustic radiation force impulse imaging(ARFI)to measure the shear wave velocity of the left renal cortex.The effective imaging methods,including conventional ultrasound,three-dimensional ultrasound and ARFI imaging,were used to evaluate the left kidney,and then renal biopsy was performed to score the histopathology.Multivariate logistic regression analysis was used to evaluate independent predictors of early pathological damage in patients with CKD,and ROC curve analysis was used to evaluate the diagnostic performance of each ultrasound index.Result:1.Renal interlobular artery AT(OR: 21.43(4.64,38.22))was the strongest independent predictor of mild damage to CKD,and the predictive efficacy of AT increased after adjusting for confounding variables.Compared the early damage group with the normal control group,ARFI was not statistically significant,although its value decreased significantly.2.In patients with moderate impairment,despite significant differences in ARFI,renal length,renal parenchymal thickness,renal three-dimensional volume,and renal interlobar arterial RI,only AT(OR: 33.77(14.11,53.43))and RI(OR: 19.59(9.36,29.83))were effective predictors by multiple logistic regression analysis.3.Renal length(OR:-1.62(-2.06,-1.19)),three-dimensional renal volume(OR:-0.05(-0.07,-0.03)),interlobar arterial RI(OR: 16.75(2.80,30.70))and AT(OR: 26.28(9.98,42.57))were all effective predictors in severely impaired CKD patients.4.The diagnostic efficacy of AT(AUC: 84.2(74,693.7))was the highest in patients with mild impairment of CKD,but the sensitivity of SWV in detecting mild impairment of kidney(83.8%)was the highest.Conclusion: Renal nterlobar artery AT may be used to predict mild damage in chronic kidney disease,which has better diagnostic performance than 3D ultrasound or ARFI.The resistance index and acceleration time of renal interlobar artery may be used to predict moderate damage in chronic kidney disease.Renal ARFI elastography and three-dimensional ultrasound may be used to predict severe damage in chronic kidney disease.