剪切波弹性成像技术在评估慢性肾病儿童中的实用性。

IF 2.6 3区 医学 Q1 PEDIATRICS Pediatric Nephrology Pub Date : 2024-11-18 DOI:10.1007/s00467-024-06573-5
Khushi Tiwari, Aliza Mittal, Binit Sureka, Durgadevi Narayanan, Aasma Nalwa, Vikarn Vishwajeet, Mithu Banerjee, Akhil Dhanesh Goel, Shoban Babu Varthya, Krishna Tiwari, Arvind Sinha, Kuldeep Singh
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引用次数: 0

摘要

背景:剪切波弹性成像(SWE)已被证实可用于肝纤维化。然而,由于肾脏的周围结构、腹膜后位置和内脏脂肪,评估肾脏存在挑战。肾脏活检是评估肝纤维化的金标准,但存在出血和镇静的固有风险。本研究探讨了 SWE 在评估 CKD 肾脏纤维化方面的潜力:共有 160 名儿童参与研究:CKD分期、GFR或蛋白尿与YM/SWE没有关系。YM/SWE 对 eGFR 2 的 CKD 预测较差(左肾,8 kPa(敏感性 53.57%,特异性 65.62%,AUC 0.5);右肾,9 kPa(敏感性 57.14%,特异性 50%,AUC 0.39))。YM 在检测右肾(11 kPa)和左肾(6 kPa)> 50%纤维化方面具有较好的诊断效用(AUC = 0.7)(右侧灵敏度为 75%,特异性为 80%,左侧灵敏度为 100%,特异性为 31.43%)。右侧和左侧的 YM 存在显著差异(P = 0.013):结论:SWE 在区分 CKD 阶段方面作用有限,但可预测超过 50% 的纤维化。SWE可能有助于识别纤维化程度的增加,但对检测早期纤维化或慢性化并无帮助。
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Utility of shear wave elastography in evaluation of children with chronic kidney disease.

Background: Shear wave elastography (SWE) is proven for liver fibrosis. However, there are challenges in assessing the kidney owing to its surrounding structures, retroperitoneal location, and visceral fat. Kidney biopsy is the gold standard for estimating fibrosis, but is associated with inherent risks of bleeding and sedation. This study explores SWE's potential in assessing kidney fibrosis in CKD.

Methods: A total of 160 children < 18 years old with CKD or those undergoing kidney biopsy were enrolled from June 2022 to June 2024 in a cross-sectional study. SWE on a Philips Epic Elite system provided Young's modulus (YM) values. We analysed SWE with estimated glomerular filtration rate (eGFR, (CKD stages)) and urine protein creatinine ratio, in patients with CKD. Forty-one patients who underwent kidney biopsy were assessed for interstitial fibrosis and tubular atrophy (IFTA) and SWE.

Results: There was no relation between CKD stages, GFR, or proteinuria with YM/SWE. YM/SWE poorly predicted CKD with eGFR < 60 ml/min/1.73 m2 (left kidney, 8 kPa (sensitivity 53.57%, specificity 65.62%, AUC 0.5), and right kidney, 9 kPa (sensitivity 57.14%, specificity 50%, AUC 0.39)). YM had fair diagnostic utility (AUC = 0.7) in detecting > 50% fibrosis in right kidney (11 kPa) and left kidney (6 kPa) (right side 75% sensitivity, 80% specificity, left side 100% sensitivity, and 31.43% specificity). Significant differences were noted in YM between right and left side (p = 0.013).

Conclusions: SWE was limited in differentiating CKD stages but could predict fibrosis over 50%. SWE might be helpful in identifying increasing fibrosis, but it is not useful in detecting early fibrosis or chronicity.

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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
期刊最新文献
Concurrent use of continuous kidney replacement therapy during extracorporeal membrane oxygenation: what pediatric nephrologists need to know-PCRRT-ICONIC practice points. Furosemide stress test to predict acute kidney injury progression in critically ill children. A better future for children with STEC-hemolytic uremic syndrome: news from Argentina. Acetaminophen induced high anion gap metabolic acidosis: a potentially under-recognized consequence from a common medication. Malnutrition management in children with chronic kidney disease.
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