Magnetic resonance imaging 3t and total fibrotic volume in autosomal dominant polycystic kidney disease

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal hereditary disorder. Several authors have attempted to identify a kidney damage marker for predicting the prognosis and the effectiveness of therapy in ADPKD. The aim of this study was to identify and quantify in ADPKD, through a novel MR protocol with 3 Tesla (MRI 3Tesla), the presence of parenchymal fibrotic tissue at early stage of disease, able to correlate the glomerular filtrate and to predict the loss of the function renal. MATERIAL AND METHODS: 15 ADPKD patients undergone to renal MRI 3Tesla at T0 and revaluated after follow up (T1) of 5 years. We have evaluated renal function, plasma aldosterone concentration (PAC), insulin resistance and surrogate markers of atherosclerosis (carotid intima media thickness (IMT), ankle/brachial index (ABI) and left ventricular mass index (LVMI). RESULTS: Our study showed a significant negative correlation between total kidney volume and estimated glomerular filtration rate (eGFR) during observational observation (p<0.02). Moreover, we showed a negative correlation between eGFR with Total Fibrotic Volume (TFV) (p<0.04) and Total Perfusion Volume/Total kidney Volume(<0.02). Moreover TFV was correlated positively with PAC (p<0.05), insulin values (p<0.05), ABI (p <0.05) and LVMI(p<0.01). CONCLUSIONS: The MRI 3Tesla, despite the high costs, could be considered an useful and non-invasive method in the evaluation of fibrotic tissue and progression of the disease in ADPKD patients. Further clinical trials on larger group are due to confirm the results of this pilot study, suggesting that MRI 3Tesla can be useful to evaluate the effectiveness of new therapeutic strategies. This article is protected by copyright. All rights reserved

ROLE OF MACHINE VISION FOR IDENTIFICATION OF KIDNEY STONES USING MULTI FEATURES ANALYSIS

The purpose of this study is to highlight the significance of machine vision for the Classification of kidney stone identification. A novel optimized fused texture features frame work was designed to identify the stones in kidney.  A fused 234 texture feature namely (GLCM, RLM and Histogram) feature set was acquired by each region of interest (ROI). It was observed that on each image 8 ROI’s of sizes (16x16, 20x20 and 22x22) were taken. It was difficult to handle a large feature space 280800 (1200x234). Now to overcome this data handling issue we have applied feature optimization technique namely POE+ACC and acquired 30 most optimized features set for each ROI. The optimized fused features data set 3600(1200x30) was used to four machine vision Classifiers that is Random Forest, MLP, j48 and Naïve Bayes. Finally, it was observed that Random Forest provides best results of 90% accuracy on ROI 22x22 among the above discussed deployed Classifier

Targeting a silent disease: vascular calcification in chronic Kidney disease

Chronic kidney disease (CKD) patients have a higher risk of developing early cardiovascular disease (CVD). Although vascular calcification (VC) is one of the strongest predictors of CVD risk, its diagnosis among the CKD population remains a serious clinical challenge. This is mainly due to the complexity of VC, which results from various interconnected pathological mechanisms occurring at early stages and at multiples sites, affecting the medial and intimal layers of the vascular tree. Here, we review the most used and recently developed imaging techniques, here referred to as imaging biomarkers, for VC detection and monitoring, while discussing their strengths and limitations considering the specificities of VC in a CKD context. Although imaging biomarkers have a crucial role in the diagnosis of VC, with important insights into CVD risk, circulating biomarkers represent an added value by reflecting the molecular dynamics and mechanisms involved in VC pathophysiological pathways, opening new avenues into the early detection and targeted interventions. We propose that a combined strategy using imaging and circulating biomarkers with a role in multiple VC molecular mechanisms, such as Fetuin-A, Matrix Gla protein, Gla-rich protein and calciprotein particles, should represent high prognostic value for management of CVD risk in the CKD population.info:eu-repo/semantics/publishedVersio

Predicting cardiovascular disease morbidity and mortality in chronic kidney disease in Spain. The rationale and design of NEFRONA: a prospective, multicenter, observational cohort study

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Cardiovascular risk assessment in this population is hampered by the failure of traditional risk factors to fully account for the elevated CVD risk (reverse epidemiology effect) and the presence of emerging risk factors specifically related to kidney failure. Therefore, diagnostic tools capable of improving cardiovascular risk assessment beyond traditional risk factors are currently warranted. We present the protocol of a 4-year prospective study aimed to assess the predictive value of non-invasive imaging techniques and biomarkers for CVD events and mortality in patients with CKD. Methods: From November 2009 to October 2010, 4137 asymptomatic adult patients with stages 2 to 5 CKD will be recruited from nephrology services and dialysis units throughout Spain. During the same period, 843 participants without CKD (control group) will be recruited from lists of primary care physicians, only at baseline. During the follow-up, CVD events and mortality will be recorded from all CKD patients. Clinical and laboratory characteristics will be collected in a medical documentation sheet. Three trained itinerant teams will carry out a carotid ultrasound to assess intima-media thickness and presence of plaques. A composite atherosclerosis score will be constructed based on carotid ultrasound data and measurement of ankle-brachial index. In CKD patients, presence and type of calcifications will be assessed in the wall of carotid, femoral and brachial arteries, and in cardiac valves, by ultrasound. From all participants, blood samples will be collected and stored in a biobank to study novel biomarkers. Conclusions: The NEFRONA study is the first large, prospective study to examine the predictive value of several non-invasive imaging techniques and novel biomarkers in CKD patients throughout Spain. Hereby, we present the protocol of this study aimed to explore the most effective way in which these tests can be integrated with traditional risk factors to maximize CVD detection in this population

ARFI: from basic principles to clinical applications in diffuse chronic disease-a review

The many factors influencing the shear wave velocity (SWV) measured with Acoustic Radiation Force Impulse (ARFI) are examined in order to define the most correct examination technique. In particular, attention is given to the information achieved by experimental models, such as phantoms and animal studies. This review targets the clinical applications of ARFI in the evaluation of chronic diffuse disease, especially of liver and kidneys. The contribution of ARFI to the clinical workout of these patients and some possible perspectives are described

Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients

Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e'), of 70 consecutive renal patients (20 with stage 2-4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction 6550% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <-18% was shown in 55% of patients with stage 2-4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e' (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e', systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e' resulted to be the most powerful independent predictor of abnormal GLS

Predictors of cardiovascular disease and mortality in patients with advanced chronic kidney disease

Cardiovascular disease is the leading cause of high mortality in advanced chronic kidney disease (CKD) patients. Treatment and prevention of cardiovascular disease should be in focus to improve prognosis in this high-risk population. The aim of the study was to assess cardiovascular determinants of mortality, to study the effect of diabetes on arterial endothelial function and structure, to evaluate exercise capacity and abdominal aortic calcification (AAC) in patients with advanced CKD, not on dialysis. 210 participants of the Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury -study underwent maximal bicycle ergometry stress test, echocardiography, lateral lumbar radiograph to study AAC score, ultrasound measures of arterial structure and function, and laboratory measures. Determinants of mortality were stress ergometry performance, AAC score, E/e’ ratio of echocardiography, and cardiac biomarkers and albumin. Diabetes was a significant determinant of AAC but did not associate with endothelial dysfunction or increased carotid intima-media thickness. Maximal stress ergometry performance was associated with troponin T (TnT) and AAC. The progression of AAC was rapid and the increment rate was similar in patients transitioning to different modalities of renal replacement therapy. To conclude, stress ergometry performance, AAC, E/e’ of echocardiography, and cardiac biomarkers and albumin predict mortality, and diabetes is associated with AAC in advanced CKD. TnT and AAC are associated with maximal ergometry stress test and AAC progresses at a comparable rate across the CKD treatment groups.Sydän- ja verisuonitautien ja kuolleisuuden ennustekijät loppuvaiheen munuaisten vajaatoimintaa sairastavilla Loppuvaiheen munuaisten vajaatoimintapotilailla sydän- ja verisuonitaudit ovat johtava kuolleisuuden syy. Sydän- ja verisuonitautien hoito ja ennaltaehkäisy tulisi olla keskiössä tämän korkean riskin ryhmän ennusteen parantumiseksi. Tutkimuksessa arvioitiin kuolleisuuteen vaikuttavia sydän- ja verisuonitautitekijöitä, diabeteksen vaikutusta verisuonen sisäkalvon toimintaan ja suonirakenteeseen, suorituskykyä, sekä vatsa-aortan kalkkisuutta ei-dialyysihoitoisessa loppuvaiheen munuaisten vajaatoiminnassa. 210 potilasta osallistui Krooninen valtimotauti, elämänlaatu ja mortaliteetti vaikeaa munuaisten vajaatoimintaa sairastavilla -tutkimukseen. Tutkittaville tehtiin polkupyörärasituskoe, sydämen ultraäänitutkimus, lannerangan röntgenkuvaus aortan kalkkisuuden määrittämiseksi, verisuoniultraäänitutkimus verisuonen rakenteen ja toiminnan tutkimiseksi sekä otettiin laboratoriokokeet. Kuolleisuutta määrittivät suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini. Diabetes määritti vatsa-aortan kalkkisuutta merkittävästi, mutta ei ollut yhteydessä verisuonen laajenemiskykyyn eikä kaulavaltimon seinämäpaksuuteen. Maksimaalinen suorituskyky oli yhteydessä troponiini T:hen (TnT) ja vatsa-aortan kalkkisuuteen. Vatsaaortan kalkkisuus kehittyi nopeasti ja kehityksen suuruus oli sama eri keinomunuaishoitomuodoissa. Yhteenvetona todetaan, että suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini ennustavat kuolleisuutta, ja diabetes on yhteydessä vatsa-aortan kalkkisuuteen, mutta ei verisuonen laajenemiskykyyn tai sisäkalvopaksuuteen, loppuvaiheen munuaisten vajaatoiminnassa. TnT ja vatsa-aortan kalkkisuus ovat yhteydessä maksimaaliseen suorituskykyyn, ja vatsa-aortan kalkkisuus etenee samalla nopeudella eri munuaiskorvaushoitomuodoissa

The role of echocardiographic study in patients with chronic kidney disease

Despite the recent enormous advances in medicine, high mortality and morbidity rates among the chronic kidney disease (CKD) patients remain an important but unresolved issue. Cardiovascular disease is a major cause of mortality and morbidity in patients with CKD. Abnormal left ventricular geometry and functions are common in this patient group and have been proven to be correlated with a high cardiovascular mortality/morbidity and all-cause mortality. For this reason, echocardiographic study plays an important role in evaluating cardiac structure and functions as well as in stratifying prognostic risk. We here summarize the reported findings on the usefulness of echocardiographic methodologies and identify their roles in diagnostic and prognostic clinical approaches