Sudhakar, G (2014) Prospective observational study to find correlation between non-invasive ultrasound based shear wave velocity by acoustic radiation force impulse ARFI and semiquantitative histopathological renal fibrosis scoring among patients undergoing diagnostic renal biopsy in native kidneys. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Renal Interstitial Fibrosis, a non-specific manifestation of several renal diseases (especially glomerular diseases), that portends poor long term prognosis in terms of renal survival and reaching end stage renal disease. It forms an essential part of the final common pathway of progressive renal damage. In various diseases the degree of interstitial fibrosis has been correlated with poor long term outcomes of kidney disease. Currently assessment of renal interstitial fibrosis could be done reliably only by histological scoring in the renal biopsy. Ultrasound based ARFI shear wave velocity assessment has been shown to be of use in assessment of hepatic fibrosis. The current study is undertaken to evaluate if the ARFI assessment correlates well with renal interstitial fibrosis as assessed by histological scoring, thereby to ascertain its utility as a non-invasive surrogate of renal interstitial fibrosis. OBJECTIVE : To study the correlation between non-invasive ultrasound based shear wave velocity (SWV) by acoustic radiation force impulse ARFI and semi-quantitative histopathological renal interstitial fibrosis (IF) scoring among patients undergoing diagnostic renal biopsy. MATERIALS AND METHODS : 110 patients with renal disease advised for renal biopsy as part of the management by the treating nephrologist were enrolled in the study. Correlations between Shear Wave Velocity in the lower pole of the native kidneys measured by a pre biopsy ARFI and laboratory tests were analyzed in study population. Standard statistical analysis was used with SPSS 11. RESULTS : The study population (n=104) included 73.08% males with a male to female ratio of 2.7:1 with mean age for males and female participant being 41.41±13.8 and 32.07±13.59 respectively.The mean height and weight of the study population was 162.14±7.94 cm and 62.70±12.76 with a mean BMI of 23.83±4.3. The mean haemoglobin was 11.43±2.1, with a mean serum albumin level of 3.34±1.03. Nephritic syndrome (46.2%) was the most common presentation followed by nephrotic syndrome (33%) and chronic interstitial nephritis (17%). The most common diagnosis was the primary glomeruloneprhitis (75%) with IgA and proliferative GN being major contributors.The clinical and radiological characteristics were evaluated for the assessment of the prediction of the interstitial fibrosis. The mean e GFR (ml/min/1.73 m2) in the study population as a function of the CKD staging was 117.49±26.37 in stage 1, 75.68±8.69 in stage 2, 42.94±8.53 in stage 3, 23.21±4.71 in stage 4 and 6.96±2.57 in stage 5.The mean SWV velocity in the different CKD stages were 1.73±0.59, 1.78±0.34, 1.82±0.51, 1.94±0.86, 1.80±0.53 in stage 1,2,3,4 and 5 respectively. There was no correlation between the Shear wave velocity (SWV) measured and the extent of IF and SWV was not helpful in prediction of the extent of fibrosis and there was good negative correlation between eGFR and the interstitial fibrosis. Smoking and hemoglobin were significant predictors of severe IF. The mean ARFI measured SWV in the realigned interstitial groups were 1.69±0.68 and 1.80±0.53 but these were not statistically significant between the early fibrosis and late fibrosis. CONCLUSION : There was no correlation in the non invasive ARFI measured mean as well as median SWV in the lower pole and the interstitial fibrosis in renal biopsy. The clinical predictors like eGFR, Systolic blood pressure, smoking, hemoglobin at presentation and echogenicity in kidneys were significant. The histological markers of tubular atrophy and the glomerulosclerosis had a good correlation with IF. The renal biopsy remains the gold standard for assessment of IF until further sensitive and valid methods are available.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | ARFI ; SWV ; Interstitial fibrosis ; biopsy ; clinical predictors ; grades of Interstitial fibrosis ; eGFR. |
| Subjects: | MEDICAL > Nephrology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 11 Jul 2017 07:47 |
| Last Modified: | 11 Jul 2017 09:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1407 |
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