Quantitative imaging in nephrology: limits and potentials of elastosonography

Abstract

Chronic kidney disease is characterized by increasingly amplified fibrotic processes regardless of etiology. The severity of renal fibrosis seems to correlate with an increased risk of end-stage renal disease; therefore, monitoring of renal fibrosis over time may play an important role in the follow-up of both focal and diffuse renal diseases and in evaluating the response to treatments. Renal biopsy is the only method capable of providing objective and comparable information on the extent of fibrosis, but it is not suitable for outpatient monitoring of chronic kidney disease due to its invasiveness. Elastosonography is an innovative and non-invasive ultrasound method that allows the measurement of tissue elasticity through the transmission of mechanical waves and the measurement of their propagation speed. Although some authors have demonstrated the usefulness of elastosonographic techniques for the quantification of liver fibrosis, few studies have investigated the applications of elastosonography in renal pathology. Furthermore, the depth of native kidneys, the high anisotropy of the renal tissue, and the possibility of examining only a small region of interest currently limit its spread in clinical practice. The aim of this review is to examine the physical principles of elastosonography and to review the latest evidence about the possible applications of the ARFI (acoustic radiation force impulse) technique in the study of kidney diseases.

Keywords: ultrasound, fibrosis, renal elastosonography, ARFI, quantitative imaging

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Introduzione

La malattia renale cronica (Chronic Kidney Disease, CKD) è una condizione patologica ad elevata prevalenza nella popolazione generale, caratterizzata da alterazioni della funzione renale e/o anomalie strutturali presenti per più di tre mesi, con variabile tendenza alla progressione verso forme più gravi di insufficienza d’organo [1]. Sebbene numerose patologie del parenchima, dei vasi o delle vie escretrici (sia primitive che secondarie) possano provocare la CKD, la fibrosi d’organo rappresenta la caratteristica comune a tutti i differenti meccanismi patogenetici responsabili di danno renale. Il grado di fibrosi sembra inoltre essere correlato con un maggior rischio di progressione verso l’End Stage Renal Disease (ESRD), pertanto possiede un elevato valore predittivo negativo per l’outcome delle patologie renali croniche [2]. 

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Antifibrotic renal role of mineralcorticoid receptor antagonists

Abstract

Cardiovascular and renal diseases are one of the main health problems in all industrialized countries. Their incidence is constantly increasing due to the aging of the population and the greater prevalence of obesity and type 2 diabetes.

Clinical evidence suggests that aldosterone and the activation of mineralocorticoid receptors (MR) have a role in the pathophysiology of cardiovascular and renal diseases. Moreover, clinical studies demonstrate the benefits of mineralocorticoid receptor antagonists (MRAs) on mortality and progression of heart and kidney disease.

In addition to renal effects on body fluid homeostasis, aldosterone has multiple extrarenal effects including the induction of inflammation, vascular rigidity, collagen formation and stimulation of fibrosis.

Given the fundamental role of MR activation in renal and cardiac fibrosis, effective and selective blocking of the signal with MRAs can be used in the clinical practice to prevent or slow down the progression of heart and kidney diseases.

The aim of the present work is to review the role of MRAs in light of the new evidence as well as its potential use as an antifibrotic in chronic kidney disease (CKD). The initial clinical results suggest that MRAs are potentially useful in treating patients with chronic kidney disease, particularly in cases of diabetic nephropathy. We don’t yet have efficacy and safety data on the progression of kidney disease up to the end stage (ESRD) and filling this gap represents an important target for future trials.

 

Key words: mineralocorticoid receptor, aldosterone, kidney, cardiac, fibrosis

Sorry, this entry is only available in Italian. For the sake of viewer convenience, the content is shown below in the alternative language. You may click the link to switch the active language.

Introduzione

L’aldosterone è un ormone steroideo con attività mineralcorticoide, prodotto principalmente nella zona glomerulare della corteccia surrenale. Le sue principali funzioni fisiologiche consistono nel mantenimento dell’equilibrio del sodio e del potassio e nel controllo della pressione arteriosa, legandosi ai recettori dei mineralcorticoidi (MR) nel tubulo distale e nel dotto collettore del rene e aumentando così il riassorbimento del sodio e la secrezione di potassio [1]. 

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