Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease

Objective: The assessment of the grade of renal fibrosis in diabetic kidney disease (DKD) requires renal biopsy, which may be associated with certain risks. To assess the severity of chronic pathologic changes in DKD, we performed a quantitative analysis of renal parenchymal stiffness in advanced DKD, using shear wave elastography (SWE) imaging. Patients and methods: Twenty-nine diabetic patients with chronic kidney disease (CKD) grades 3-4 due to DKD, and 23 healthy subjects were enrolled. Combined conventional ultrasound and SWE imaging were performed on all participants. The length, width, and cortical thickness and stiffness were recorded for each kidney. Results: Cortical thickness was lower in patients with DKD than in healthy subjects (13.8 +/- 2.2 vs 14.8 +/- 1.6 mm; P=0.002) and in DKD patients with CKD grade 4 than in those with grade 3 (13.0 +/- 3.5 vs 14.7 +/- 2.1 mm; P<0.001). Cortical stiffness was greater in patients with DKD than in healthy subjects (23.72 +/- 14.33 vs 9.02 +/- 2.42 kPa; P<0.001), in DKD patients with CKD grade 4 than in those with grade 3 (30.4 +/- 16.2 vs 14.6 +/- 8.1 kPa; P<0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (15.7 +/- 6.7 vs 11.0 +/- 4.2 kPa; P=0.03). Daily proteinuria was higher in DKD patients with CKD grade 4 than in those with grade 3 (5.52 +/- 0.96 vs 1.13 +/- 0.72; P=0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (1.59 +/- 0.59 vs 0.77 +/- 0.48; P<0.001). Cortical stiffness was inversely correlated with the estimated glomerular filtration rate (r=-0.65, P<0.001) and with cortical thickness (r=-0.43, P<0.001) in patients with DKD. Conclusions: In patients with advanced DKD, SWE imaging may be utilized as a simple and practical method for quantitative evaluation of the chronic morphological changes and for the differentiation between CKD grades.