title: Diagnostic value of quantitative contrast-enhanced ultrasound (CEUS) for early detection of renal hyperperfusion in diabetic kidney disease.
abstract: OBJECTIVE
  To investigate the diagnostic value of quantitative contrast-enhanced ultrasound (CEUS) for early detection of renal hyperperfusion in diabetic kidney disease (DKD).
  
  
  METHODS
  55 DKD patients with estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m(2) and 26 normal controls (NCs) were enrolled. Clinical data was well documented. Blood samples were drawn for evaluation of renal function including blood urea nitrogen (BUN), serum creatinine (SCr) and serum uric acid (SUA), and urine samples were assayed for total protein quantification, and various microprotein markers. According to eGFR level, DKD patients were divided into early-stage DKD (eGFR ≥90 ml/min/1.73 m(2), n = 18) and middle-stage DKD (eGFR 30-90 ml/min/1.73 m(2), n = 37). Based on urinary microalbumin/creatinine ratio (MALB/UCR), early-stage DKD patients were further classified into two groups: MALB/UCR <10 g/mol (n = 11) and MALB/UCR ≥10 g/mol (n = 7). Then, CEUS was performed to observe the real-time renal perfusion, and low acoustic power contrast-specific imaging was used for quantitative analysis.
  
  
  RESULTS
  The renal perfusion images of CEUS were well developed successively. The corresponding perfusion curves based on echo-power signals in time series were constructed. Quantitative analysis showed that area under the descending curve (AUC2) was significantly increased in early-stage DKD compared to middle-stage DKD (p < 0.05), but AUC showed no significant difference. Further comparison between different MALB/UCR levels of early-stage DKD showed that patients with MALB/UCR ≥10 g/mol had significantly increased levels of AUC, AUC2 and proteinuria than patients with low MALB/UCR (p < 0.05). Also, high MALB/UCR DKD patients had increased proteinuria but similar eGFR compared to low MALB/UCR patients.
  
  
  CONCLUSIONS
  Renal microvascular hyperperfusion may be responsible for overt proteinuria until decline of renal filtration in DKD. AUC2 could be an early and sensitive marker for early renal injury and renal microvascular hyperperfusion in DKD.
authors.affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. nowax@126.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Ultrasound in Medicine, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. apagar@126.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. 034379@tongji.edu.cn.
authors.forename: Jia-Fen
authors.initials: JF
authors.lastname: Cheng
authors.affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. singing_l@163.com.
authors.forename: Xin-Ying
authors.initials: XY
authors.lastname: Liu
authors.affiliation: Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. mafang59@126.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Ma
authors.affiliation: Department of Ultrasound in Medicine, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. gopp1314@hotmail.com.
authors.forename: Le-Hang
authors.initials: LH
authors.lastname: Guo
authors.affiliation: Department of Ultrasound in Medicine, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. Junmei_510@hotmail.com.
authors.forename: Jun-Mei
authors.initials: JM
authors.lastname: Xu
authors.affiliation: Department of Biomedical Engineering, University of Houston, 3605 Cullen Blvd, Houston, TX, 77204, USA. tianfu.wu@gmail.com.
authors.forename: Tianfu
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Biomedical Engineering, University of Houston, 3605 Cullen Blvd, Houston, TX, 77204, USA. cmohan@central.uh.edu.
authors.forename: Chandra
authors.initials: C
authors.lastname: Mohan
authors.affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. pengai@tongji.edu.cn.
authors.forename: Ai
authors.initials: A
authors.lastname: Peng
authors.affiliation: Department of Ultrasound in Medicine, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. xuhuixiong@hotmail.com.
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, District of Zhabei, Shanghai, 200072, China. yaxiangs@126.com.
authors.forename: Ya-Xiang
authors.initials: YX
authors.lastname: Song
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D019540:Area Under Curve; D016022:Case-Control Studies; D003287:Contrast Media; D003404:Creatinine / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging; D008875:Middle Aged; D010743:Phospholipids; D012079:Renal Circulation; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D003404:Creatinine; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Diabetic kidney disease; Renal perfusion