title: Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease.
abstract: 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.
  
  
  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.
authors.affiliation: Faculty of Medicine in the Galilee, Bar-Ilan University, Safed; Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center.
authors.forename: Kamal
authors.initials: K
authors.lastname: Hassan
authors.affiliation: Department of Radiology, Galilee Medical Center, Nahariya.
authors.forename: Norman
authors.initials: N
authors.lastname: Loberant
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
authors.forename: Nur
authors.initials: N
authors.lastname: Abbas
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hassan
authors.initials: H
authors.lastname: Fadi
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hassan
authors.initials: H
authors.lastname: Shadia
authors.affiliation: Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center.
authors.forename: Khaled
authors.initials: K
authors.lastname: Khazim
keywords: cortical stiffness; diabetic kidney disease; elastography; shear wave