At present, there remains a lack of a reliable indicator for monitoring renal function in patients with hyperuricemia.
Purpose
This study aimed to evaluate the feasibility of diffusion kurtosis imaging in the assessment of renal function in patients with hyperuricemia.
Material and Methods
A total of 75 male participants, including 25 with asymptomatic hyperuricemia, 25 with gouty arthritis, and 25 age-matched male healthy controls, were enrolled in this study. Diffusion kurtosis imaging data were acquired to derive axial (Ka), radial (Kr), and mean kurtosis (MK), fractional anisotropy, axial (Da), radial (Dr), and mean diffusivity (MD) for comparisons among the three groups. They were also correlated with estimated glomerular filtration rate (eGFR).
Results
The MK values of the renal cortex and medulla and Kr value of the renal medulla in patients with asymptomatic hyperuricemia and gouty arthritis significantly increased compared with those in the controls (P < 0.05). Patients with gouty arthritis showed significant higher cortical and medullary Ka values compared with the other two groups (P < 0.05). The cortical Kr values of the asymptomatic hyperuricemia and gouty arthritis patients were significantly higher than that of the controls (P < 0.05). The medullary fractional anisotropy value showed a significant difference between the control and gouty arthritis groups (P < 0.05). No correlation was found between any diffusion kurtosis imaging parameters and eGFR value.
Conclusion
Diffusion kurtosis imaging is feasible in the assessment of the early changes of renal cortex and medulla in patients with hyperuricemia.
CouserWGGiuseppeRMendisS, et al.
The contribution of chronic kidney disease to the global burden of major noncommunicable diseases.Kidney Int2011;
80:1258–1270.
2.
ObermayrRPTemmlCGutjahrG, et al.
Elevated uric acid increases the risk for kidney disease.J Am Soc Nephrol2008;
19:2407–2413.
3.
LinBShaoLLuoQ, et al.
Prevalence of chronic kidney disease and its association with metabolic diseases: a cross-sectional survey in Zhejiang province, Eastern China.BMC Nephrol2014;
15:36.
4.
Sánchez-LozadaLGTapiaESantamaríaJ, et al.
Mild hyperuricemia induces vasoconstriction and maintains glomerular hypertension in normal and remnant kidney rats.Kidney Int2005;
67:237–247.
5.
LevyGDRashidNNiuF, et al.
Effect of Urate-lowering therapies on renal disease progression in patients with hyperuricemia.J Rheumatol2014;
41:955–962.
6.
JalalDIChoncholMChenW, et al.
Uric acid as a target of therapy in CKD.Am J Kidney Dis2013;
61:134–146.
7.
FicocielloLHRosolowskyETNiewczasMA, et al.
High-normal serum uric acid increases risk of early progressive renal function loss in type 1 diabetes: results of a 6-year follow-up.Diabetes Care2010;
33:1337–1343.
8.
ChaudharyKMalhotraKSowersJ, et al.
Uric acid – key ingredient in the recipe for cardiorenal metabolic syndrome.Cardiorenal Med2013;
3:208–220.
9.
ZhouXMatavelliLFrohlichED.Uric acid: its relationship to renal hemodynamics and the renal renin-angiotensin system.Curr Hypertens Rep2006;
8:120–124.
10.
WheltonAMacdonaldPAChefoS, et al.
Preservation of renal function during gout treatment with febuxostat: a quantitative study.Postgrad Med2013;
125:106–114.
11.
SircarDChatterjeeSWaikhomR, et al.
Efficacy of Febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6-month, double-blind, randomized, placebo-controlled trial.Am J Kidney Dis2015;
66:945–950.
12.
JiangSHKarpeKMTalaulikarGS.Safety and predictors of complications of renal biopsy in the outpatient setting.Clin Nephrol2011;
76:464–469.
13.
ZhuoJXuSProctorJL, et al.
Diffusion kurtosis as an in vivo imaging marker for reactive astrogliosis in traumatic brain injury.Neuroimage2012;
59:467–477.
14.
RaabPHattingenEFranzK, et al.
Cerebral gliomas: diffusional kurtosis imaging analysis of microstructural differences.Radiology2010;
254:876–881.
15.
KamagataKTomiyamaHMotoiY, et al.
Diffusional kurtosis imaging of cingulate fibers in Parkinson disease: Comparison with conventional diffusion tensor imaging.Magn Reson Imaging2013;
31:1501–1506.
16.
VanhoutteGPeresonSDelgadoY, et al.
Diffusion kurtosis imaging to detect amyloidosis in an APP/PS1 mouse model for Alzheimer’s disease.Magn Reson Med2013;
69:1115–1121.
17.
TamuraCShinmotoHSogaS, et al.
Diffusion kurtosis imaging study of prostate cancer: preliminary findings.J Mage Reson Imaging2014;
40:723–729.
18.
RoethkeMCKuderTAKuruTH, et al.
Evaluation of diffusion kurtosis imaging versus standard diffusion imaging for detection and grading of peripheral zone prostate cancer.Invest Radiol2015;
50:483–489.
19.
QuentinMPentangGSchimmöllerL, et al.
Feasibility of diffusional kurtosis tensor imaging in prostate MRI for the assessment of prostate cancer: preliminary results.Magn Reson Imaging2014;
32:880–885.
20.
HectorsSJSemaanSSongC, et al.
Advanced diffusion-weighted imaging modeling for prostate cancer characterization: correlation with quantitative histopathologic tumor tissue composition-a hypothesis-generating study.Radiology2018;
286:918–928.
21.
YoshimaruDMiyatiTSuzukiY, et al.
Diffusion kurtosis imaging with the breath-hold technique for staging hepatic fibrosis: A preliminary study. Magn Reson Imaging2018;
59:18–25.
22.
GoshimaSKanematsuMNodaY, et al.
Diffusion kurtosis imaging to assess response to treatment in hypervascular hepatocellular carcinoma.Am J Roentgenol2015;
204:W543–549.
23.
BudjanJSauterEAZoellnerFG, et al.
Diffusion kurtosis imaging of the liver at 3 Tesla: in vivo comparison to standard diffusion-weighted imaging.Acta Radiol2017:11–28.
24.
PentangGLanzmanRSHeuschP, et al.
Diffusion kurtosis imaging of the human kidney: A feasibility study.Magn Reson Imaging2014;
32:413–420.
25.
HuangYChenXZhangZ, et al.
MRI quantification of non-Gaussian water diffusion in normal human kidney: a diffusional kurtosis imaging study.NMR Biomed2015;
28:154–161.
26.
NeogiTJansenTLDalbethN, et al.
2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Ann Rheum Dis2015;
74:1789–1798.
27.
ChuangSChenJHYehWT, et al.
Hyperuricemia and increased risk of ischemic heart disease in a large Chinese cohort.Int J Cardiol2012;
154:316–321.
28.
KongXMaYChenJ, et al.
Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating glomerular filtration rate in the Chinese population.Nephrol Dial Transplant2013;
28:641–651.
29.
NotohamiprodjoMDietrichOHorgerW, et al.
Diffusion tensor imaging (DTI) of the kidney at 3 tesla-feasibility, protocol evaluation and comparison to 1.5 Tesla.Invest Radiol2010;
45:245–254.
30.
KidoAKataokaMYamamotoA, et al.
Diffusion tensor MRI of the kidney at 3.0 and 1.5 Tesla.Acta Radiol2010;
51:1059–1063.
31.
LiuZXuYZhangJ, et al.
Chronic kidney disease: pathological and functional assessment with diffusion tensor imaging at 3T MR.Eur Radiol2015;
25:652–660.
32.
WheltonAMacdonaldPAChefoS, et al.
Preservation of renal function during gout treatment with febuxostat: a quantitative study.Postgrad Med2013;
125:106–114.
33.
JensenJHHelpernJA.MRI quantification of non-Gaussian water diffusion by kurtosis analysis.NMR Biomed2010;
23:698–710.
34.
JensenJHHelpernJARamaniA, et al.
Diffusional kurtosis imaging: the quantification of non-gaussian water diffusion by means of magnetic resonance imaging.Magn Reson Med2005;
53:1432–1440.
35.
GaudianoCClementiVBusatoF, et al.
Diffusion tensor imaging and tractography of the kidneys: assessment of chronic parenchymal diseases.Eur Radiol2013;
23:1678–1685.
36.
FengQMaZWuJ, et al.
DTI for the assessment of disease stage in patients with glomerulonephritis-correlation with renal histology.Eur Radiol2015;
25:92–98.
37.
Le BihanDBretonELallemandD, et al.
Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.Radiology1988;
168:497–505.
38.
Le BihanD.Apparent diffusion coefficient and beyond: what diffusion MR imaging can tell us about tissue structure.Radiology2013;
268:318–322.
39.
RosenkrantzABPadhaniARChenevertTL, et al.
Body diffusion kurtosis imaging: Basic principles, applications, and considerations for clinical practice.J Magn Reson Imaging2015;
42:1190–1202.
40.
KanellisJWatanabeSLiJH, et al.
Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2.Hypertension2003;
41:1287–1293.
41.
RomiMMArfianNTranggonoU, et al.
Uric acid causes kidney injury through inducing fibroblast expansion, Endothelin-1 expression, and inflammation.BMC Nephrol2017;
18:326–334.
42.
VerzolaDRattoEVillaggioB, et al.
Uric acid promotes apoptosis in human proximal tubule cells by oxidative stress and the activation of NADPH oxidase NOX 4.PLoS One2014;
9:e115210.
43.
WeinerDETighiouartHElsayedEF, et al.
Uric acid and incident kidney disease in the community.J Am Soc Nephrol2008;
19:1204–1211.
44.
IchikawaSMotosugiUIchikawaT, et al.
Intravoxel incoherent motion imaging of the kidney: alterations in diffusion and perfusion in patients with renal dysfunction.Magn Reson Imaging2013;
31:414–417.
45.
SigmundEEVivierPHSuiD, et al.
Intravoxel incoherent motion and diffusion-tensor imaging in renal tissue under hydration and furosemide flow challenges.Radiology2012;
263:758–769.
46.
FengYZChenXQYuJ, et al.
Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients.Abdom Radiol2018;
43:2764–2773.
47.
Sánchez-LozadaLGTapiaELópez-MolinaR, et al.
Effects of acute and chronic L-arginine treatment in experimental hyperuricemia.Am J Physiol Renal Physiol2007;
292:F1238–1244.
48.
MazzaliMHughesJKimYG, et al.
Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism.Hypertension2001;
38:1101–1106.
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