Kidney Week

Abstract: TH-PO1129

Diffusion MRI Detects an Increase in Interstitial Fibrosis Earlier Than the Decline of Renal Function

Session Information

• Transplantation: Clinical - Predictors of Outcomes - Biomarkers and Beyond
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Berchtold, Lena, Hôpitaux Universitaire de Genève, Geneva, Switzerland

Lena Berchtold,

• Moll, Solange, University Hospital of Geneva, Geneva, Switzerland

Solange Moll,

• Martin, Pierre-Yves F., Hospital Universitaire de Geneve, Geneva City, Switzerland

Pierre-Yves F. Martin,

• De Seigneux, Sophie M., Hôpitaux Universitaire de Genève, Geneva, Switzerland

Sophie M. De Seigneux,

Background

Interstitial fibrosis(IF) is one of the major predicting factors in CKD. Diffusion Weighted Magnetic resonance imaging(DWI-MRI) is a new tool for non–invasive IF assessment, but its value for IF follow up is unknown. We recently adapted a DWI sequence, allowing for the discrimination between the kidney cortex and medulla. The cortico-medullary ADC difference(ΔADC) was better correlated to IF than absolute ADC. We aimed at analyzing the use of DWI-MRI for the follow up of IF in patients having undergone repeated biopsies in comparison to renal function evolution.

Methods

In this prospective study, we included patients having undergone repeated biopsies for clinical purpose and who agreed to undergo repeated DWI-MRI at the time of biopsy.

Results

19 kidney allografts patients had repeated biopsies for clinical purposes and parallel MRI examinations. The average interval between the two biopsies was 1.7year. There was no significant correlation between eGFR and IF at baseline(r=-0.39,p=0.10), whereas baseline ΔADC correlated negatively with IF(r=-0.76,p<0.001). Between the two visits, IF as estimated from the biopsy, increased significantly from a fibrosis score of 20% to 32.5%(p=0.03) in individual patients, whereas estimated renal function remained stable(eGFR 54 to 52ml/min/1.73m²;p=0.19). ΔADC decreased significantly from 30 to -23 x10^-6mm²/S(Figure A). Considering the difference between the basal and follow-up values, there was a good correlation between the evolution of IF and ΔADC(r=-0.51,p=0.03)(Figure B) but not between the evolution of IF and eGFR (r=0.24,p=0.34).

Conclusion

Thus modifications of ΔADC derived from DWI-MRI outperformed eGFR to follow IF evolution within a given patient. ΔADC may be more reliable than eGFR to allow earlier detection of an increase in IF.

Funding

• Government Support - Non-U.S.