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Niendorf T, Gladytz T, Cantow K, Millward JM, Waiczies S, Seeliger E. Magnetic resonance imaging of renal oxygenation. Nat Rev Nephrol 2025:10.1038/s41581-025-00956-z. [PMID: 40269325 DOI: 10.1038/s41581-025-00956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2025] [Indexed: 04/25/2025]
Abstract
Renal hypoxia has a key role in the pathophysiology of many kidney diseases. MRI provides surrogate markers of oxygenation, offering a critical opportunity to detect renal hypoxia. However, studies that have assessed the diagnostic performance of oxygenation MRI for kidney disorders have provided inconsistent results because MRI metrics do not fully capture the complexity of renal oxygenation. Most oxygenation MRI studies are descriptive in nature and fail to detail the pathophysiological importance of the imaging findings. These limitations have restricted the clinical application of oxygenation MRI and the full potential of this technology to facilitate early diagnosis, risk prediction and treatment monitoring of kidney disease has not yet been realized. Understanding of the relationship between renal tissue oxygenation and MRI metrics, which is affected by kidney size, tubular volume fraction and renal blood volume fraction, and measurement of these factors using novel MR methods is imperative for correct physiological interpretation of renal MR oximetry findings. Next steps to enable the clinical adoption of MR oximetry should involve multidisciplinary collaboration to address standardization of acquisition and data analysis protocols and establish reference values of MRI metrics.
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Affiliation(s)
- Thoralf Niendorf
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany.
- Experimental and Clinical Research Center, A joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
| | - Thomas Gladytz
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
- Experimental and Clinical Research Center, A joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Kathleen Cantow
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Jason M Millward
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
- Experimental and Clinical Research Center, A joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sonia Waiczies
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
- Experimental and Clinical Research Center, A joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Hillaert A, Sanmiguel Serpa LC, Bogaert S, Broeckx BJG, Hesta M, Vandermeulen E, Germonpré J, Stock E, Pullens P, Vanderperren K. Assessment of pharmacologically induced changes in canine kidney function by multiparametric magnetic resonance imaging and contrast enhanced ultrasound. Front Vet Sci 2024; 11:1406343. [PMID: 38966564 PMCID: PMC11223176 DOI: 10.3389/fvets.2024.1406343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
IntroductionDynamic contrast-enhanced (DCE) MRI and arterial spin labeling (ASL) MRI enable non-invasive measurement of renal blood flow (RBF), whereas blood oxygenation level-dependent (BOLD) MRI enables non-invasive measurement of the apparent relaxation rate (R2*), an indicator of oxygenation. This study was conducted to evaluate the potential role of these MRI modalities in assessing RBF and oxygenation in dogs. The correlation between contrast-enhanced ultrasound (CEUS) and the MRI modalities was examined and also the ability of the MRI modalities to detect pharmacologically induced changes.MethodsRBF, using CEUS, ASL- and DCE-MRI, as well as renal oxygenation, using BOLD-MRI of eight adult beagles were assessed at two time-points, 2–3 weeks apart. During each time point, the anesthetized dogs received either a control (0.9% sodium chloride) or a dopamine treatment. For each time point, measurements were carried out over 2 days. An MRI scan at 3 T was performed on day one, followed by CEUS on day two.ResultsUsing the model-free model with caudal placement of the arterial input function (AIF) region of interest (ROI) in the aorta, the DCE results showed a significant correlation with ASL measured RBF and detected significant changes in blood flow during dopamine infusion. Additionally, R2* negatively correlated with ASL measured RBF at the cortex and medulla, as well as with medullary wash-in rate (WiR) and peak intensity (PI). ASL measured RBF, in its turn, showed a positive correlation with cortical WiR, PI, area under the curve (AUC) and fall time (FT), and with medullary WiR and PI, but a negative correlation with medullary rise time (RT). During dopamine infusion, BOLD-MRI observed a significant decrease in R2* at the medulla and entire kidney, while ASL-MRI demonstrated a significant increase in RBF at the cortex, medulla and the entire kidney.ConclusionASL- and BOLD-MRI can measure pharmacologically induced changes in renal blood flow and renal oxygenation in dogs and might allow detection of changes that cannot be observed with CEUS. However, further research is needed to confirm the potential of ASL- and BOLD-MRI in dogs and to clarify which analysis method is most suitable for DCE-MRI in dogs.
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Affiliation(s)
- Amber Hillaert
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luis Carlos Sanmiguel Serpa
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stephanie Bogaert
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
| | - Bart J. G. Broeckx
- Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Myriam Hesta
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jolien Germonpré
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pim Pullens
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
- Institute of Biomedical Engineering and Technology, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Katrien Vanderperren
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Hillaert A, Sanmiguel Serpa LC, Xu Y, Hesta M, Bogaert S, Vanderperren K, Pullens P. Optimization of Fair Arterial Spin Labeling Magnetic Resonance Imaging (ASL-MRI) for Renal Perfusion Quantification in Dogs: Pilot Study. Animals (Basel) 2024; 14:1810. [PMID: 38929429 PMCID: PMC11201026 DOI: 10.3390/ani14121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Arterial spin labeling (ASL) MRI allows non-invasive quantification of renal blood flow (RBF) and shows great potential for renal assessment. To our knowledge, renal ASL-MRI has not previously been performed in dogs. The aim of this pilot study was to determine parameters essential for ALS-MRI-based quantification of RBF in dogs: T1, blood (longitudinal relaxation time), λ (blood tissue partition coefficient) and TI (inversion time). A Beagle was scanned at 3T with a multi-TI ASL sequence, with TIs ranging from 250 to 2500 ms, to determine the optimal TI value. The T1 of blood for dogs was determined by scanning a blood sample with a 2D IR TSE sequence. The water content of the dog's kidney was determined by analyzing kidney samples from four dogs with a moisture analyzer and was subsequently used to calculate λ. The optimal TI and the measured values for T1,blood, and λ were 2000 ms, 1463 ms and 0.91 mL/g, respectively. These optimized parameters for dogs resulted in lower RBF values than those obtained from inline generated RBF maps. In conclusion, this study determined preliminary parameters essential for ALS-MRI-based RBF quantification in dogs. Further research is needed to confirm these values, but it may help guide future research.
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Affiliation(s)
- Amber Hillaert
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Luis Carlos Sanmiguel Serpa
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yangfeng Xu
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Myriam Hesta
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Stephanie Bogaert
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
| | - Katrien Vanderperren
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Pim Pullens
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
- Institute of Biomedical Engineering and Technology (IBiTech)—MEDISP, Faculty of Engineering and Architecture, Ghent University, 9000 Ghent, Belgium
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Wang B, Wang Y, Wang J, Jin C, Zhou R, Guo J, Zhang H, Wang M. Multiparametric Magnetic Resonance Investigations on Acute and Long-Term Kidney Injury. J Magn Reson Imaging 2024; 59:43-57. [PMID: 37246343 DOI: 10.1002/jmri.28784] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023] Open
Abstract
Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality. The prediction of the progression of AKI to long-term injury has been difficult for renal disease treatment. Radiologists are keen for the early detection of transition from AKI to long-term kidney injury, which would help in the preventive measures. The lack of established methods for early detection of long-term kidney injury underscores the pressing needs of advanced imaging technology that reveals microscopic tissue alterations during the progression of AKI. Fueled by recent advances in data acquisition and post-processing methods of magnetic resonance imaging (MRI), multiparametric MRI is showing great potential as a diagnostic tool for many kidney diseases. Multiparametric MRI studies offer a precious opportunity for real-time noninvasive monitoring of pathological development and progression of AKI to long-term injury. It provides insight into renal vasculature and function (arterial spin labeling, intravoxel incoherent motion), tissue oxygenation (blood oxygen level-dependent), tissue injury and fibrosis (diffusion tensor imaging, diffusion kurtosis imaging, T1 and T2 mapping, quantitative susceptibility mapping). The multiparametric MRI approach is highly promising but the longitudinal investigation on the transition of AKI to irreversible long-term impairment is largely ignored. Further optimization and implementation of renal MR methods in clinical practice will enhance our comprehension of not only AKI but chronic kidney diseases. Novel imaging biomarkers for microscopic renal tissue alterations could be discovered and benefit the preventative interventions. This review explores recent MRI applications on acute and long-term kidney injury while addressing lingering challenges, with emphasis on the potential value of the development of multiparametric MRI for renal imaging on clinical systems. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Bin Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yongfang Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jing Wang
- Department of Nuclear Medicine and PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jinxia Guo
- GE Healthcare, MR Research China, Beijing, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Min Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Infante B, Conserva F, Pontrelli P, Leo S, Stasi A, Fiorentino M, Troise D, dello Strologo A, Alfieri C, Gesualdo L, Castellano G, Stallone G. Recent advances in molecular mechanisms of acute kidney injury in patients with diabetes mellitus. Front Endocrinol (Lausanne) 2023; 13:903970. [PMID: 36686462 PMCID: PMC9849571 DOI: 10.3389/fendo.2022.903970] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Several insults can lead to acute kidney injury (AKI) in native kidney and transplant patients, with diabetes critically contributing as pivotal risk factor. High glucose per se can disrupt several signaling pathways within the kidney that, if not restored, can favor the instauration of mechanisms of maladaptive repair, altering kidney homeostasis and proper function. Diabetic kidneys frequently show reduced oxygenation, vascular damage and enhanced inflammatory response, features that increase the kidney vulnerability to hypoxia. Importantly, epidemiologic data shows that previous episodes of AKI increase susceptibility to diabetic kidney disease (DKD), and that patients with DKD and history of AKI have a generally worse prognosis compared to DKD patients without AKI; it is therefore crucial to monitor diabetic patients for AKI. In the present review, we will describe the causes that contribute to increased susceptibility to AKI in diabetes, with focus on the molecular mechanisms that occur during hyperglycemia and how these mechanisms expose the different types of resident renal cells to be more vulnerable to maladaptive repair during AKI (contrast- and drug-induced AKI). Finally, we will review the list of the existing candidate biomarkers of diagnosis and prognosis of AKI in patients with diabetes.
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Affiliation(s)
- Barbara Infante
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Conserva
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Paola Pontrelli
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Serena Leo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandra Stasi
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Dario Troise
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Carlo Alfieri
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Stallone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Wang B, Wang Y, Tan Y, Guo J, Chen H, Wu PY, Wang X, Zhang H. Assessment of Fasudil on Contrast-Associated Acute Kidney Injury Using Multiparametric Renal MRI. Front Pharmacol 2022; 13:905547. [PMID: 35784704 PMCID: PMC9242620 DOI: 10.3389/fphar.2022.905547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Aims: To evaluate the utility of fasudil in a rat model of contrast-associated acute kidney injury (CA-AKI) and explore its underlying mechanism through multiparametric renal magnetic resonance imaging (mpMRI). Methods: Experimental rats (n = 72) were grouped as follows: controls (n = 24), CA-AKI (n = 24), or CA-AKI + Fasudil (n = 24). All animals underwent two mpMRI studies (arterial spin labeling, T1 and T2 mapping) at baseline and post iopromide/fasudil injection (Days 1, 3, 7, and 13 respectively). Relative change in renal blood flow (ΔRBF), T1 (ΔT1) and T2 (ΔT2) values were assessed at specified time points. Serum levels of cystatin C (CysC) and interleukin-1β (IL-1β), and urinary neutrophil gelatinase-associated lipocalin (NGAL) concentrations were tested as laboratory biomarkers, in addition to examining renal histology and expression levels of various proteins (Rho-kinase [ROCK], α-smooth muscle actin [α-SMA]), hypoxia-inducible factor-1α (HIF-1α), and transforming growth factor-β1 (TGF-β1) that regulate renal fibrosis and hypoxia. Results: Compared with the control group, serum levels of CysC and IL-1β, and urinary NGAL concentrations were clearly increased from Day 1 to Day 13 in the CA-AKI group (all p < 0.05). There were significant reductions in ΔT2 values on Days 1 and 3, and ΔT1 reductions were significantly more pronounced at all time points (Days 1–13) in the CA-AKI + Fasudil group (vs. CA-AKI) (all p < 0.05). Fasudil treatment lowered expression levels of ROCK-1, and p-MYPT1/MYPT1 proteins induced by iopromide, decreasing TGF-β1 expression and suppressing both extracellular matrix accumulation and α-SMA expression relative to untreated status (all p < 0.05). Fasudil also enhanced PHD2 transcription and inhibition of HIF-1α expression after CA-AKI. Conclusions: In the context of CA-AKI, fasudil appears to reduce renal hypoxia, fibrosis, and dysfunction by activating (Rho/ROCK) or inhibiting (TGF-β1, HIF-1α) certain signaling pathways and reducing α-SMA expression. Multiparametric MRI may be a viable noninvasive tool for monitoring CA-AKI pathophysiology during fasudil therapy.
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Affiliation(s)
- Bin Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Yongfang Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Tan
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinxia Guo
- GE Healthcare MR Research China, Beijing, China
| | - Haoyuan Chen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Pu-Yeh Wu
- GE Healthcare MR Research China, Beijing, China
| | - Xiaochun Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiaochun Wang, ; Hui Zhang,
| | - Hui Zhang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiaochun Wang, ; Hui Zhang,
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Magnetic Resonance Imaging of Contrast-Induced Acute Renal Injury and Related Pathological Alterations In Vivo. Anal Cell Pathol (Amst) 2022; 2022:6984200. [PMID: 35256925 PMCID: PMC8898140 DOI: 10.1155/2022/6984200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background. The definitive mechanisms of CI-AKI include contrast medium (CM) nephrotoxicity and CM disturbances in renal blood flow, but how the immune system responds to CM has rarely been mentioned in previous studies, and different cell death pathways have not been clearly distinguished. Aim. To confirm whether MRI detect early CI-AKI and to investigate whether immunity-related responses, pyroptosis, and mitophagy participate in contrast-induced acute renal injury (CI-AKI). Methods. C57BL/6 mice with CI-AKI were established by tail vein injection of iodixanol 320. Magnetic resonance imaging of 9.4 T scanner and microscopic appearance of renal H&E staining were tools to test the occurrence of CI-AKI at different times. Immunohistochemistry and NGAL were used to examine the immune responses in the kidneys with CI-AKI. Transmission electron microscopy and western blot methods were used to distinguish various cell death pathways in CI-AKI. Key Results. The densitometry of T2WI, DTI, and BOLD presents CI-AKI in a regular way. The microscopic appearance presents the strongest renal damage in CI-AKI mice that existed between 12 h (
) and 24 h (
) after contrast medium (CM) injection. Strong correlation may exist between MRI densitometry (T2WI, DTI, and BOLD) and pathology. Neutrophil and macrophage chemotaxis occurred in CI-AKI, and we observed that Ly6G was the strongest at 48 h (
). Pyroptosis (Nlrp3/caspase-1,
), mitophagy (BNIP/Nix,
), and apoptosis (Bax,
) occurred in CI-AKI. Conclusions. fMRI can detect early CI-AKI immediately after CM injection. NLRP3 inflammasomes are involved in CI-AKI, and mitophagy may play a role in mitigating kidney injury. The mitochondrion is one of the key organelles in the tubular epithelium implicated in CI-AKI.
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Zdziechowska M, Gluba-Brzózka A, Franczyk B, Rysz J. Biochemical Markers in the Prediction of Contrast-induced Acute Kidney Injury. Curr Med Chem 2021; 28:1234-1250. [PMID: 32357810 DOI: 10.2174/0929867327666200502015749] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/21/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
For many years clinicians have been searching for "kidney troponin"- a simple diagnostic tool to assess the risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography (CT), percutaneous coronary intervention (PCI) and angiography) has resulted in the increased number of contrast-induced acute kidney injuries (CI-AKI). CIAKI remains an important cause of overall mortality, prolonged hospitalisation and it increases the total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable methods of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney-specific molecules. High concentrations of these substances before the implementation of contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have the predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g., CRP, WBC, and neutrophil count) may be helpful in the prediction of CIAKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast- induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains a serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury.
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Affiliation(s)
- Magdalena Zdziechowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
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Physical Training Is a Potential Modifier of Risk for Contrast-Induced Acute Kidney Injury in Diabetes Mellitus. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1830934. [PMID: 33282938 PMCID: PMC7688348 DOI: 10.1155/2020/1830934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022]
Abstract
Background Iodinated contrast (IC) is a leading cause of hospital-based acute kidney injury (AKI). Contrast-induced acute kidney injury (CI-AKI) is a decline in renal function due to iodinated contrast administration and occurs more frequently in individuals with increasingly common risk factors, such as diabetes mellitus (DM). Physical training (PT) can have renoprotective effects on CI-AKI in diabetic nephropathy. The aim of this study was to evaluate the injury in kidneys of diabetic rats submitted to treatment with IC, evaluating the impact of PT on hemodynamics and renal function in addition to oxidative profile in diabetic rats submitted to IC-AKI. Materials and Methods Adult male Wistar rats are randomized into four groups: citrate (n = 7): control group, citrate buffer (streptozotocin-STZ vehicle), intravenous tail (iv), single dose; DM (n = 7): STZ, 60 mg/kg, iv, single dose; DM+IC (n = 7): DM rats treated with IC (sodium meglumine ioxithalamate, 6 mL/kg, intraperitoneal (ip), single dose); DM+IC+PT (n = 7): DM rats treated with IC as mentioned and submitted to physical training. Renal function parameters (inulin clearance, neutrophil gelatinase-associated lipocalin (NGAL), serum creatinine, and urinary albumin), hemodynamics (renal blood flow and renal vascular resistance), and oxidative profile (urinary peroxides, urinary TBARS, urinary nitric oxide, and renal tissue thiols) were evaluated. Results It was possible to observe a decrease in inulin clearance, renal blood flow, and thiols in renal tissue accompanied by an increase in urinary flow, serum creatinine, urinary albumin, renal vascular resistance, urinary peroxides, urinary nitrate, and TBARS in the DM group compared to the citrate group. The DM+IC group showed a reduction in inulin clearance, and the renal dysfunction was also seen by the increased NGAL. Renal hemodynamics and oxidative profile compared were also worsened in the DM group. PT improved renal function by increasing renal blood flow and thiol levels in renal tissue and reduced renal vascular resistance, metabolites of reactive oxygen, nitrogen species, and lipid peroxidation in the DM+IC+PT group compared to DM+IC. Conclusions Our results confirmed that DM induction increases renal vulnerability to the toxicity of IC and an association between DM with IC predisposes to severe AKI with reduced renal function alongside with renal hemodynamic alterations and oxidative mechanism of injury. The PT showed a renoprotective effect in DM animals subjected to damage with IC by modulating renal hemodynamics and oxidative profile, confirming a potential to modify the risk of CI-AKI when diabetes mellitus is present.
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Zhao K, Pohlmann A, Feng Q, Mei Y, Yang G, Yi P, Feng Q, Chen W, Zhou L, Wu EX, Seeliger E, Niendorf T, Feng Y. Physiological system analysis of the kidney by high-temporal-resolution T 2 ∗ monitoring of an oxygenation step response. Magn Reson Med 2020; 85:334-345. [PMID: 32710578 DOI: 10.1002/mrm.28399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Examine the feasibility of characterizing the regulation of renal oxygenation using high-temporal-resolution monitoring of the T 2 ∗ response to a step-like oxygenation stimulus. METHODS For T 2 ∗ mapping, multi-echo gradient-echo imaging was used (temporal resolution = 9 seconds). A step-like renal oxygenation challenge was applied involving sequential exposure to hyperoxia (100% O2 ), hypoxia (10% O2 + 90% N2 ), and hyperoxia (100% O2 ). In vivo experiments were performed in healthy rats (N = 10) and in rats with bilateral ischemia-reperfusion injury (N = 4). To assess the step response of renal oxygenation, a second-order exponential model was used (model parameters: amplitude [A], time delay [Δt], damping constant [D], and period of the oscillation [T]) for renal cortex, outer stripe of the outer medulla, inner stripe of the outer medulla, and inner medulla. RESULTS The second-order exponential model permitted us to model the exponential T 2 ∗ recovery and the superimposed T 2 ∗ oscillation following renal oxygenation stimulus. The in vivo experiments revealed a difference in Douter medulla between healthy controls (D < 1, indicating oscillatory recovery) and ischemia-reperfusion injury (D > 1, reflecting aperiodic recovery). The increase in Douter medulla by a factor of 3.7 (outer stripe of the outer medulla) and 10.0 (inner stripe of the outer medulla) suggests that this parameter might be rather sensitive to (patho)physiological oxygenation changes. CONCLUSION This study demonstrates the feasibility of monitoring the dynamic oxygenation response of renal tissues to a step-like oxygenation challenge using high-temporal-resolution T 2 ∗ mapping. Our results suggest that the implemented system analysis approach may help to unlock questions regarding regulation of renal oxygenation, with the ultimate goal of providing imaging means for diagnostics and therapy of renal diseases.
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Affiliation(s)
- Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Qijian Feng
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingjie Mei
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Philips Healthcare, Guangzhou, China
| | - Guixiang Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Peiwei Yi
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Wufang Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Lili Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong, China
| | - Erdmann Seeliger
- Center for Cardiovascular Research, Institute of Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
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11
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The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:3295176. [PMID: 32788887 PMCID: PMC7330652 DOI: 10.1155/2020/3295176] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is the third most common hospital-acquired AKI after AKI induced by renal perfusion insufficiency and nephrotoxic drugs, taking great adverse effects on the prognosis and increasing hospital stay and medical cost. Diabetes nephropathy (DN) is a common chronic complication of DM (diabetes mellitus), and DN is an independent risk factor for chronic kidney disease (CKD) and CI-AKI. The incidence of CI-AKI significantly increases in patients with renal injury, especially in DM-related nephropathy. The etiology of CI-AKI is not fully clear, and research studies on how DM becomes a facilitated factor of CI-AKI are limited. This review describes the mechanism from three aspects. ① Pathophysiological changes of CI-AKI in kidney under high-glucose status (HGS). HGS can enhance the oxidative stress and increase ROS which next causes stronger vessel constriction and insufficient oxygen supply in kidney via vasoactive substances. HGS also aggravates some ion pump load and the latter increases oxygen consumption. CI-AKI and HGS are mutually causal, making the kidney function continue to decline. ② Immunological changes of DM promoting CI-AKI. Some innate immune cells and pattern recognition receptors (PRRs) in DM and/or DN may respond to some damage-associated molecular patterns (DAMPs) formed by CI-AKI. These effects overlap with some pathophysiological changes in hyperglycemia. ③ Signaling pathways related to both CI-AKI and DM. These pathways involved in CI-AKI are closely associated with apoptosis, inflammation, and ROS production, and some studies suggest that these pathways may be potential targets for alleviating CI-AKI. In conclusion, the pathogenesis of CI-AKI and the mechanism of DM as a predisposing factor for CI-AKI, especially signaling pathways, need further investigation to provide new clinical approaches to prevent and treat CI-AKI.
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12
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Wang Y, Zhang X, Hua Z, Xie L, Jiang X, Wang R, Gao P, Ren K. Blood Oxygen Level-Dependent Imaging and Intravoxel Incoherent Motion MRI of Early Contrast-Induced Acute Kidney Injury in a Rabbit Model. Kidney Blood Press Res 2019; 44:496-512. [PMID: 31256149 DOI: 10.1159/000500052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To evaluate the application of blood oxygenation level-dependent (BOLD)imaging and intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) on assessing early contrast-induced acute kidney injury (CIAKI). MATERIALS Sixty rabbits were randomly chosen to undergo iohexol (1.0, 2.5, and 5.0 [gI/kg], respectively; n = 15 for each group) or saline injection (n = 15). In each group, 6 rabbits underwent MRI at 24 h before injection and after injection of iohexol or saline (1 h and 1, 2, 3, and 4 days); meanwhile, out of the remaining 9 rabbits, 3 were chosen for MRI acquisition, and then they were killed at specific time points (1 h, 1 day, and 3 days, respectively). RESULTS The strong attenuation of pure molecular diffusion (D), apparent diffusion coefficient (ADC), and perfusion fraction (f) was observed at 1 day, while pseudodiffusion coefficient (D*) showed a significant decrease at 1 h after iohexol injection. A distinct elevation of apparent transverse relaxation rate (R2*) reached the maximum levels on day 1, which was consistent with the expression of hypoxia-inducible factor-1α and vascular endothelial growth factor. ADC, D, and R2* correlated well with histopathological parameters and biochemical parameters. CONCLUSION BOLD combined with IVIM is effective to monitor renal pathophysiology associated with CIAKI.
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Affiliation(s)
- Yongfang Wang
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Xin Zhang
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Zhengxu Hua
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, China
| | - Xuan Jiang
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Rongjia Wang
- Department of Radiology, First Hospital of China Medical University, Shenyang, China
| | - Peirong Gao
- Department of Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Ke Ren
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China,
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13
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Application of Blood Oxygenation Level-Dependent Magnetic Resonance Imaging and Intravoxel Incoherent Motion to Assess Bilateral Renal Pathophysiological Processes Induced by Iodixanol Renal Artery First-Pass in Rabbit Model. J Comput Assist Tomogr 2019; 43:634-640. [PMID: 31162241 DOI: 10.1097/rct.0000000000000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noninvasive blood oxygen level-dependent imaging and intravoxel incoherent motion sequences were used to assess bilateral renal oxygenation, hemodynamics, and proton diffusion in iodixanol renal artery first-pass in rabbit model. METHODS Forty-two rabbits were divided into 2 groups. Saline and iodixanol (1 g iodine/kg, left renal artery) were administered. Magnetic resonance imaging scans were acquired longitudinally at 24 hours prior to and 1, 24, 48, and 72 hours after administration to assess apparent diffusion coefficient, pure molecular diffusion (D), perfusion-related diffusion (D*), volume fraction (f), and relative spin-spin relaxation rate (R2*) values, respectively. The experiment evaluated serum creatinine, histological, and hypoxia-inducible factor 1α immunoexpression. RESULTS During 1 to 48 hours, the values of D, f, and D* significantly decreased (P < 0.05), but R2* values significantly increased (P < 0.05) in cortex, outer medulla, and inner medulla after administration of iodixanol through left renal artery, which showed in the 72 hours. The change of the left kidney is noteworthy. Significant negative correlations were observed between apparent diffusion coefficient, D, f, and R2* in cortex, outer medulla, and inner medulla (all P < 0.001, r = -0.635-0.697). CONCLUSIONS The first-pass effect of the contrast agent significantly reduces ipsilateral renal perfusion and renal oxygenation, and noninvasive monitoring can be performed by using blood oxygen level-dependent magnetic resonance imaging and intravoxel incoherent motion.
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14
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Payton P, Eter A. Periprocedural Concerns in the Patient with Renal Disease. Clin Podiatr Med Surg 2019; 36:59-82. [PMID: 30446045 DOI: 10.1016/j.cpm.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treating patients with kidney disease can be both a difficult and a complex process. Understanding how to care for patients who have kidney disease is essential for lowering perioperative as well as periprocedural morbidity and mortality. The primary aim in renal evaluation and care is to control and mitigate factors that may result in acute kidney injury (AKI) and/or cause further decline in renal function. It is essential for the foot and ankle specialist to recognize patients who are predisposed to developing or already have impairment of renal function.
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Affiliation(s)
- Paris Payton
- St Vincent Charity Medical Center, 2351 East 22nd Street, Cleveland, OH 44115, USA.
| | - Ahmad Eter
- Nephrology, Princeton Community Hospital, 122 12th Street, Princeton, WV 24740, USA
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15
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Hypoxia and Renal Tubulointerstitial Fibrosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1165:467-485. [PMID: 31399980 DOI: 10.1007/978-981-13-8871-2_23] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypoxia, one of the most common causes of kidney injury, is a key pathological condition in various kidney diseases. Renal fibrosis is the terminal pathway involved in the continuous progression of chronic kidney disease (CKD), characterized by glomerulosclerosis and tubulointerstitial fibrosis (TIF). Recent studies have shown that hypoxia is a key factor promoting the progression of TIF. Loss of microvasculature, reduced oxygen dispersion, and metabolic abnormality of cells in the kidney are the main causes of the hypoxic state. Hypoxia can, in turn, profoundly affect the tubular epithelial cells, endothelial cells, pericytes, fibroblasts, inflammatory cells, and progenitor cells. In this chapter, we reviewed the critical roles of hypoxia in the pathophysiology of TIF and discussed the potential of anti-hypoxia as its promising therapeutic target.
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16
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Ow CPC, Ngo JP, Ullah MM, Hilliard LM, Evans RG. Renal hypoxia in kidney disease: Cause or consequence? Acta Physiol (Oxf) 2018; 222:e12999. [PMID: 29159875 DOI: 10.1111/apha.12999] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
Tissue hypoxia has been proposed as an important factor in the pathophysiology of both chronic kidney disease (CKD) and acute kidney injury (AKI), initiating and propagating a vicious cycle of tubular injury, vascular rarefaction, and fibrosis and thus exacerbation of hypoxia. Here, we critically evaluate this proposition by systematically reviewing the literature relevant to the following six questions: (i) Is kidney disease always associated with tissue hypoxia? (ii) Does tissue hypoxia drive signalling cascades that lead to tissue damage and dysfunction? (iii) Does tissue hypoxia per se lead to kidney disease? (iv) Does tissue hypoxia precede pathology? (v) Does tissue hypoxia colocalize with pathology? (vi) Does prevention of tissue hypoxia prevent kidney disease? We conclude that tissue hypoxia is a common feature of both AKI and CKD. Furthermore, at least under in vitro conditions, renal tissue hypoxia drives signalling cascades that lead to tissue damage and dysfunction. Tissue hypoxia itself can lead to renal pathology, independent of other known risk factors for kidney disease. There is also some evidence that tissue hypoxia precedes renal pathology, at least in some forms of kidney disease. However, we have made relatively little progress in determining the spatial relationships between tissue hypoxia and pathological processes (i.e. colocalization) or whether therapies targeted to reduce tissue hypoxia can prevent or delay the progression of renal disease. Thus, the hypothesis that tissue hypoxia is a "common pathway" to both AKI and CKD still remains to be adequately tested.
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Affiliation(s)
- C. P. C. Ow
- Cardiovascular Disease Program Biomedicine Discovery Institute and Department of Physiology Monash University Melbourne Vic. Australia
| | - J. P. Ngo
- Cardiovascular Disease Program Biomedicine Discovery Institute and Department of Physiology Monash University Melbourne Vic. Australia
| | - M. M. Ullah
- Cardiovascular Disease Program Biomedicine Discovery Institute and Department of Physiology Monash University Melbourne Vic. Australia
| | - L. M. Hilliard
- Cardiovascular Disease Program Biomedicine Discovery Institute and Department of Physiology Monash University Melbourne Vic. Australia
| | - R. G. Evans
- Cardiovascular Disease Program Biomedicine Discovery Institute and Department of Physiology Monash University Melbourne Vic. Australia
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17
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Zhang B, Dong Y, Guo B, Chen W, Ouyang F, Lian Z, Liu J, Zhang S. Application of noninvasive functional imaging to monitor the progressive changes in kidney diffusion and perfusion in contrast-induced acute kidney injury rats at 3.0 T. Abdom Radiol (NY) 2018; 43:655-662. [PMID: 28677006 DOI: 10.1007/s00261-017-1247-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury is a prevalent cause of renal failure, and the noninvasive tools to monitor its progress are lacking. We applied intravoxel incoherent motion (IVIM) DWI to measure the progressive changes in kidney diffusion and perfusion of CI-AKI. METHODS Twenty-four rats received Iopromide (370 mg/ml, 1600 mg iodine/kg) to induce CI-AKI. IVIM DWI was performed on rats (n = 6) at 24 h prior to and 12, 24, 48, 72, and 96 h after the injection using a 3.0 T MRI scanner. The progressive changes in the diffusion (D) and perfusion parameters (D* and f) were studied in the cortex (CO), outer medulla (OM), and inner medulla (IM). For the histology group (n = 18), three rats were sacrificed at each time point. RESULTS In the CO, D reduced progressively from 24 to 48 h (P < 0.001) and increased starting from 72 h (P < 0.001). However, D decreased until to 72 h in the medulla (P < 0.001) and increased starting from 96 h (P < 0.001). D* decreased to the bottom at 24 h in the cortex and medulla (P = 0.037) and started to recover at 48 h (P = 0.007). f decreased in the cortex and medulla in an early stage (12 h) (P = 0.035) of CI-AKI and then ascended in the later stage (72 h) (P = 0.017). The H & E staining showed different degrees of serial pathological change including cloudy swelling, atrophy, even necrosis, and interstitial vasodilation of tubule epithelial cells and glomerulus cells. CONCLUSION Our study demonstrates the feasibility of using IVIM DWI to monitor the progress of CI-AKI, implying that IVIM DWI is a useful biomarker in the staging of CI-AKI.
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18
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Siedek F, Persigehl T, Mueller RU, Burst V, Benzing T, Maintz D, Haneder S. Assessing renal changes after remote ischemic preconditioning (RIPC) of the upper extremity using BOLD imaging at 3T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:367-374. [PMID: 29063424 DOI: 10.1007/s10334-017-0658-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) is an important risk factor for a number of adverse outcomes including end-stage renal disease and cardiovascular morbidity and mortality. Whilst many clinical situations that can induce AKI are known-e.g. drug toxicity, contrast agent exposure or ischemia during surgery-targeted preventive or therapeutic measures are still lacking. As to renoprotective strategies, remote ischemic preconditioning (RIPC) is one of the most promising novel approaches and has been examined by a number of clinical trials. The aim of this study was to use blood oxygenation level-dependent (BOLD) MRI as a surrogate parameter to assess the effect of RIPC in healthy volunteers. MATERIALS AND METHODS In this IRB-approved, prospective study, 40 healthy volunteers were stratified with 20 undergoing an RIPC procedure (i.e. RIPC group) with a transient ischemia of the right arm, and 20 undergoing a sham procedure. Before and after the procedure, both kidneys of all participants were scanned using a 12-echo mGRE sequence for functional BOLD imaging at 3T. For each volunteer, 180 ROIs were placed in the cortex and the medulla of the kidneys. Ultimately, R2* values, which have an inverse correlation with the oxygenation level of tissue, were averaged for the RIPC and control groups. RESULTS Following intervention, mean R2* values significantly decreased in the RIPC group in both the cortex (18.6 ± 2.3 vs. 17.5 ± 1.7 Hz; p = 0.0047) and medulla (34 ± 5.2 vs. 32.2 ± 4.2 Hz; p = 0.0001). However, no significant differences were observed in the control group. CONCLUSION RIPC can be non-invasively assessed in healthy volunteers using BOLD MRI at 3T, demonstrating a higher oxygen content in kidney tissue. This study presents a first-in-man trial establishing a quantifiable readout of RIPC and its effects on kidney physiology. BOLD measurements may advance clinical trials in further evaluating RIPC for future clinical care.
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Affiliation(s)
- Florian Siedek
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Roman-Ulrich Mueller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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19
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Ozkok S, Ozkok A. Contrast-induced acute kidney injury: A review of practical points. World J Nephrol 2017; 6:86-99. [PMID: 28540198 PMCID: PMC5424439 DOI: 10.5527/wjn.v6.i3.86] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of AKI in clinical practice. CI-AKI has been found to be strongly associated with morbidity and mortality of the patients. Furthermore, CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease. Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies. CI-AKI is an active research area thus clinicians should be updated periodically about this topic. In this review, we aimed to discuss the indications of contrast-enhanced imaging, types of contrast media and their impact on nephrotoxicity, major pathophysiological mechanisms, risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.
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20
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Diercks DB, Owen KP, Kline JA, Sutter ME. Urine metabolomic analysis to detect metabolites associated with the development of contrast induced nephropathy. Clin Exp Emerg Med 2016; 3:204-212. [PMID: 28168227 PMCID: PMC5292299 DOI: 10.15441/ceem.15.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/08/2016] [Accepted: 02/01/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Contrast induced nephropathy (CIN) is a result of injury to the proximal tubules. The incidence of CIN is around 11% for imaging done in the acute care setting. We aim to analyze the metabolic patterns in the urine, before and after dosing with intravenous contrast for computed tomography (CT) imaging of the chest, to determine if metabolomic changes exist in patients who develop CIN. Methods A convenience sample of high risk patients undergoing a chest CT with intravenous contrast were eligible for enrollment. Urine samples were collected prior to imaging and 4 to 6 hours post imaging. Samples underwent gas chromatography/mass spectrometry profiling. Peak metabolite values were measured and data was log transformed. Significance analysis of microarrays and partial least squares was used to determine the most significant metabolites prior to CT imaging and within subject. Analysis of variance was used to rank metabolites associated with temporal change and CIN. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or ≥ 25% above baseline within 48 hours after contrast administration. Results We sampled paired urine samples from 63 subjects. The incidence of CIN was 6/63 (9.5%). Patients without CIN had elevated urinary citric acid and taurine concentrations in the pre-CT urine. Xylulose increased in the post CT sample in patients who developed CIN. Conclusion Differences in metabolomics patterns in patients who do and do not develop CIN exist. Metabolites may be potential early identifiers of CIN and identify patients at high-risk for developing this condition prior to imaging.
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Affiliation(s)
- Deborah B Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kelly P Owen
- Department of Emergency Medicine, Davis Medical Center, University of California, Sacramento, CA, USA
| | | | - Mark E Sutter
- Department of Emergency Medicine, Davis Medical Center, University of California, Sacramento, CA, USA
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Histopathological Evaluation of Contrast-Induced Acute Kidney Injury Rodent Models. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3763250. [PMID: 27975052 PMCID: PMC5128699 DOI: 10.1155/2016/3763250] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) can occur in 3–25% of patients receiving radiocontrast material (RCM) despite appropriate preventive measures. Often patients with an atherosclerotic vasculature have to receive large doses of RCM. Thus, animal studies to uncover the exact pathomechanism of CI-AKI are needed. Sensitive and specific histologic end-points are lacking; thus in the present review we summarize the histologic appearance of different rodent models of CI-AKI. Single injection of RCM causes overt renal damage only in rabbits. Rats and mice need an additional insult to the kidney to establish a clinically manifest CI-AKI. In this review we demonstrate that the concentrating ability of the kidney may be responsible for species differences in sensitivity to CI-AKI. The most commonly held theory about the pathomechanism of CI-AKI is tubular cell injury due to medullary hypoxia. Thus, the most common additional insult in rats and mice is some kind of ischemia. The histologic appearance is tubular epithelial cell (TEC) damage; however severe TEC damage is only seen if RCM is combined by additional ischemia. TEC vacuolization is the first sign of CI-AKI, as it is a consequence of RCM pinocytosis and lysosomal fusion; however it is not sensitive as it does not correlate with renal function and is not specific as other forms of TEC damage also cause vacuolization. In conclusion, histopathology alone is insufficient and functional parameters and molecular biomarkers are needed to closely monitor CI-AKI in rodent experiments.
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Wang C, Zhao K, Zhang R, Jiang L, Wang R, Zhang X, Wang H, Jin L, Zhang J, Wang X, Fang J. Evaluation of renal oxygenation change under the influence of carbogen breathing using a dynamic R 2 , R 2 ' and R 2 * quantification approach. NMR IN BIOMEDICINE 2016; 29:1601-1607. [PMID: 27670144 DOI: 10.1002/nbm.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to demonstrate the feasibility of dynamic renal R2 /R2 '/R2 * measurements based on a method, denoted psMASE-ME, in which a periodic 180° pulse-shifting multi-echo asymmetric spin echo (psMASE) sequence, combined with a moving estimation (ME) strategy, is adopted. Following approval by the institutional animal care and use committee, a block design of respiratory challenge with interleaved air and carbogen (97% O2 , 3% CO2 ) breathing was employed in nine rabbits. Parametrical R2 /R2 '/R2 * maps were computed and average R2 /R2 '/R2 * values were measured in regions of interest in the renal medulla and cortex. Bland-Altman plots showed good agreement between the proposed method and reference standards of multi-echo spin echo and multi-echo gradient echo sequences. Renal R2 , R2 ' and R2 * decreased significantly from 16.2 ± 4.4 s-1 , 9.8 ± 5.2 s-1 and 25.9 ± 5.0 s-1 to 14.9 ± 4.4 s-1 (p < 0.05), 8.5 ± 4.1 s-1 (p < 0.05) and 23.4 ± 4.8 s-1 (p < 0.05) in the cortex when switching the gas mixture from room air to carbogen. In the renal medulla, R2 , R2 ' and R2 * also decreased significantly from 12.9 ± 4.7 s-1 , 15.1 ± 5.8 s-1 and 27.9 ± 5.3 s-1 to 11.8 ± 4.5 s-1 (p < 0.05), 14.2 ± 4.2 s-1 (p < 0.05) and 25.8 ± 5.1 s-1 (p < 0.05). No statistically significant differences in relative R2 , R2 ' and R2 * changes were observed between the cortex and medulla (p = 0.72 for R2 , p = 0.39 for R2 ' and p = 0.61 for R2 *). The psMASE-ME method for dynamic renal R2 /R2 '/R2 * measurements, together with the respiratory challenge, has potential use in the evaluation of renal oxygenation in many renal diseases.
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Affiliation(s)
- Chengyan Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Rui Zhang
- College of Engineering, Peking University, Beijing, China
| | - Li Jiang
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - He Wang
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Lixin Jin
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- College of Engineering, Peking University, Beijing, China.
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- Department of Radiology, Peking University First Hospital, Beijing, China.
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
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Wu CJ, Bao ML, Wang Q, Wang XN, Liu XS, Shi HB, Zhang YD. Acute kidney damage induced by low- and iso-osmolar contrast media in rats: Comparison study with physiologic MRI and histologic-gene examination. J Magn Reson Imaging 2016; 45:291-302. [PMID: 27367527 DOI: 10.1002/jmri.25346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/31/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the physiopathological effects of low- and iso-osmolar contrast media (CM) on renal function with physiologic MRI and histologic-gene examination. MATERIALS AND METHODS Forty-eight rats underwent time-course DWI and DCE-MRI at 3.0 Tesla (T) before and 5-15 min after exposure of CM or saline (Iop.370: 370 mgI/mL iopromide; Iod.320: 320 mgI/mL iodixanol; Iod.270: 270 mgI/mL iodixanol; 4 gI/kg body weight). Intrarenal viscosity was reflected by apparent diffusion coefficient (ADC). Renal physiologies were evaluated by DCE-derived glomerular filtration rate (GFR), renal blood flow (RBF), and renal blood volume (RBV). Potential acute kidney injury (AKI) was determined by histology and the expression of kidney injury molecule 1 (Kim-1). RESULTS Iop.370 mainly increased ADC in inner-medulla (△ADCIM : 12.3 ± 11.1%; P < 0.001). Iod.320 and Iod.270 mainly decreased ADC in outer-medulla (△ADCIM ; Iod.320: 16.8 ± 7.5%; Iod.270: 18.1 ± 9.5%; P < 0.001) and inner-medulla (△ADCIM ; Iod.320: 28.4 ± 9.3%; Iod.270: 30.3 ± 6.3%; P < 0.001). GFR, RBF and RBV were significantly decreased by Iod.320 (△GFR: 45.5 ± 24.1%; △RBF: 44.6 ± 19.0%; △RBV: 35.2 ± 10.1%; P < 0.001) and Iod.270 (33.2 ± 19.0%; 38.1 ± 15.6%; 30.1 ± 10.1%; P < 0.001), while rarely changed by Iop.370 and saline. Formation of vacuoles and increase in Kim-1 expression was prominently detected in group of Iod.320, while rarely in Iod.270 and Iop.370. CONCLUSION Iso-osmolar iodixanol, given at high-dose, produced prominent AKI in nonhydrated rats. This renal dysfunction could be assessed noninvasively by physiologic MRI. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:291-302.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mei-Ling Bao
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qing Wang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiao-Ning Wang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xi-Sheng Liu
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yu-Dong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Tao SM, Wichmann JL, Schoepf UJ, Fuller SR, Lu GM, Zhang LJ. Contrast-induced nephropathy in CT: incidence, risk factors and strategies for prevention. Eur Radiol 2015; 26:3310-8. [PMID: 26685852 DOI: 10.1007/s00330-015-4155-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/28/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED In the past, a high percentage of hospital-acquired renal failure was attributed to contrast media. That position is now very controversial. Recently, doubts have been raised regarding the real relationship between acute kidney injury and intravenous contrast media administration. Similarly, statements about specific methods of preventing contrast-inducing nephropathy have been challenged. This review article addresses the controversies of incidence, causation, and prevention in an attempt to help the practicing radiologist adopt methods for their own department. KEY POINTS • The reported CIN incidence ranges from 2-12 % following contrast-enhanced CT. • Studies without a non-contrast CT control group may overestimate CIN incidence. • Development and application of a comprehensive CIN prevention strategy is recommended.
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Affiliation(s)
- Shu Min Tao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Stephen R Fuller
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Fulcher J, Patel S, Nicholls SJ, Bao S, Celermajer D. Optical coherence tomography for serial in vivo imaging of aortic plaque in the rabbit: a preliminary experience. Open Heart 2015; 2:e000314. [PMID: 26468403 PMCID: PMC4600250 DOI: 10.1136/openhrt-2015-000314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 01/31/2023] Open
Abstract
Background In this pilot feasibility study, we aimed to establish a reproducible means of performing serial optical coherence tomography (OCT) procedures in the abdominal aorta of the cholesterol-fed rabbit. Methods Eight cholesterol-fed New Zealand White rabbits were assigned to abdominal aortic balloon injury at baseline (n=6) or as controls (n=2). Three of the balloon injured rabbits received statins from weeks 6 to 12 post balloon injury. OCT of the abdominal aorta in each rabbit was performed at baseline±week 6±week 12 via alternate vascular access points (left or right femoral artery or left carotid artery). OCT sequences were analysed to derive an indexed plaque volume and other OCT measures of plaque complexity, and results were compared between groups. Histopathological correlations with OCT images were made following terminal procedures. Results Of the 16 OCT procedures in these rabbits (6 at baseline, 4 at 6 weeks, 6 at 12 weeks), excellent and analysable images were obtained on 15 occasions (94%). Inability to obtain adequate arterial access for the OCT catheter was the major experimental limitation encountered in the early part of our experience. Balloon injured rabbits developed larger volume and more complex plaque than non-balloon injured rabbits on all OCT indices measured (eg, both mean plaque volume and lumen stenosis were approximately double in the balloon injured group, p<0.0001). A significant correlation between 12 week measures of plaque area by OCT and histology was demonstrated (Pearson correlation coefficient: 0.992, p<0.0001). Conclusions Our preliminary experience suggests that serial OCT of the abdominal aorta in the New Zealand White rabbit is feasible and a potentially promising means of performing serial studies of aortic atherosclerosis.
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Affiliation(s)
- Jordan Fulcher
- Department of Cardiology , Royal Prince Alfred Hospital , Camperdown, New South Wales , Australia ; NHMRC Clinical Trials Centre , Camperdown, New South Wales , Australia ; Heart Research Institute , Newtown, New South Wales , Australia
| | - Sanjay Patel
- Department of Cardiology , Royal Prince Alfred Hospital , Camperdown, New South Wales , Australia ; Heart Research Institute , Newtown, New South Wales , Australia ; Sydney Medical School, The University of Sydney , New South Wales , Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute , Adelaide, South Australia , Australia
| | - Shisan Bao
- Discipline of Pathology , The University of Sydney , New South Wales , Australia
| | - David Celermajer
- Department of Cardiology , Royal Prince Alfred Hospital , Camperdown, New South Wales , Australia ; Heart Research Institute , Newtown, New South Wales , Australia ; Sydney Medical School, The University of Sydney , New South Wales , Australia
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26
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Using intravoxel incoherent motion MR imaging to study the renal pathophysiological process of contrast-induced acute kidney injury in rats: Comparison with conventional DWI and arterial spin labelling. Eur Radiol 2015; 26:1597-605. [DOI: 10.1007/s00330-015-3990-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
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27
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Comparison of Utility of Histogram Apparent Diffusion Coefficient and R2* for Differentiation of Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma. AJR Am J Roentgenol 2015. [PMID: 26204307 DOI: 10.2214/ajr.14.13802] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Significant perturbation in renal functional magnetic resonance imaging parameters and contrast retention for iodixanol compared with iopromide: an experimental study using blood-oxygen-level-dependent/diffusion-weighted magnetic resonance imaging and computed tomography in rats. Invest Radiol 2015; 49:699-706. [PMID: 24879299 DOI: 10.1097/rli.0000000000000073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the renal changes after intravenous administration of a high dose of either iodixanol or iopromide using functional magnetic resonance imaging (MRI) and computed tomography (CT). MATERIALS AND METHODS The study was approved by the institutional committee on animal research. Seventy-two male Sprague-Dawley rats were divided into 5 cohorts, comprising normal saline (NS), iopromide, iopromide + NS, iodixanol, and iodixanol + NS. Intravenous contrast was administrated at 8 g iodine/kg of body weight. Renal CT, quantitative functional MRI of blood-oxygen-level-dependent (BOLD) imaging and diffusion-weighted imaging (DWI), and histologic examinations were performed for 18 days after contrast administration. Statistical analysis was performed by using 1-way analysis of variance, Mann-Whitney test, and regression analysis. RESULTS In the renal cortex, BOLD showed persistent elevation of R2* and DWI showed persistent suppression of apparent diffusion coefficient after iodixanol administration for 18 days. Compared with iopromide, adjusted ΔR2* (ΔR2*adj) was significantly higher in the iodixanol group from 1 hour to 18 days (P < 0.04) after contrast; adjusted ΔADC (ΔADCadj) was significantly more pronounced at day 6 (P = 0.01) after contrast. The iodixanol cohort also exhibited persistently higher attenuation in the renal cortex on CT and more severe microscopic renal cortical vacuolization up to 18 days. Intravenous hydration decreased the magnetic resonance changes in both groups but more markedly with iodixanol. CONCLUSIONS At high doses, iodixanol induced greater changes in renal functional MRI (BOLD and DWI) relative to iopromide. Combined with longer contrast retention within the kidney, this suggests that iodixanol may produce more severe and longer-lasting contrast-induced renal damage.
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To evaluate the damage of renal function in CIAKI rats at 3T: using ASL and BOLD MRI. BIOMED RESEARCH INTERNATIONAL 2015; 2015:593060. [PMID: 25893196 PMCID: PMC4393899 DOI: 10.1155/2015/593060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/15/2015] [Indexed: 01/08/2023]
Abstract
Purpose. To investigate noninvasive arterial spin-labeling (ASL) and blood oxygen level-dependent imaging (BOLD) sequences for measuring renal hemodynamics and oxygenation in contrast induced acute kidney injury (CIAKI) rat. Materials and Methods. Thirteen SD rats were randomly grouped into CIAKI group and control group. Both ASL and BOLD sequences were performed at 24 h preinjection and at intervals of 0.5, 12, 24, 48, 72, and 96 h postinjection to assess renal blood flow (RBF) and relative spin-spin relaxation rate (R2*), respectively. Results. For the CIAKI group, the value of RBF in the cortex (CO) and outer medulla (OM) of the kidney was significantly decreased (P < 0.05) at 12–48 h and regressed to baseline level (P = NS) at 72–96 h. In OM, the value of R2* was increased at 0.5–48 h (P < 0.05) and not statistically significant (P = NS) at 72 and 96 h. Conclusions. RBF in OM and CO and oxygen level in OM were decreased postinjection of CM. ASL combining BOLD can further identify the primary cause of the decrease of renal oxygenation in CIAKI. This approach provides means for noninvasive monitoring renal function during the first 4 days of CIAKI in clinical routine work.
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30
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Prevost VH, Girard OM, Callot V, Cozzone PJ, Duhamel G. Fast imaging strategies for mouse kidney perfusion measurement with pseudocontinuous arterial spin labeling (pCASL) at ultra high magnetic field (11.75 tesla). J Magn Reson Imaging 2015; 42:999-1008. [DOI: 10.1002/jmri.24874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/04/2015] [Indexed: 12/28/2022] Open
Affiliation(s)
- Valentin H Prevost
- Aix-Marseille Université, CNRS Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Olivier M Girard
- Aix-Marseille Université, CNRS Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Virginie Callot
- Aix-Marseille Université, CNRS Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Patrick J Cozzone
- Aix-Marseille Université, CNRS Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
| | - Guillaume Duhamel
- Aix-Marseille Université, CNRS Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Marseille, France
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31
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Niendorf T, Pohlmann A, Arakelyan K, Flemming B, Cantow K, Hentschel J, Grosenick D, Ladwig M, Reimann H, Klix S, Waiczies S, Seeliger E. How bold is blood oxygenation level-dependent (BOLD) magnetic resonance imaging of the kidney? Opportunities, challenges and future directions. Acta Physiol (Oxf) 2015; 213:19-38. [PMID: 25204811 DOI: 10.1111/apha.12393] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/04/2014] [Accepted: 09/04/2014] [Indexed: 12/11/2022]
Abstract
Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. Yet, in vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Many of the established approaches are invasive, hence not applicable in humans. Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) offers an alternative. BOLD-MRI is non-invasive and indicative of renal tissue oxygenation. Nonetheless, recent (pre-) clinical studies revived the question as to how bold renal BOLD-MRI really is. This review aimed to deliver some answers. It is designed to inspire the renal physiology, nephrology and imaging communities to foster explorations into the assessment of renal oxygenation and haemodynamics by exploiting the powers of MRI. For this purpose, the specifics of renal oxygenation and perfusion are outlined. The fundamentals of BOLD-MRI are summarized. The link between tissue oxygenation and the oxygenation-sensitive MR biomarker T2∗ is outlined. The merits and limitations of renal BOLD-MRI in animal and human studies are surveyed together with their clinical implications. Explorations into detailing the relation between renal T2∗ and renal tissue partial pressure of oxygen (pO2 ) are discussed with a focus on factors confounding the T2∗ vs. tissue pO2 relation. Multi-modality in vivo approaches suitable for detailing the role of the confounding factors that govern T2∗ are considered. A schematic approach describing the link between renal perfusion, oxygenation, tissue compartments and renal T2∗ is proposed. Future directions of MRI assessment of renal oxygenation and perfusion are explored.
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Affiliation(s)
- T. Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - A. Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - K. Arakelyan
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
- Institute of Physiology and Center for Cardiovascular Research (CCR); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - B. Flemming
- Institute of Physiology and Center for Cardiovascular Research (CCR); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Cantow
- Institute of Physiology and Center for Cardiovascular Research (CCR); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Hentschel
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - D. Grosenick
- Physikalisch-Technische Bundesanstalt (PTB); Berlin Germany
| | - M. Ladwig
- Institute of Physiology and Center for Cardiovascular Research (CCR); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Reimann
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - S. Klix
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - S. Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin Germany
| | - E. Seeliger
- Institute of Physiology and Center for Cardiovascular Research (CCR); Charité - Universitätsmedizin Berlin; Berlin Germany
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Lauver DA, Carey E.G, Bergin IL, Lucchesi BR, Gurm HS. Sildenafil citrate for prophylaxis of nephropathy in an animal model of contrast-induced acute kidney injury. PLoS One 2014; 9:e113598. [PMID: 25426714 PMCID: PMC4245209 DOI: 10.1371/journal.pone.0113598] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/29/2014] [Indexed: 01/08/2023] Open
Abstract
Contrast-induced acute kidney injury (CIAKI) is one of the commonest complications associated with contrast media (CM). Although the exact etiology of CIAKI remains unclear, one hypothesis involves vasoconstriction of afferent arterioles resulting in renal ischemia. Increased renal blood flow, therefore, might represent an attractive target for the treatment of CIAKI. In this study we evaluated the protective effects of the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil citrate, in a rabbit model of CIAKI. New Zealand white rabbits were used due to their susceptibility to CIAKI. To evaluate the effects of sildenafil, the drug was administered before CM infusion and repeatedly throughout the remainder of the experiment (6 mg/kg, p.o.). Animals were sacrificed after 48 hours and kidneys were prepared for histological evaluation. Intravenous administration of CM produced marked kidney injury. Serum creatinine concentrations were elevated within two hours of the infusion and remained elevated for the duration of the experiment. Histological evaluation of the kidneys revealed significant tubular necrosis. The effects of the CM were dose dependent. Treatment with sildenafil was associated with lesser degree of histological injury, attenuation in markers of acute kidney injury (48 hour creatinine 1.54±0.21 versus 4.42±1.31 mg/dl, p<0.05) and reduction in electrolyte derangement (percent change in serum K+ at 48 hours 2.55±3.80% versus 15.53±4.47%, p<0.05; serum Na+ at 48 hours −0.14±0.26% versus −1.97±1.29%, p = 0.20). The results suggest a possible role for PDE5 inhibitors in the treatment of CIAKI and warrant further evaluation to determine the exact mechanism of protection.
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Affiliation(s)
- D. Adam Lauver
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
- * E-mail:
| | - E . Grant Carey
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
| | - Ingrid L. Bergin
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Benedict R. Lucchesi
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States
| | - Hitinder S. Gurm
- Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States
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Neugarten J, Golestaneh L. Blood oxygenation level-dependent MRI for assessment of renal oxygenation. Int J Nephrol Renovasc Dis 2014; 7:421-35. [PMID: 25473304 PMCID: PMC4247132 DOI: 10.2147/ijnrd.s42924] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) has recently emerged as an important noninvasive technique to assess intrarenal oxygenation under physiologic and pathophysiologic conditions. Although this tool represents a major addition to our armamentarium of methodologies to investigate the role of hypoxia in the pathogenesis of acute kidney injury and progressive chronic kidney disease, numerous technical limitations confound interpretation of data derived from this approach. BOLD MRI has been utilized to assess intrarenal oxygenation in numerous experimental models of kidney disease and in human subjects with diabetic and nondiabetic chronic kidney disease, acute kidney injury, renal allograft rejection, contrast-associated nephropathy, and obstructive uropathy. However, confidence in conclusions based on data derived from BOLD MRI measurements will require continuing advances and technical refinements in the use of this technique.
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Affiliation(s)
- Joel Neugarten
- Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ladan Golestaneh
- Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Chen B, Zhang Y, Song X, Wang X, Zhang J, Fang J. Quantitative estimation of renal function with dynamic contrast-enhanced MRI using a modified two-compartment model. PLoS One 2014; 9:e105087. [PMID: 25141138 PMCID: PMC4139329 DOI: 10.1371/journal.pone.0105087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/19/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish a simple two-compartment model for glomerular filtration rate (GFR) and renal plasma flow (RPF) estimations by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS A total of eight New Zealand white rabbits were included in DCE-MRI. The two-compartment model was modified with the impulse residue function in this study. First, the reliability of GFR measurement of the proposed model was compared with other published models in Monte Carlo simulation at different noise levels. Then, functional parameters were estimated in six healthy rabbits to test the feasibility of the new model. Moreover, in order to investigate its validity of GFR estimation, two rabbits underwent acute ischemia surgical procedure in unilateral kidney before DCE-MRI, and pixel-wise measurements were implemented to detect the cortical GFR alterations between normal and abnormal kidneys. RESULTS The lowest variability of GFR and RPF measurements were found in the proposed model in the comparison. Mean GFR was 3.03±1.1 ml/min and mean RPF was 2.64±0.5 ml/g/min in normal animals, which were in good agreement with the published values. Moreover, large GFR decline was found in dysfunction kidneys comparing to the contralateral control group. CONCLUSION Results in our study demonstrate that measurement of renal kinetic parameters based on the proposed model is feasible and it has the ability to discriminate GFR changes in healthy and diseased kidneys.
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Affiliation(s)
- Bin Chen
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yudong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaojian Song
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Department of Electrical Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Department of Radiology, Peking University First Hospital, Beijing, China
- * E-mail: (XW); (JZ)
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
- * E-mail: (XW); (JZ)
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
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Seeliger E, Lenhard DC, Persson PB. Contrast media viscosity versus osmolality in kidney injury: lessons from animal studies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:358136. [PMID: 24707482 PMCID: PMC3950904 DOI: 10.1155/2014/358136] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/29/2013] [Indexed: 01/01/2023]
Abstract
Iodinated contrast media (CM) can induce acute kidney injury (AKI). CM share common iodine-related cytotoxic features but differ considerably with regard to osmolality and viscosity. Meta-analyses of clinical trials generally failed to reveal renal safety differences of modern CM with regard to these physicochemical properties. While most trials' reliance on serum creatinine as outcome measure contributes to this lack of clinical evidence, it largely relies on the nature of prospective clinical trials: effective prophylaxis by ample hydration must be employed. In everyday life, patients are often not well hydrated; here we lack clinical data. However, preclinical studies that directly measured glomerular filtration rate, intrarenal perfusion and oxygenation, and various markers of AKI have shown that the viscosity of CM is of vast importance. In the renal tubules, CM become enriched, as water is reabsorbed, but CM are not. In consequence, tubular fluid viscosity increases exponentially. This hinders glomerular filtration and tubular flow and, thereby, prolongs intrarenal retention of cytotoxic CM. Renal cells become injured, which triggers hypoperfusion and hypoxia, finally leading to AKI. Comparisons between modern CM reveal that moderately elevated osmolality has a renoprotective effect, in particular, in the dehydrated state, because it prevents excessive tubular fluid viscosity.
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Affiliation(s)
- Erdmann Seeliger
- Institute of Physiology and Center for Cardiovascular Research, Charité-University Medicine Berlin, Campus Mitte, Hessische Straße 3-4, 10115 Berlin, Germany
| | - Diana C. Lenhard
- Institute of Physiology and Center for Cardiovascular Research, Charité-University Medicine Berlin, Campus Mitte, Hessische Straße 3-4, 10115 Berlin, Germany
| | - Pontus B. Persson
- Institute of Physiology and Center for Cardiovascular Research, Charité-University Medicine Berlin, Campus Mitte, Hessische Straße 3-4, 10115 Berlin, Germany
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Low-Dose Nitrite Alleviates Early Effects of an X-ray Contrast Medium on Renal Hemodynamics and Oxygenation in Rats. Invest Radiol 2014; 49:70-7. [DOI: 10.1097/rli.0b013e3182a6fea6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Gassanov N, Nia AM, Caglayan E, Er F. Remote ischemic preconditioning and renoprotection: from myth to a novel therapeutic option? J Am Soc Nephrol 2013; 25:216-24. [PMID: 24309187 DOI: 10.1681/asn.2013070708] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is currently no effective prophylactic regimen available to prevent contrast-induced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.
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Affiliation(s)
- Natig Gassanov
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
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Why is diabetes mellitus a risk factor for contrast-induced nephropathy? BIOMED RESEARCH INTERNATIONAL 2013; 2013:123589. [PMID: 24350240 PMCID: PMC3856131 DOI: 10.1155/2013/123589] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/24/2013] [Indexed: 12/21/2022]
Abstract
Contrast-induced nephropathy (CIN) remains a leading cause of iatrogenic acute kidney injury, as the usage of contrast media for imaging and intravascular intervention keeps expanding. Diabetes is an important predisposing factor for CIN, particularly in patients with renal functional impairment. Renal hypoxia, combined with the generation of reactive oxygen species, plays a central role in the pathogenesis of CIN, and the diabetic kidney is particularly susceptible to intensified hypoxic and oxidative stress following the administration of contrast media. The pathophysiology of this vulnerability is complex and involves various mechanisms, including a priori enhanced tubular transport activity, oxygen consumption, and the generation of reactive oxygen species. The regulation of vascular tone and peritubular blood flow may also be altered, particularly due to defective nitrovasodilation, enhanced endothelin production, and a particular hyperresponsiveness to adenosine-related vasoconstriction. In addition, micro- and macrovascular diseases and chronic tubulointerstitial changes further compromise regional oxygen delivery, and renal antioxidant capacity might be hampered. A better understanding of these mechanisms and their control in the diabetic patient may initiate novel strategies in the prevention of contrast nephropathy in these susceptible patients.
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Zhang YD, Wang J, Zhang J, Wang X, Jiang X. Effect of iodinated contrast media on renal function evaluated with dynamic three-dimensional MR renography. Radiology 2013; 270:409-15. [PMID: 24091357 DOI: 10.1148/radiol.13122495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the hemodynamic effect of iodinated contrast media (CM) on glomerular filtration rate (GFR) by using dynamic three-dimensional magnetic resonance (MR) renography in a rabbit model. MATERIALS AND METHODS This study was approved by the university animal care and use committee. Twelve healthy male New Zealand rabbits (body mass range, 2.5-3.0 kg) were included. Two of them were sacrificed before MR examination to obtain renal histologic samples as controls. The other ten rabbits completed 4-minute dynamic contrast material-enhanced MR imaging 24 hours before and 20 minutes after intravenous injection of iopamidol (370 mg of iodine per milliliter) at a dose of 6 mL per kilogram of body weight. Blood volume (V(B)), GFR, and tubule volume (V(E)) of the renal cortex were determined with a two-compartment kinetic model. Maximum upslope (K(m)), peak concentration (P(c)), and initial 60-second area under the curve (IAUC) of the whole kidney renogram curve were measured with semiquantitative analysis. The self-control data were compared by using the Student paired t test. RESULTS Iopamidol significantly decreased cortical V(B) (mean, 42.53% ± 10.16 [standard deviation] before CM administration vs 27.23% ± 16.13 after CM administration; P < .01), V(E) (mean, 22.40% ± 11.69 before CM administration vs 11.51% ± 6.58 after CM administration; P < .01), and GFR (mean, 31.92 mL/100 g per minute ± 12.52 before CM administration vs 21.48 mL/100 g per minute ± 10.02 after CM administration; P < .01). Results of whole-kidney renogram analysis showed a decrease in K(m), P(c), and IAUC caused by iopamidol administration. CONCLUSION High-dose iopamidol resulted in a marked decrease in renal function, which could be detected at dynamic three-dimensional MR renography.
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Affiliation(s)
- Yu-Dong Zhang
- From the Center for MRI Research, Peking University, Beijing, China (J.W.); Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China (J.Z.); and Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, China 100034 (Y.D.Z., X.W., X.J.)
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Sadat U. Radiographic contrast-media-induced acute kidney injury: pathophysiology and prophylactic strategies. ISRN RADIOLOGY 2013; 2013:496438. [PMID: 24967281 PMCID: PMC4045530 DOI: 10.5402/2013/496438] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/14/2013] [Indexed: 12/17/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is one of the most widely discussed and debated topics in cardiovascular medicine. With increasing number of contrast-media- (CM-) enhanced imaging studies being performed and growing octogenarian population with significant comorbidities, incidence of CI-AKI remains high. In this review, pathophysiology of CI-AKI, its relationship with different types of CM, role of serum and urinary biomarkers for diagnosing CI-AKI, and various prophylactic strategies used for nephroprotection against CI-AKI are discussed in detail.
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Affiliation(s)
- Umar Sadat
- Department of Surgery, Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 201, Cambridge CB2 0QQ, UK
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Arakelyan K, Cantow K, Hentschel J, Flemming B, Pohlmann A, Ladwig M, Niendorf T, Seeliger E. Early effects of an x-ray contrast medium on renal T(2) */T(2) MRI as compared to short-term hyperoxia, hypoxia and aortic occlusion in rats. Acta Physiol (Oxf) 2013; 208:202-13. [PMID: 23480578 DOI: 10.1111/apha.12094] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/08/2013] [Accepted: 03/05/2013] [Indexed: 01/26/2023]
Abstract
AIM X-ray contrast media (CM) can cause acute kidney injury (AKI). Medullary hypoxia is pivotal in CM-induced AKI, as indicated by invasively and pin-point measured tissue oxygenation. MRI provides spatially resolved blood oxygenation level-dependent data using T2 * and T2 mapping. We studied CM effects on renal T2 */T2 and benchmarked them against short periods of hyperoxia, hypoxia and aortic occlusion (AO). METHODS Rats were equipped with carotid artery catheters (tip towards aorta) and supra-renal aortic occluders. T2 */T2 mapping was performed using a 9.4-T animal scanner. CM (1.5 mL iodixanol) was injected into the thoracic aorta with the animal in the scanner followed by 2 h of T2 */T2 mapping. For T2 */T2 assessment, regions of interest in the cortex (C), outer medulla (OM), inner medulla (IM) and papilla (P) were determined according to morphological features. RESULTS Hyperoxia increased T2 * in C (by 17%) and all medullary layers (25-35%). Hypoxia decreased T2 * in C (40%) and all medullary layers (55-60%). AO decreased T2 * in C (18%) and all medullary layers (30-40%). Upon injection of CM, T2 * increased transiently, then decreased, reaching values 10-20% below baseline in C and OM and 30-40% below baseline in IM and P. CONCLUSION T2 * mapping corroborates data previously obtained with invasive methods and demonstrates that CM injection affects renal medullary oxygenation. CM-induced T2 * decrease in OM was small vs. hypoxia and aortic occlusion. T2 * decrease obtained for hypoxia was more pronounced than for AO. This indicates that T2 * may not accurately reflect blood oxygenation under certain conditions.
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Affiliation(s)
| | - K. Cantow
- Center for Cardiovascular Research; Institut für Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - J. Hentschel
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin; Germany
| | - B. Flemming
- Center for Cardiovascular Research; Institut für Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - A. Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin; Germany
| | - M. Ladwig
- Center for Cardiovascular Research; Institut für Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | | | - E. Seeliger
- Center for Cardiovascular Research; Institut für Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin; Germany
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Duhamel G, Prevost V, Girard OM, Callot V, Cozzone PJ. High-resolution mouse kidney perfusion imaging by pseudo-continuous arterial spin labeling at 11.75T. Magn Reson Med 2013; 71:1186-96. [DOI: 10.1002/mrm.24740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Guillaume Duhamel
- Aix-Marseille Université, CNRS; CRMBM UMR 7339, 13385; Marseille France
| | - Valentin Prevost
- Aix-Marseille Université, CNRS; CRMBM UMR 7339, 13385; Marseille France
| | - Olivier M. Girard
- Aix-Marseille Université, CNRS; CRMBM UMR 7339, 13385; Marseille France
| | - Virginie Callot
- Aix-Marseille Université, CNRS; CRMBM UMR 7339, 13385; Marseille France
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Pohlmann A, Cantow K, Hentschel J, Arakelyan K, Ladwig M, Flemming B, Hoff U, Persson PB, Seeliger E, Niendorf T. Linking non-invasive parametric MRI with invasive physiological measurements (MR-PHYSIOL): towards a hybrid and integrated approach for investigation of acute kidney injury in rats. Acta Physiol (Oxf) 2013; 207:673-89. [PMID: 23336404 DOI: 10.1111/apha.12065] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/17/2012] [Accepted: 01/16/2013] [Indexed: 01/11/2023]
Abstract
Acute kidney injury of various origins shares a common link in the pathophysiological chain of events: imbalance between renal medullary oxygen delivery and oxygen demand. For in vivo assessment of kidney haemodynamics and oxygenation in animals, quantitative but invasive physiological methods are established. A very limited number of studies attempted to link these invasive methods with parametric Magnetic Resonance Imaging (MRI) of the kidney. Moreover, the validity of parametric MRI (pMRI) as a surrogate marker for renal tissue perfusion and renal oxygenation has not been systematically examined yet. For this reason, we set out to combine invasive techniques and non-invasive MRI in an integrated hybrid setup (MR-PHYSIOL) with the ultimate goal to calibrate, monitor and interpret parametric MR and physiological parameters by means of standardized interventions. Here we present a first report on the current status of this multi-modality approach. For this purpose, we first highlight key characteristics of renal perfusion and oxygenation. Second, concepts for in vivo characterization of renal perfusion and oxygenation are surveyed together with the capabilities of MRI for probing blood oxygenation-dependent tissue stages. Practical concerns evoked by the use of strong magnetic fields in MRI and interferences between MRI and invasive physiological probes are discussed. Technical solutions that balance the needs of in vivo physiological measurements together with the constraints dictated by small bore MR scanners are presented. An early implementation of the integrated MR-PHYSIOL approach is demonstrated including brief interventions of hypoxia and hyperoxia.
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Affiliation(s)
- A. Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin; Germany
| | - K. Cantow
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte, and Center for Cardiovascular Research; Berlin; Germany
| | - J. Hentschel
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max Delbrück Center for Molecular Medicine; Berlin; Germany
| | | | - M. Ladwig
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte, and Center for Cardiovascular Research; Berlin; Germany
| | - B. Flemming
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte, and Center for Cardiovascular Research; Berlin; Germany
| | - U. Hoff
- Nephrology and Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Campus Virchow-Klinikum, and Center for Cardiovascular Research; Berlin; Germany
| | - P. B. Persson
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte, and Center for Cardiovascular Research; Berlin; Germany
| | - E. Seeliger
- Institute of Physiology; Charité - Universitätsmedizin Berlin; Campus Mitte, and Center for Cardiovascular Research; Berlin; Germany
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Semerci T, Çuhadar S, Akçay FA, Aydın TK, Atay A, Köseoğlu M, Bayata S. Comparing the Renal Safety of Isoosmolar Versus Low-Osmolar Contrast Medium by Renal Biomarkers N-Acetyl-β-d-Glucosaminidase and Endothelin. Angiology 2013; 65:108-12. [DOI: 10.1177/0003319712469094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Iodixanol and iopamidol are commonly used contrast agents in coronary angiography. We evaluated the nephrotoxic effects of both contrast media in relation to renal biomarkers. A total of 38 low-risk patients who underwent coronary angiography were enrolled. Patients were randomized to receive either low-osmolar nonionic monomer or isoosmolar nonionic dimer contrast medium. N-Acetyl-β-d-glucosaminidase (NAG), endothelin, blood urea nitrogen, and urine and serum creatinine (SCr) levels were measured before the procedure (T0), at 6 hours (T6), and at 1 year after the procedure. Plasma endothelin, urine NAG/creatinine, and SCr were higher; accordingly, the urine creatinine values were lower in both the groups when comparing T0 versus T6. The groups were similar with each other when comparing T0 and T6 values. Both the contrast agents may be safely used at a low volume for coronary angiography in low-risk patients. Endothelin and NAG are sensitive to acute renal changes in function. There is a need for further prospective investigations with more patients.
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Affiliation(s)
- Tuna Semerci
- Department of Clinical Biochemistry, Afyon Sandıklı State Hospital, Afyon, Turkey
| | - Serap Çuhadar
- Department of Clinical Biochemistry, Ataturk Research and Training Hospital, Izmir, Turkey
| | | | | | - Ayşenur Atay
- Department of Clinical Biochemistry, Ataturk Research and Training Hospital, Izmir, Turkey
| | - Mehmet Köseoğlu
- Department of Clinical Biochemistry, Ataturk Research and Training Hospital, Izmir, Turkey
| | - Serdar Bayata
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir, Turkey
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