Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Renal elasticity assessment in patients of glomerulonephritis by shear-wave elastography and its correlation with histopathology and renal biomarkers
Raghunandan Prasad, Robin Verma, Anuradha Singh, Manas R Behera, Monika Yachha, Ravi S Kushwaha, Manoj Jain, Vinita Agrawal, Priyank Yadav, Hira Lal
Raghunandan Prasad, Robin Verma, Anuradha Singh, Hira Lal, Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Manas R Behera, Monika Yachha, Ravi S Kushwaha, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Manoj Jain, Vinita Agrawal, Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Priyank Yadav, Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Author contributions: Prasad R contributed to conceptualization; Verma R contributed to data collection, ultrasound and SWE acquisition, investigation, formal analysis, drafting of the manuscript, data curation; Singh A contributed to statistical analysis, validation; writing - review & editing, interpretation of results; Behera MR contributed to patient recruitment, clinical evaluation, nephrology inputs, interpretation of biochemical and clinical correlations, manuscript review; Yachha M contributed to patient screening, sample handling, clinical data coordination; Kushwaha RS contributed to clinical supervision, nephrology expertise, guidance on biopsy indications and follow-up interpretation, review of final manuscript; Jain M contributed to contributed to histopathology reporting, IF/TA grading, pathology data interpretation, critical revision of pathology-related content; Agrawal V contributed to histopathology supervision, quality control of biopsy interpretation, contribution to manuscript sections related to pathology; Yadav P contributed to study design support and final approval; Prasad R and Lal H contributed to study design, supervision, methodology, critical revision of the manuscript; Yachha M and Lal H contributed to manuscript editing.
Institutional review board statement: The study was reviewed and approved by institutional review board of SGPGIMS, Lucknow, India (IEC code: 2021-52-MD-EXP-36; PGI/BE/1137/2021).
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: All authors of this manuscript having no conflicts of interest to disclose.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: There is no additional data available.
Corresponding author: Hira Lal, Professor, Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, Uttar Pradesh, India.
hiralal2007@yahoo.co.in
Received: November 4, 2025
Revised: November 29, 2025
Accepted: January 6, 2026
Published online: March 25, 2026
Processing time: 130 Days and 20.8 Hours
BACKGROUND
Glomerulonephritis (GN) is a major cause of chronic kidney disease and end-stage renal disease. Renal biopsy remains the gold standard for assessing interstitial fibrosis and tubular atrophy (IF/TA), but it is invasive and unsuitable for repeated assessments. Shear-wave elastography (SWE) is a promising non-invasive technique for quantifying renal cortical stiffness.
AIM
To evaluate renal elasticity using SWE in patients with GN and correlate SWE values with histopathology and serum transforming growth factor-β1 (TGF-β1) levels.
METHODS
This prospective study included 201 consecutive adults with suspected GN undergoing renal biopsy. SWE was performed using a standardized protocol (6 cortical measurements per kidney). Histopathological IF/TA grade served as the reference standard. Serum TGF-β1 was measured using ELISA. Receiver operating characteristic analysis, analysis of variance, and Pearson correlation were applied. Additionally, 53 patients underwent follow-up SWE after 3-6 months.
RESULTS
Patients were classified as: No fibrosis (n = 22), mild (n = 96), moderate (n = 74), and marked fibrosis (n = 9). Mean SWE values increased progressively with IF/TA severity: 13.38 ± 1.36 kPa, 21.66 ± 4.49 kPa, 28.57 ± 4.91 kPa, and 40.31 ± 5.06 kPa, respectively (P < 0.001). SWE accurately detected any fibrosis (area under the curve = 0.986); an optimal cutoff of 13.98 kPa achieved 98% sensitivity and 73% specificity. Serum TGF-β1 levels showed an increasing trend across groups but were not statistically significant (P = 1.0). Etiology-wise, diabetic nephropathy exhibited the highest stiffness, while minimal change disease showed values comparable to the no-fibrosis group. Follow-up SWE revealed a small but statistically significant increase (23.48 ± 6.83 vs 24.04 ± 6.58 kPa, P < 0.001).
CONCLUSION
SWE correlates strongly with histological fibrosis in GN, outperforming conventional ultrasound and serum TGF-β1. It may serve as a non-invasive surrogate marker for moderate-to-marked fibrosis and assist in minimizing unnecessary biopsies. SWE also demonstrates potential for monitoring disease progression.
Core Tip: This research explored a new, painless ultrasound method that measures kidney stiffness. In patients with kidney inflammation (glomerulonephritis), we found that increased kidney stiffness directly corresponds to more scarring inside the organ. This technique proved to be highly accurate in detecting this scarring, which is a key factor in predicting kidney disease progression. Our findings suggest that this simple, non-invasive scan can be a valuable tool for doctors to identify scarring early, monitor the disease over time, and make more informed decisions about which patients truly need a biopsy.
