Jean-François Deux1, Vincent Audard2, Pierre Brugières3, Anoosha Habibi4, Elena-Maria Manea5, Constance Guillaud-Danis6, Bertrand Godeau6, Frédéric Galactéros4, Thomas Stehlé2, Philippe Lang2, Philippe Grimbert2, Etienne Audureau7, Alain Rahmouni8, Pablo Bartolucci4. 1. Service d'Imagerie Médicale, AP-HP (Assistance Publique-Hôpitaux de Paris, Créteil), Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France; Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, Université Paris-Est-Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France. Electronic address: jean-francois.deux@aphp.fr. 2. Service de Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Institut Francilien de recherche en Néphrologie et Transplantation, Centre de référence maladie rare Syndrome Néphrotique Idiopathique, Créteil, France; Département Hospitalo-Universitaire Virus-Immunity-Cancer, Université Paris-Est-Créteil, Institut Mondor de Recherche Biomédicale, Equipe 21, INSERM U 955, Créteil, France. 3. Service d'Imagerie Médicale, AP-HP (Assistance Publique-Hôpitaux de Paris, Créteil), Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. 4. AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Centre de Référence des Syndromes Drépanocytaires Majeurs, Créteil, France; Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, Université Paris-Est-Créteil, Institut Mondor de Recherche Biomédicale, Equipe 2, Laboratoire d'excellence GRex, Créteil, France; Service de Médecine Interne, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. 5. AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Centre de Référence des Syndromes Drépanocytaires Majeurs, Créteil, France; Service de Médecine Interne, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. 6. Service de Médecine Interne, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. 7. Service de Santé Publique, AP-HP, CEpiA EA7376, Université Paris-Est-Créteil, Créteil, France. 8. Service d'Imagerie Médicale, AP-HP (Assistance Publique-Hôpitaux de Paris, Créteil), Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France; Département Hospitalo-Universitaire Ageing-Thorax-Vessels-Blood, Université Paris-Est-Créteil, Institut Mondor de Recherche Biomédicale, Créteil, France.
Abstract
BACKGROUND: Our understanding of the pathophysiologic processes underlying sickle cell nephropathy remains incomplete. We performed a pilot study to investigate the potential value of magnetic resonance imaging (MRI) for the assessment of kidney oxygenation and detection of potential changes to tissue perfusion and cellular integrity during a vaso-occlusive crisis. STUDY DESIGN: A case-control study. SETTING & PARTICIPANTS: 10 homozygous patients with sickle cell disease (SCD), without kidney disease (based on estimated glomerular filtration rate and albuminuria), underwent renal MRI during a vaso-occlusive crisis episode. The imaging data obtained were compared with those for a second MRI performed at steady state (median, 56 [IQR, 37-72] days after the vaso-occlusive crisis MRI). The control group consisted of 10 apparently healthy individuals. MEASUREMENTS: Deoxyhemoglobin level assessed by R2* value was calculated using the blood oxygen level-dependent technique. The intravoxel incoherent motion diffusion-weighted imaging technique was used to calculate D, D*, and F parameters. RESULTS: Median medullary R2* values on steady-state MRI were significantly higher for patients with SCD than for controls (P=0.01) and did not change significantly during the vaso-occlusive crisis. No significant differences in median cortical R2* values were observed. Both cellular integrity (D) and local perfusion (D* and F) were significantly altered in medullary and cortical areas during vaso-occlusive crises in comparison to steady state in patients with SCD. These parameters did not differ significantly between patients with SCD assessed at steady state and the control group. LIMITATIONS: Small sample size, estimation of glomerular filtration rate according to CKD-EPI creatinine equation without adjustment for race. CONCLUSIONS: Deoxyhemoglobin levels in the medullary area are higher in patients with SCD, during vaso-occlusive crises and at steady state, than in controls. Alterations to the tissue perfusion and cellular integrity of renal parenchyma are a common finding during vaso-occlusive crises that provide additional evidence that a vaso-occlusive crisis may be associated with subclinical kidney injury detectable on MRI.
BACKGROUND: Our understanding of the pathophysiologic processes underlying sickle cell nephropathy remains incomplete. We performed a pilot study to investigate the potential value of magnetic resonance imaging (MRI) for the assessment of kidney oxygenation and detection of potential changes to tissue perfusion and cellular integrity during a vaso-occlusive crisis. STUDY DESIGN: A case-control study. SETTING & PARTICIPANTS: 10 homozygous patients with sickle cell disease (SCD), without kidney disease (based on estimated glomerular filtration rate and albuminuria), underwent renal MRI during a vaso-occlusive crisis episode. The imaging data obtained were compared with those for a second MRI performed at steady state (median, 56 [IQR, 37-72] days after the vaso-occlusive crisis MRI). The control group consisted of 10 apparently healthy individuals. MEASUREMENTS: Deoxyhemoglobin level assessed by R2* value was calculated using the blood oxygen level-dependent technique. The intravoxel incoherent motion diffusion-weighted imaging technique was used to calculate D, D*, and F parameters. RESULTS: Median medullary R2* values on steady-state MRI were significantly higher for patients with SCD than for controls (P=0.01) and did not change significantly during the vaso-occlusive crisis. No significant differences in median cortical R2* values were observed. Both cellular integrity (D) and local perfusion (D* and F) were significantly altered in medullary and cortical areas during vaso-occlusive crises in comparison to steady state in patients with SCD. These parameters did not differ significantly between patients with SCD assessed at steady state and the control group. LIMITATIONS: Small sample size, estimation of glomerular filtration rate according to CKD-EPI creatinine equation without adjustment for race. CONCLUSIONS: Deoxyhemoglobin levels in the medullary area are higher in patients with SCD, during vaso-occlusive crises and at steady state, than in controls. Alterations to the tissue perfusion and cellular integrity of renal parenchyma are a common finding during vaso-occlusive crises that provide additional evidence that a vaso-occlusive crisis may be associated with subclinical kidney injury detectable on MRI.
Authors: Essa Hariri; Anthony Mansour; Andrew El Alam; Yazan Daaboul; Serge Korjian; Sola Aoun Bahous Journal: Int Urol Nephrol Date: 2018-01-30 Impact factor: 2.370