Non-invasive assessment of kidney allograft fibrosis with shear wave elastography: A radiological-pathological correlation analysis.

OBJECTIVES: To evaluate the use of shear wave elastography in assessment of kidney allograft tubulointerstitial fibrosis. METHODS: Shear wave elastography assessment was carried out by two independent operators in kidney transplant recipients who underwent allograft biopsy for clinical indications (i.e. rising creatinine >15% or proteinuria >1 g/day). Allograft biopsies were interpreted by the same pathologist according to the 2013 Banff Classification. RESULTS: A total of 40 elastography scans were carried out (median creatinine 172.5 µmol/L [interquartile range 133.8-281.8 µmol/L]). Median tissue stiffness at the cortex (22.6 kPa [interquartile range 18.8-25.7 kPa] vs 22.3 kPa [interquartile range 19.0-26.5 kPa], P = 0.70) and medulla (15.0 kPa [interquartile range 13.7-18.0 kPa] vs 15.6 kPa [interquartile range 14.4-18.2 kPa]) showed no significant differences between the two observers. Interobserver agreement was satisfactory (intraclass correlation coefficient of the cortex 0.84, 95% CI 0.70-0.92 and intraclass correlation coefficient of the medulla 0.88, 95% CI 0.78-0.94). The areas under the receiver operating characteristic curves for detection of tubulointerstitial fibrosis were estimated to be 0.75 (95% CI 0.61-0.89), 0.85 (95% CI 0.75-0.95) and 0.65 (95% CI 0.53-0.78) for cortical, medullary tissue stiffness and serum creatinine, respectively. CONCLUSIONS: Shear wave elastography can be used as a non-invasive tool to evaluate kidney allograft fibrosis with reasonable interobserver agreement and superior test performance to serum creatinine in detecting early tubulointerstitial fibrosis.

Serial changes of computed tomographic peritoneogram in patients with symptomatic ultrafiltration failure complicating continuous ambulatory peritoneal dialysis.

INTRODUCTION: It is well-known that continuous ambulatory peritoneal dialysis (CAPD) is associated with complications. And some of these complications are well-demonstrated as abnormalities on computed tomographic peritoneogram (CTP). The objective of our study is to document the serial changes of these complications. METHODS: We retrospectively reviewed 125 patients treated with CAPD for end staged renal failure (ESRF) who had CTP conducted in our hospital between December 2006 and August 2015. A total of 164 (n = 164) CTPs were performed. Patients with only one CTP performed were excluded from our study. A retrospective review of 68 serial CTPs studies on 28 patients during the 9-year period was undertaken. We looked into the serial changes on CTP. RESULTS: Among the 28 patients who had serial imaging, 46.43% of patients were found to have retroperitoneal leakage; 92.31% of them showed resolution in subsequent serial CTP. 21.43% of patients had anterior abdominal wall leakage; none of them resolved in subsequent CTP. 14.29% of patients were found to have inguinal hernias; 75% of them showed interval progression in subsequent serial CTPs. CONCLUSION: Retroperitoneal leakage is a common complication in patients on CAPD and tends to resolve whereas other complications including anterior abdominal wall leakage and hernias are unlikely to resolve and may progress further.