RESUMO
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.
Assuntos
Técnicas de Imagem por Elasticidade , Nefropatias/diagnóstico por imagem , Transplante de Rim , Rim/diagnóstico por imagem , Adulto , Aloenxertos , Biópsia , Feminino , Fibrose , Sobrevivência de Enxerto , Hong Kong , Humanos , Rim/patologia , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos TestesAssuntos
Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/terapia , Paratireoidectomia/efeitos adversos , Diálise Peritoneal , Tireoidite/etiologia , Doença Aguda , Idoso , Feminino , Humanos , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Diálise Peritoneal/efeitos adversos , Tireoidite/diagnóstico , Tireoidite/tratamento farmacológico , Resultado do TratamentoAssuntos
Hidronefrose/etiologia , Transplante de Rim/efeitos adversos , Obstrução Ureteral/etiologia , Aloenxertos , Dilatação , Drenagem , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/fisiopatologia , Hidronefrose/terapia , Testes de Função Renal , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/fisiopatologia , Obstrução Ureteral/terapia , Procedimentos Cirúrgicos UrológicosRESUMO
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.