7
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Innovative Perspective: Gadolinium-Free Magnetic Resonance Imaging in Long-Term Follow-Up after Kidney Transplantation

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Since the mid-1980s magnetic resonance imaging (MRI) has been investigated as a non- or minimally invasive tool to probe kidney allograft function. Despite this long-standing interest, MRI still plays a subordinate role in daily practice of transplantation nephrology. With the introduction of new functional MRI techniques, administration of exogenous gadolinium-based contrast agents has often become unnecessary and true non-invasive assessment of allograft function has become possible. This raises the question why application of MRI in the follow-up of kidney transplantation remains restricted, despite promising results. Current literature on kidney allograft MRI is mainly focused on assessment of (sub) acute kidney injury after transplantation. The aim of this review is to survey whether MRI can provide valuable diagnostic information beyond 1 year after kidney transplantation from a mechanistic point of view. The driving force behind chronic allograft nephropathy is believed to be chronic hypoxia. Based on this, techniques that visualize kidney perfusion and oxygenation, scarring, and parenchymal inflammation deserve special interest. We propose that functional MRI mechanistically provides tools for diagnostic work-up in long-term follow-up of kidney allografts.

          Related collections

          Most cited references96

          • Record: found
          • Abstract: found
          • Article: not found

          Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics.

          In chronic kidney disease, functional impairment correlates with tubulointerstitial fibrosis characterised by inflammation, accumulation of extracellular matrix, tubular atrophy and rarefaction of peritubular capillaries. Loss of the microvasculature implies a hypoxic milieu and suggested an important role for hypoxia when the "chronic hypoxia hypothesis" was proposed a decade ago as an explanation for the progressive nature of fibrosis. Recent data in man provide evidence of decreased renal oxygenation in chronic kidney disease while more direct support for a causal role comes from data in rodent models showing that the decline in renal oxygenation precedes matrix accumulation, suggesting hypoxia may both initiate and promote the fibrotic response. Indeed, in vitro studies show that hypoxia can induce pro-fibrotic changes in tubulointerstitial cells. Additional postulated roles for hypoxia in chronic kidney disease are the sustaining of the inflammatory response, the recruitment, retention and differentiation towards a pro-fibrotic phenotype of circulating progenitor cells and the alteration of the function of intrinsic stem cell populations. Given that accumulating data suggests that chronic hypoxia is a final common pathway to end-stage renal disease, therapeutic strategies that target hypoxia may be of benefit in retarding progression. Normalisation of microvascular tone, administration of pro-angiogenic factors to restore microvasculature integrity, activation of hypoxia-inducible transcription factors and hypoxia-mediated targeting and mobilisation of progenitor cells are all potential targets for future therapy. The limited success of existing strategies in retarding chronic kidney disease mandates that these new avenues of treatment be explored.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Strategies to improve long-term outcomes after renal transplantation.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

              Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. Meta-analysis of randomized controlled trials and prospective or retrospective observational studies. Adults undergoing native kidney biopsy in an inpatient or outpatient setting. MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more. Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance. Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes. 34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant. Publication bias, few randomized controlled trials, and missing data. Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
                Bookmark

                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                16 May 2017
                2017
                : 8
                : 296
                Affiliations
                [1] 1Department of Nephrology and Hypertension, University Medical Center Utrecht Utrecht, Netherlands
                [2] 2Department of Radiology, University Medical Center Utrecht Utrecht, Netherlands
                [3] 3Department of Pathology, University Medical Center Utrecht Utrecht, Netherlands
                Author notes

                Edited by: Christine Kranz, University of Ulm, Germany

                Reviewed by: Samuel Heyman, Hadassah Hebrew University Hospitals, Israel; Pottumarthi Vara Prasad, NorthShore University HealthSystem, USA

                *Correspondence: Marianne C. Verhaar m.c.verhaar@ 123456umcutrecht.nl

                This article was submitted to Renal and Epithelial Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2017.00296
                5432553
                834832c9-8dd0-4fa3-a67f-c2de8efffaf5
                Copyright © 2017 van Eijs, van Zuilen, de Boer, Froeling, Nguyen, Joles, Leiner and Verhaar.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 January 2017
                : 24 April 2017
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 101, Pages: 12, Words: 9660
                Funding
                Funded by: Nierstichting 10.13039/501100002997
                Award ID: 150KK119
                Categories
                Physiology
                Review

                Anatomy & Physiology
                magnetic resonance imaging,functional mri,kidney transplantation follow-up,chronic allograft nephropathy,protocol kidney biopsy,chronic hypoxia theory

                Comments

                Comment on this article