Shear Wave Elastography in the Evaluation of Renal Parenchymal Stiffness in Patients with Early Diabetic Kidney Disease

Background: Diabetic kidney disease (DKD) is one of diabetes serious complications. Early detection and treatment of DKD are important for reducing mortality and giving an opportunity to improve disease prognosis.Objectives: To assess the role of shear wave elastography in the evaluation of renal parenchymal stiffness in patients with early diabetic kidney disease.Patients and Methods: This is a prospective comparative study included a total of 90 subjects, divided into 2 groups including control (non-diabetic) and diabetic patient groups. The non-diabetic (control) group included twenty non-diabetic cases with normal renal function tests and calculated GFR, whereas, the patient group comprised seventy patients with diabetes having clinico-laboratory proven diabetic nephropathy. All of the patients were submitted to history taking, clinical examination and laboratory investigations including serum creatinine, estimated GFR and glycosylated Hb test. All subjects underwent kidney assessment using color duplex followed by SWE examination.Results: There was statistically significant increase in stiffness (kilopascal) of middle zone of both kidneys in patients group [10.4 (6.6-12.1) and 10.05 (5.6-14.7)] compared to control group [3.85 (2.9-4.35) and 3.45 (3-4.25)] with p-value < 0.001 with best cut off point >5.1 with sensitivity of (82.14%), specificity of (100.0%) and AUC of (0.932). In addition, the level of velocity (m/s) showed significantly increase in patients group [1.55 (1.2-2.1) and 1.8 (1.1-2.1)] than control group [1.3 (1.2-1.45) and 1.2 (1.05-1.4)] with p-value =0.002. The best cut off point for velocity was > 1.7 with sensitivity of (47.86%), specificity of (92.50%) and AUC of (0.704). Also, there was statistically significant positive correlation between RI, stiffness and velocity of shear wave in patients group.Conclusions: Shear wave elastography is a useful tool in diagnosing early diabetic kidney disease.