Assessment of Renal Cortical Stiffness in Diabetes Mellitus by Shear Wave Elastography Ultrasound

Abstract Background: Diabetic kidney disease (DKD) is a major complication of diabetes and a leading cause of end-stage kidney disease. Renal fibrosis worsens the prognosis of DKD. While biopsy is the gold standard for assessing fibrosis, noninvasive alternatives like elastography – which measures tissue stiffness – are promising. This study aimed to evaluate renal cortical stiffness in patients with diabetes using shear wave elastography (SWE) and assess its diagnostic value compared to conventional ultrasound. Methods: A case–control study was conducted at Beni Suef University Hospital between October 2023 and April 2024, including 30 patients with diabetes and 30 age-and sex-matched healthy controls. Participants underwent clinical evaluation, laboratory tests (including hemoglobin A1C [HbA1c], serum creatinine, albumin/creatinine ratio), and renal ultrasound with SWE. SWE measurements were taken from both kidneys, and mean stiffness values were calculated. Statistical analysis included t -tests, receiver operating characteristic (ROC) curve analysis, and correlation assessments. Results: Conventional ultrasound parameters showed no significant differences between cases and controls. However, SWE values were significantly higher in patients with diabetes (mean SWE: 12.90 ± 1.23 kPa) compared to controls (9.71 ± 0.88 kPa, P < 0.001). ROC analysis revealed excellent diagnostic accuracy for mean SWE (area under the curve = 0.998), with 96.67% sensitivity and 100% specificity at a cut-off of 10.95 kPa. SWE values strongly correlated with diabetes duration, HbA1c, fasting glucose, creatinine, and albumin/creatinine ratio ( P < 0.001). Conclusion: SWE is a highly sensitive, noninvasive tool for detecting early renal changes in patients with diabetes, with superior diagnostic performance to conventional ultrasound.