Ultrasonography (Seoul, Korea) · 2026
Early ultrasound markers for predicting the transition from acute kidney injury to chronic kidney disease and treatment response in a murine model.
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Moon Min Hoan, Lee Jeonghwan, Sung Chang Kyu, Lee Jung Pyo, Lee Myoung Seok
Аннотация
PURPOSE: This study evaluated the feasibility of ultrasound (US) parameters for predicting the transition from acute kidney injury (AKI) to chronic kidney disease (CKD) and assessing the therapeutic response to 17-DMAG, a fibrosis-mitigating agent, in a murine unilateral ischemia-reperfusion injury (UIRI) model.
METHODS: Male C57BL/6 mice were assigned to sham (n=16) or UIRI (n=24) groups, with half of the UIRI mice receiving 17-DMAG (20 mg/kg intraperitoneally, three times weekly). Serial US examinations were performed on postoperative days (PODs) 3 and 8 to evaluate morphological parameters (kidney size and parenchymal thickness [PT]), vascular parameters (resistive index [RI] and vascular index [VI] derived from microvascular imaging [MVI]), and tissue stiffness assessed by shear-wave speed (SWS). Pathologic fibrosis was defined as a Sirius red-positive area >4%. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: At the early stage (POD 3), vascular parameters (VI and RI) demonstrated high diagnostic performance for predicting fibrosis progression (area under the receiver operating characteristic curve, 0.948 and 0.890, respectively), with VI serving as the only significant predictor of early treatment response to 17-DMAG. At POD 8, all parameters showed significant diagnostic performance for predicting fibrosis progression. However, for treatment response, only kidney size, PT, and RI demonstrated significant ROC performance, whereas VI and SWS did not reach statistical significance. These findings reflect the temporal transition from early functional microvascular compromise to established structural remodeling and parenchymal atrophy.
CONCLUSION: RI and VI are promising noninvasive surrogate markers for predicting the AKI-to-CKD transition, and VI may be useful for assessing early responses to 17-DMAG treatment. Whereas conventional US parameters identify late-stage structural remodeling, MVI provides a critical diagnostic window during the acute phase by detecting early microvascular compromise. These findings highlight the potential utility of MVI for real-time monitoring of AKI progression and anti-fibrotic treatment responses in clinical practice.
METHODS: Male C57BL/6 mice were assigned to sham (n=16) or UIRI (n=24) groups, with half of the UIRI mice receiving 17-DMAG (20 mg/kg intraperitoneally, three times weekly). Serial US examinations were performed on postoperative days (PODs) 3 and 8 to evaluate morphological parameters (kidney size and parenchymal thickness [PT]), vascular parameters (resistive index [RI] and vascular index [VI] derived from microvascular imaging [MVI]), and tissue stiffness assessed by shear-wave speed (SWS). Pathologic fibrosis was defined as a Sirius red-positive area >4%. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: At the early stage (POD 3), vascular parameters (VI and RI) demonstrated high diagnostic performance for predicting fibrosis progression (area under the receiver operating characteristic curve, 0.948 and 0.890, respectively), with VI serving as the only significant predictor of early treatment response to 17-DMAG. At POD 8, all parameters showed significant diagnostic performance for predicting fibrosis progression. However, for treatment response, only kidney size, PT, and RI demonstrated significant ROC performance, whereas VI and SWS did not reach statistical significance. These findings reflect the temporal transition from early functional microvascular compromise to established structural remodeling and parenchymal atrophy.
CONCLUSION: RI and VI are promising noninvasive surrogate markers for predicting the AKI-to-CKD transition, and VI may be useful for assessing early responses to 17-DMAG treatment. Whereas conventional US parameters identify late-stage structural remodeling, MVI provides a critical diagnostic window during the acute phase by detecting early microvascular compromise. These findings highlight the potential utility of MVI for real-time monitoring of AKI progression and anti-fibrotic treatment responses in clinical practice.