Renovascular disease (RVD) is the most common potentially reversible cause of hypertension and renal failure in the US. Its diagnosis is problematic because renal artery stenosis (RAS) alone is insufficient for diagnosis. Essential hypertension and RAS often coexist, hence anatomic studies such as x-ray angiography do not accurately predict response to revascularization. To date, no test provides both accurate anatomic and functional assessment to diagnose RVD. Management of RAS patients is also a dilemma. The inability to differentiate RVD from incidental RAS has also contributed to the widespread uncertainty treatment, and lack of a sensitive test for detecting individual kidney response has further limited clinical trials. In the first funding period we developed a robust and quantitative low dose Gd-enhanced MR renography method for measuring single kidney glomerular filtration rate (GFR) and implemented a dual-injection method for ACE-inhibitor- enhanced MR renography to diagnose RVD. Our functional study can be performed in conjunction with renal MRA for anatomic evaluation with promising early results. We have also shown the feasibility of combining furosemide-enhanced BOLD MR with ACE-I MR renography for measuring renal ischemia in patients with RAS and have also investigated new non-Gd-enhanced MRA methods. In the next funding period, we propose to test a comprehensive-anatomic and functional-MR protocol to diagnose RVD and also to use MR longitudinally to measure single kidney functional outcomes. Broad, long-term objectives: To reduce the morbidity and mortality associated with hypertension and renal failure due to RVD by correctly diagnosing the disease and by determining which patients are likely to benefit from revascularization therapy and which patients should be treated with medication alone.
Specific Aims /Methods: (1) To determine the accuracy of a single comprehensive exam that combines MRA with ACE-inhibitor MR renography and furosemide-BOLD MRI for the diagnosis of RVD. We will perform a prospective study in 264 subjects over 3 years and compare our MR results with MRA and x-ray angiography, using response to revascularization measures of blood pressure and renal function as the reference standard. (2) To perform a longitudinal study using MR renography and furosemide-BOLD MRI to study ipsi- and contralateral single kidney GFR in RAS patients who undergo revascularization or who are medically managed. We will use measurements of single kidney GFR and oxygenation to assess responses to therapies with the hypothesis that our methods will detect otherwise subclinical improvements in renal function after revascularization and otherwise subclinical declines in patients with RVD managed medically. At its conclusion, our study highly likely to show that a comprehensive MR exam, by uniquely providing both anatomic and functional information in a single test, will accurately diagnose RVD and provide a valuable tool for measuring outcomes following therapy.

Public Health Relevance

The proposed project will be important for helping to improve the accuracy of diagnosis of a common disease, renovascular disease, which causes hypertension and kidney failure. With novel MRI methods, we can detect narrowings of the renal arteries and assess their impact on the functioning of kidneys in order to predict who should undergo an interventional treatment to open the arteries and who should be treated with medications only. Our anatomic and functional MRI techniques also have the potential to offer new insights into the diagnosis and treatment of other kidney diseases such as diabetes and kidney transplant dysfunction.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK063183-10
Application #
8432503
Study Section
Special Emphasis Panel (ZRG1-SBIB-P (04))
Program Officer
Flessner, Michael Francis
Project Start
2003-01-01
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
10
Fiscal Year
2013
Total Cost
$420,994
Indirect Cost
$138,763
Name
University of Utah
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
009095365
City
Salt Lake City
State
UT
Country
United States
Zip Code
84112
Hofstetter, Lorne W; Morrell, Glen; Kaggie, Joshua et al. (2016) T2* Measurement bias due to concomitant gradient fields. Magn Reson Med :
Zhang, Jeff L; Morrell, Glen; Rusinek, Henry et al. (2014) Measurement of renal tissue oxygenation with blood oxygen level-dependent MRI and oxygen transit modeling. Am J Physiol Renal Physiol 306:F579-87
Zhang, Jeff L; Morrell, Glen; Rusinek, Henry et al. (2014) New magnetic resonance imaging methods in nephrology. Kidney Int 85:768-78
Vivier, Pierre-Hugues; Storey, Pippa; Chandarana, Hersh et al. (2013) Renal blood oxygenation level-dependent imaging: contribution of R2 to R2* values. Invest Radiol 48:501-8
Kang, Stella K; Huang, William C; Lee, Vivian S et al. (2013) MR renographic measurement of renal function in patients undergoing partial nephrectomy. AJR Am J Roentgenol 200:1204-9
Kang, Stella K; Huang, William C; Wong, Samson et al. (2013) Dynamic contrast-enhanced magnetic resonance imaging measurement of renal function in patients undergoing partial nephrectomy: preliminary experience. Invest Radiol 48:687-92
Zhang, Jeff L; Rusinek, Henry; Chandarana, Hersh et al. (2013) Functional MRI of the kidneys. J Magn Reson Imaging 37:282-93
Zhang, Jeff L; Morrell, Glen R; Lee, Vivian S (2013) Blood oxygen level-dependent MR in renal disease: moving toward clinical utility. Radiology 268:619-21
Morrell, Glen R; Zhang, Jeff L; Lee, Vivian S (2013) Science to practice: Renal hypoxia and fat deposition in diabetic neuropathy--new insights with functional renal MR imaging. Radiology 269:625-6
Zhang, Jeff L; Sigmund, Eric E; Rusinek, Henry et al. (2012) Optimization of b-value sampling for diffusion-weighted imaging of the kidney. Magn Reson Med 67:89-97

Showing the most recent 10 out of 23 publications