The number of people affected by chronic kidney disease (CKD) is on the rise. This is partly attributed to the increasing number of diabetics and hypetensives. Currently it is estimated that over 15 million people have moderate CKD in the US. But only a fraction of these will progress and ultimately require transplantaion or dialysis services. Currently, there is not a good way of identifying subjects who will progress. Determining this has important implications in terms of patient management. So, there has recently been an increased interest in developing alternate markers to characterize CKD. We propose to test whether one or several MRI markers would be useful in identifying subjects at risk of progression. In this study, we will evaluate these measurements in a small number of subjects with moderate CKD. Three types of markers are being proposed, one is simple kidney size measurement. The second is to characterize the structural makeup of the kidney. Fibrosis is a consequence of CKD and is known to be a key determinant for the disease progression. We will use apparent diffusion coefficient measurement to evaluate the degree of fibrosis. It is also now becoming well accepted that kidneys become more hypoxic under diseased conditions and this actually may drive the processes responsible for development of fibrosis. We have pioneered in the use of BOLD MRI to evaluate intrarenal oxygenation and will test if it can identify subjects at risk of progression. We will also test arterial spin labeling method to evaluae relative renal perfusion. All the proposed methods do not require any exogenous contrast administration. If the project is successful, it may lead to one or more markers for identifying subjects at risk of progression and in turn may have a significant impact on patient management. Also, these markers could be useful in monitoring disease progression and interventions. This would be significant for drug development and testing novel interventional strategies both in animal models and in humans.
Currently it is estimated that over 15 million people in the US have moderate level of chronic kidney disease, but only a fraction of these will progress and ultimately require transplantaion or dialysis services. Currently, there is not a good way of identifying subjects who will progress. This study is designed to test whether one or several MRI markers would be useful in identifying subjects at risk of progression. This will have significant impact on our understanding of the disease and the ability to evaluate novel interventions.
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