Non-Invasive Diagnosis and Monitoring of Diabetic Nephropathy: Assessment of Renal Function and Fibrosis by Diffusion Kurtosis Imaging.

Background: This monocentric, cross-sectional study explored the use of diffusion kurtosis imaging (DKI) as a non-invasive means to diagnose and monitor diabetic nephropathy (DN).

Methods: Patients with diabetes mellitus (DM, n = 11), mild DN (N = 14), and severe DN (n = 29) were recruited. Eight DKI metrics (MK, MD, Da, Dr, Ka, Kr, FA, FAk) were determined from the imaging results, and their correlations with routine laboratory results were analyzed. The receiver operating characteristic (ROC) curves were plotted, and the diagnostic value of the DKI metrics was analyzed. In addition, renal biopsy was carried out for ten DN patients who had appropriate indications. Their interstitial fibrosis and tubular atrophy (IFTA) score and the fibrosis ratio of cortical area (F%) were analyzed in combination with the DKI metrics.

Results: The progression of DN, reflected by the estimated glomerular filtration rate (eGFR), was accompanied by rising mean kurtosis (MK) and axial kurtosis (Ka) along with decreasing mean diffusivity (MD), axial diffusivity (Da), and radial diffusivity (Dr). Whereas MK was correlated negatively with hemoglobin (Hb) and eGFR and positively with neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), and serum creatinine (Scr), MD, Da, and Dr were positively correlated with Hb and eGFR and negatively correlated with CysC and Scr. For the biopsied patients, MK was positively correlated with IFTA, and fractional anisotropy of kurtosis (FAk) was negatively correlated with F% and IFTA. Among the DKI indicators, MK had the highest AUC (0.922, 95% CI: 0.843-1.000).

Conclusion: The noninvasive monitoring of DN was feasible with DKI, and MK could indicate the renal function and fibrosis of DN patients. Changes in MK may also serve as a biomarker to assess treatment response (eg, microstructural improvement) after therapeutic interventions (eg, drug therapy for diabetic nephropathy, anti-fibrotic therapy).