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Renal tissue oxygenation in children with chronic kidney disease due to vesicoureteral reflux

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Abstract

Background

Vesicoureteral reflux (VUR) is a frequent cause of chronic kidney disease (CKD) in children. Using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), we measured cortical and medullary oxygenation in children with CKD due to VUR and compared the results to those obtained on healthy controls.

Method

The study population comprised 37 children (19 with CKD due to VUR and 18 healthy age-matched controls). BOLD-MRI was performed before and after furosemide treatment. MR images were analyzed with the region-of-interest (ROI) technique to assess the mean R2* values (=1/T2*) of the cortex and medulla of each kidney and with the concentric object (CO) technique that divides renal parenchyma in 12 equal layers.

Results

R2* values were significantly lower (corresponding to higher oxygenation) in the cortex and medulla of kidneys of children with CKD due to VUR than in those of the healthy controls (cortex 16.4 ± 1.4 vs. 17.2 ± 1.6 s−1 , respectively; medulla 28.4 ± 3.2 vs. 30.3 ± 1.9 s−1 , respectively; P < 0.05), and furosemide-induced changes in medullary R2* were smaller in the former than in the latter (−5.7 ± 3.0 vs. −6.9 ± 3.4 s−1, respectively; P < 0.05). Similar results were found with the CO technique. In children with a history of unilateral reflux (n = 9), the non-affected contralateral kidneys presented similar R2* values as the diseased kidneys, but their response to furosemide was significantly larger (−7.4 ± 3.2 vs. −5.7 ± 3.0, respectively; P = 0.05).

Conclusions

Chronic kidney disease due to VUR is not associated with kidney tissue hypoxia in children. The significantly larger furosemide-induced decrease in medullary R2* levels in the healthy group and unaffected contralateral kidneys of the VUR group points towards more intense renal sodium transport in these kidneys.

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Authors and Affiliations

  1. Pediatric Nephrology Unit, Department of Pediatrics, University Hospital of Lausanne (CHUV), Rue Bugnon 46, 1011, Lausanne, Switzerland

    Hassib Chehade & Francois Cachat

  2. Service of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

    Bastien Milani, Annalisa Ansaloni, Christiane Anex, Isabelle Bassi, Maciej Piskunowicz, Michel Burnier & Menno Pruijm

  3. Radiology Department, Medical University of Gdansk, Gdansk, Poland

    Maciej Piskunowicz

  4. Center for Biomedical Imaging (CIBM), Lausanne, Switzerland

    Matthias Stuber

Authors
  1. Hassib Chehade
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  2. Bastien Milani
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  3. Annalisa Ansaloni
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  4. Christiane Anex
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  5. Isabelle Bassi
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  7. Matthias Stuber
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  8. Francois Cachat
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  9. Michel Burnier
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  10. Menno Pruijm
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Corresponding author

Correspondence to Hassib Chehade.

Ethics declarations

This research project was approved by the local institutional review committee (Ethical Committee of Canton de Vaud, Switzerland) and conducted according to the principles expressed in the Declaration of Helsinki. Written informed consent was obtained from each participant and parents.

Conflict of interest

The authors have no conflicts of interest to disclose.

Funding source

This study was supported by a grant from the Swiss National Science Foundation (FN 32003B-149309).

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The authors have no financial relationships relevant to this article to disclose.

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Chehade, H., Milani, B., Ansaloni, A. et al. Renal tissue oxygenation in children with chronic kidney disease due to vesicoureteral reflux. Pediatr Nephrol 31, 2103–2111 (2016). https://doi.org/10.1007/s00467-016-3419-0

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  • DOI: https://doi.org/10.1007/s00467-016-3419-0

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