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Pediatric nephrology (Berlin, Germany)
03, 2021;36 (3): 517-525.

The old becomes new: advances in imaging techniques to assess nephron mass in children.

Marissa J DeFreitas, Chryso P Katsoufis, Juan C Infante, Michael L Granda, Carolyn L Abitbol, Alessia Fornoni
Author Information
  1. Marissa J DeFreitas: Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA. mdefreitas@med.miami.edu. ORCID
  2. Chryso P Katsoufis: Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA.
  3. Juan C Infante: Section of Pediatric Radiology, Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, FL, USA.
  4. Michael L Granda: Division of General Internal Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
  5. Carolyn L Abitbol: Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA.
  6. Alessia Fornoni: Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
PMID: 31953750 DOI: 10.1007/s00467-020-04477-8

Abstract

Renal imaging is widely used in the assessment of surrogate markers of nephron mass correlated to renal function. Autopsy studies have tested the validity of various imaging modalities in accurately estimating "true" nephron mass. However, in vivo assessment of nephron mass has been largely limited to kidney volume determination by ultrasonography (US) in pediatric populations. Practical limitations and risks create challenges in incorporating more precise 3D volumetric imaging, like magnetic resonance imaging (MRI), and computed tomography (CT) technologies, compared to US for routine kidney volume assessment in children. Additionally, accounting for structural anomalies such as hydronephrosis when estimating renal parenchymal area in congenital anomalies of the kidney and urinary tract (CAKUT) is important, as it correlates with chronic kidney disease (CKD) progression. 3D imaging using CT and MRI has been shown to be superior to US, which has traditionally relied on 2D measurements to estimate kidney volume using the ellipsoid calculation. Recent innovations using 3D and contrast-enhanced US (CEUS) provide improved accuracy with low risk. Indexing kidney volume to body surface area in children is an important standard that may allow early detection of CKD progression in high-risk populations. This review highlights current understanding of various imaging modalities in assessing nephron mass, discusses applications and limitations, and describes recent advances in the field of imaging and kidney disease. Although renal imaging has been a long-standing, essential tool in assessing kidney disease, innovation and new applications of established technologies provide important tools in the study and management of kidney disease in children.

Keywords

Children Chronic kidney disease Kidney volume Nephron mass Renal imaging Ultrasound

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Grants

  1. R01 DK104753/NIDDK NIH HHS

MeSH Term

Child
Humans
Hydronephrosis
Kidney
Magnetic Resonance Imaging
Nephrons
Renal Insufficiency, Chronic
Ultrasonography
Journal Article Review
Article has an altmetric score of 3

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