Associations between MRI signs of kidney parenchymal changes and biomarkers of renal dysfunction in resistant hypertension

Objective. Resistant hypertension (RHT) is often associated with kidney injury and chronic kidney disease, especially in diabetic patients. Early detection of renal changes contributes to avoiding severe cardiovascular complications, but imaging characteristics of renal dysfunction in RHT remain unclear. The aim of the present study was to determine the relationships between the renal parenchyma volumes and biomarkers reflecting kidney function in a cohort of patients with RHT.

Material and Methods. The study comprised 34 patients with RHT meeting the inclusion criteria. Evaluation of renal function was based on the measurements of estimated glomerular filtration rate (eGFR) and serum levels of creatinine and cystatin C. Renal sizes were assessed by MRI based on absolute and normalized parenchymal kidney volumes.

Results. Primary MRI-based changes in renal parenchyma in patients with RHT demonstrated altered cortical surface, attenuated cortical thickness, lower renal volumes, and round shape of the kidneys compared with the reference characteristics. Positive correlation of moderate power was found between eGFR value and all parameters characterizing renal parenchyma. The strongest direct correlation was found between eGFR and bsa-TKV (r = 0.6166, p = 0.000); ht-TKV correlated with eGFR (r = 0.4751, p = 0.007) and creatinine (r = –0.4302, p = 0.016). According to linear regression analysis, ht-T-Cortex-V < 32.4 was a key element of MRI-presentation of renal dysfunction in patients with eGFR below 60 mL/min/1.73 m2 (sensitivity of 83.3%, specificity of 60.7%, p = 0.03).

Conclusion. MRI study allowed to detect early renal parenchymal changes suggesting the presence of association between renal function and renal parenchymal volume in RHT patients. For the first time, the study revealed MRI-pattern of renal dysfunction in RHT. 

1. Chiu N., Lauffenburger J.C., Franklin J.M., Choudhry N.K. Prevalence, predictors, and outcomes of both true- and pseudo-resistant hypertension in the action to control cardiovascular risk in diabetes trial: a cohort study. Hypertens. Res. 2021;4(11):1471–1482. DOI: 10.1038/s41440-021-00739-6.

2. Sinnott S.J., Smeeth L., Williamson E., Douglas I.J. Trends for prevalence and incidence of resistant hypertension: population based cohort study in the UK 1995–2015. BMJ. 2017;358:j3984. DOI: 10.1136/bmj.j3984.

3. Iskenderov B.G. Cardiorenal syndrome in cardiological patients. Penza; 2013:160 (In Russ.).

4. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 2018;36(10):1953–2041. DOI: 10.1097/HJH.0000000000001940.

5. Caroli A., Remuzzi A., Lerman L.O. Basic principles and new advances in kidney imaging. Kidney Int. 2021;1009(5):1001–1011. DOI: 10.1016/j. kint.2021.04.032.

6. Chazova I.E., Zhernakova Yu.V. Diagnosis and treatment of arterial hypertension (Guidelines). Systemic Hypertension. 2019;16(1):6–31 (In Russ.). DOI: 10.26442/2075082X.2019.1.190179.

7. Melnikova L.V., Osipova E.V. Kidney damage in essential arterial hypertension: Pathogenetic issues for early diagnostics. Arterial Hypertension. 2019;25(1):6–13 (In Russ.). DOI: 10.18705/1607-419X-2019-25-1-6-13.

8. Ryumshina N.I., Lukyanenok P.I., Mordovin V.F., Usov V.Yu. Magnetic-resonance tomography for anthropometric value of kidneys and adrenals in prognosis efficiency of renal sympathetic denervation in patients with treatment-resistant hypertension. Medical Visualization. 2017;21(4):58–64 (In Russ.). DOI: 10.24835/1607-0763-2017-4-58-64.

9. Roseman D.A., Hwang S.J., Oyama-Manabe N., Chuang M.L., O’Donnell C.J., Manning W.J. et al. Clinical associations of total kidney volume: The Framingham Heart Study. Nephrol. Dial. Transplant. 2017;32(8):1344–1350. DOI: 10.1093/ndt/gfw237.

10. Go A.S., Chertow G.M., Fan D., McCulloch C.E., Hsu C.Y. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N. Engl. J. Med. 2004;351(13):1296–1305. DOI: 10.1056/NEJMoa041031.

11. Noda Y., Ito K., Kanki A., Tamada T., Yamamoto A., Kazuya Y. et al. Measurement of renal cortical thickness using noncontrast-enhanced steady-state free precession MRI with spatially selective inversion recovery pulse: Association with renal function. J. Magn. Reson. Imaging. 2015;41(6):1615–1621. DOI: 10.1002/jmri.24719.

12. Zhou H., Yang M., Jiang Z., Ding J., Di J., Cui L. Renal hypoxia: An important prognostic marker in patients with chronic kidney disease. Am. J. Nephrol. 2018;48(1):46–55. DOI: 10.1159/000491551.

13. Hommos M.S., Glassock R.J., Rule A.D. Structural and functional changes in human kidneys with healthy aging. J. Am. Soc. Nephrol. 2017;28(10):2838–2844. DOI: 10.1681/ASN.2017040421.

14. Falkovskaya A.Yu., Mordovin V.F., Rumshina N.I., Pekarskiy S.E., Ripp T.M., Manukyan M.A. et al. Renal denervation may attenuate the severity of MRI-signs of vascular wall damage in diabetic patients with resistant hypertension due to the anti-inflammatory effect. Arterial Hypertension. 2020;26(5):552–563 (In Russ.). DOI: 10.18705/1607-419X2020-26-5-552-563.

15. Georgianos P.I., Agarwal R. Resistant hypertension in chronic kidney disease (CKD): Prevalence, treatment particularities, and research agenda. Curr. Hypertens. Rep. 2020;22(10):84. DOI: 10.1007/s11906-020-01081-x.

16. Nakazato T., Ikehira H., Imasawa T. Determinants of renal shape in chronic kidney disease patients. Clin. Exp. Nephrol. 2016;20(5):748– 756. DOI: 10.1007/s10157-015-1220-1.

17. Jiang K., Ferguson C.M., Lerman L.O. Noninvasive assessment of renal fibrosis by magnetic resonance imaging and ultrasound techniques. Transl. Res. 2019;209:105–120. DOI: 10.1016/j.trsl.2019.02.009.

18. Sasaki T., Tsuboi N., Okabayashi Y., Haruhara K., Kanzaki G., Koike K. et al. Synergistic impact of diabetes and hypertension on the progression and distribution of glomerular histopathological lesions. Am. J. Hypertens. 2019;32(10):900–908. DOI: 10.1093/ajh/hpz059.

19. Müller A., Meier M. Assessment of renal volume with MRI: Experimental protocol. Method. Mol. Biol. 2021;2216:369–382. DOI: 10.1007/978-1-0716-0978-1_21.

20. Matsuo M., Yamagishi F., Higuchi A. A pilot study of prediction of creatinine clearance by ellipsoid volumetry of kidney using noncontrast computed tomography. JMA J. 2019;2(1):60–66. DOI: 10.31662/jmaj.2018-0021.

21. Korkmaz M., Aras B., Güneyli S., Yılmaz M. Clinical significance of renal cortical thickness in patients with chronic kidney disease. Ultrasonography. 2018;37(1):50–54. DOI: 10.14366/usg.17012.

22. Wang X., Vrtiska T.J., Avula R.T., Walters L.R., Chakkera H.A., Kremers W.K. et al. Age, kidney function, and risk factors associate differently with cortical and medullary volumes of the kidney. Kidney Int. 2014;85(3):677– 685. DOI: 10.1038/ki.2013.359.

23. Bax L., van der Graaf Y., Rabelink A.J., Algra A., Beutler J.J., Mali W.P. et al. Influence of atherosclerosis on age-related changes in renal size and function. Eur. J. Clin. Invest. 2003;33(1):34–40. DOI: 10.1046/j.1365-2362.2003.01091.x.