Diagnostic accuracy of shear wave elastography in evaluating renal fibrosis in children with chronic kidney disease: a comparative study with nuclear scan

Background Chronic kidney disease (CKD) is a significant health issue in pediatric patients due to fibrosis progression. Shear wave elastography (SWE) is a noninvasive technique used to assess fibrosis in CKD, but its efficacy needs to be better established. This study aimed to compare SWE with nuclear scan in assessing fibrosis in pediatric CKD patients. Aim To determine the area of scarring/fibrosis of each kidney using shear wave elastography in chronic kidney disease and compare it with technetium-99m dimercaptosuccinic acid (DMSA) results. Methods A prospective study included 39 chronic kidney disease patients who underwent shear wave elastography and grayscale ultrasound. DMSA scans were performed to identify scar areas of the kidneys. Young modulus was recorded for each pole of both kidneys and compared with scar areas on DMSA. Thirty-nine age-matched controls underwent shear wave elastography to estimate the average elasticity value in the normal population. Results Thirty-nine CKD patients underwent this study, with 10 females and 29 males. The median age was 6.5 years. The cutoff value of cortical thickness ≤ 10.2 predicted scar on DMSA with a sensitivity of 79% and a specificity of 77%. The cutoff value of elasticity value ≥ 5.57 kPa predicted scar on DMSA with a sensitivity of 87% and a specificity of 96%. Median SWE values were significantly higher with the scar on DMSA (12.6 kPa) compared to no scar on DMSA (4.1 kPa). The controls mean values and standard deviation were 2.42 kPa and 0.45 kPa, respectively. Conclusions Shear wave elastography has revealed that patients with chronic kidney disease exhibit higher values in the areas where scarring has occurred, compared to non-scarred areas. Fortunately, integrating shear wave elastography into routine ultrasonography assessments is a straightforward and painless process that requires no additional preparation from the patient. Not only is this method time efficient, but it also eliminates the need for potentially risky radiation exposure from radionuclide tests in the future.