#4869 ULTRASOUND IMAGING PATTERNS OF KIDNEY DISEASE IN PATIENTS WITH METABOLIC SYNDROME
Authors: Bubnov Rostyslav 
Published: June 2023

Abstract

Background and Aims
Meeting definition of metabolic syndrome (MetS) requires detection of central obesity (increasing waist circumference, WC) plus any two of the other four factors (hyperglycemia, dyslipidemia, cardiovascular disease, hypertension) [1]. Up to date, kidney evaluation is not fully reflected in MetS evaluation. Multiparameter ultrasound (US) can provide accurate information on every MetS sign [2] and for specific detecting type of chronic kidney disease (CKD) [3]. The Aim was to study added diagnostic value of ultrasound diagnosis of chronic kidney disease in patients with MetS for precise diagnosis and patients stratification.

Method
We included 48 overweight subjects patients (27-75 years; 25 women) with signs of MetS, BMI &gt; 30, waist circumference (WC) &gt; 110. The control group included 50 healthy individuals (26 women), mean age 43 ± 7 years without clinical, laboratory signs of MetS, nephropathy and liver pathology. All patients underwent general clinical, lab tests; abdominal US including precise multiparameter US of kidneys as in [3] measuring shear wave elastography (SWE), Doppler in parenchyma and vessels. We determined fat accumulations measuring VF and subcutaneous (SF) fat thickness (cm) and areas (cm2) on US.

Results
We detected hypertension (in 62%); hypercholesterolemia (in 45%); hyperuricemia (in 28%); hyperglycemia (in 32%); nephropathy (in 37%), portal hypertension (in 32%) in obese individuals (vs controls p &lt; 0.05). In all patients we found increasing of visceral fat and various abnormalities in kidneys on US, we distinguished patterns in according to constituents of MetS by its definition s follows:
Diabetic nephropathy included mild decresing or normal kidneys size, thinning parenchyma, low differentiation, clear smooth margings, Doppler showed mild decreasing velocities, increasing of RI in segmental arteries over 0.7 (Figure 1).
Ischemic pattern associated with advanced atherosclerosis included severe decreasing of size, thinned, hyperechoic parenchyma; decreasing velocities under 25 cm/s., severe increasing of RI over 0.8.
Hypertension associated nephropathy: mild changes in structure, normal velocities, increased RI (Figure 2). Hypertension correlated with levels of RI.
Nephropathy in hyperuricemia and gout: signs as in [3] included thinning, increasing echogenicity of kidney parenchyma (P &lt; 0.05), detection of fibrotic changes and small hyperechoic inclusions, hilly margins, anaechoic strips under the capsule, RI increasing in segmental arteries over 0.7.
“Circular pyramyds pattern” included hyoerechoic circles around pyramids (white pyramid sign, hyperdense renal pyramids sign) with normal size, normal / mild increase of RI. SWE showed increased parenchyma stiffness to 10 ± 1.7 kPa (6–17 kPa) versus 4.2 ± 1.2 kPa (P &lt; .05), showed differences among patterns, highest values were in nephropathy in gout and ischemia.

Conclusion
Multiparameter ultrasound is effective for detecting and distinguishing patterns of kidney disease in MetS provides additional value for differentiation and modification treatment and targeted prevention. Kidney involvement should be considered in management of MetS.