Renal MR Feasibility in Renal Disease

Study Overview
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Brief Summary
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To use Non-invasive MR Imaging of Renal Physiology and structure to assess patients with Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

Detailed Description
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Multi centre observational pilot study using novel, contrast free functional renal MRI scans. A series of functional renal MRI scans will be performed (These scans do not constitute part patients routine clinical care). The results will initially be used to assess renal perfusion and fibrosis in patients with AKI and CKD. Subsequent analysis will be used to identify specific markers on the renal MRI scans that differentiate chronic kidney damage from acute injury to the kidney. Finally results will be used to stratify patients with AKI and CKD into low and high risk of subsequent deterioration in renal function. AKI Cohort 25 patients with AKI stage 2/3 with or without renal replacement therapy (RRT) will undergo functional renal MRI imaging at day 0, day 90 and day 365. First Study Scan (Day 0): A functional renal MRI scan will be performed during an admission to hospital with an episode of AKI 2/3. Vital signs and SOFA score will be recorded on the day of the scan. Renal function assessment will occur± 2 days either side of the scan with an Iohexol clearance test. Second Study Scan (Day 90): Repeat functional renal MRI imaging will be planned at 90 days (±14 days) after the 1st study scan day. Renal function assessment will occur±7 days either side of the scan with an Iohexol clearance test. Third Study Scan (Day 365): The final functional renal MRI imaging will take place 12 months (±30 days) after the 1st study scan day. Renal function assessment will occur±7 days either side of the scan with an Iohexol clearance test. CKD Cohort: 25 patients with CKD stage 3-4 eGFR 20-59ml/min/1.73m2 will undergo functional renal MRI imaging at day 0, day 7 and day 365. First Study Scan (Day 0): A functional renal MRI scan will be performed as an outpatient. Vital signs will be recorded on the day of the scan. Renal function assessment will occur ±7 days either side of the scan with an Iohexol clearance test. Second Study Scan (Day 7): A functional renal MRI scan will be performed as an outpatient. Vital signs will be recorded on the day of the scan. Third Study Scan (Day 365): The second functional renal MRI imaging will take place 12 months (±30 days) after the 1st study scan day. Renal function assessment will occur±7 days either side of the scan with an Iohexol clearance test.

Official Title
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Using MRI ASL Techniques for Quantitative Measurement of Renal Haemodynamics and Structural Parameters in Acute Kidney Injury and Chronic Kidney Disease.

Conditions
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Renal Disease

Intervention / Treatment
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* Other: 3 Tesla multiparametric MR
* Other: renal histopathology scoring
* Biological: Blood and urine sampling
* Biological: Iohexol clearance test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: AKI Patients: Acute Kidney Injury stage 2/3 (duration >24 hours) including patients requiring renal replacement therapy >18 years & < 95 years Able to give informed consent CKD Patients: Patients with CKD Stage 3 - 4 (e GFR> 20 and <60 ml/min) >18 years & < 95 years Able to give informed consent Exclusion Criteria: AKI Patients: Renal transplant Contraindications to MRI e.g. claustrophobia, cardiac pacemaker, metallic fragments or implants Pregnancy or breast feeding or intending pregnancy Unable to give consent or understand written information Pre-existing CKD of any stage as per eGFR Obstructive uropathy AKI duration <24hrs, in the opinion of the investigator Not medically fit for transfer to MRI scan, in the opinion of the clinical team or the investigator Iodine allergy Patients unable to comply with basic verbal English commands whilst in scanner due to special communication needs CKD Patients: Renal transplant Contraindications to MRI e.g. claustrophobia, cardiac pacemaker, metallic fragments or implants Pregnancy or breast feeding or intending pregnancy Unable to give consent or understand written information Unstable CKD; AKI Stage 1 or more or other unplanned hospital admission within the last 90 days Iodine allergy Patients unable to comply with basic verbal English commands whilst in scanner due to special communication needs

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic Kidney Disease<br>CKD stage 3-4 eGFR 59-20mls/min/1.73 '3 Tesla multiparametric MR: Renal MRI Scan to assess blood flow, perfusion, oxygenation and microstructure (MR T1 relaxation time and diffusion). Each patient will have 3 renal MRI scans. renal histopathology scoring: Blinded fibrosis scoring of renal histopathology (If biopsy performed for clinical indication) Iohexol clearance test: Blood and urine sampling around scan sessions; this will include routine patient care biochemistry and haematology panel. urine protein and albumin measurements, stored plasma/serum/urine for subsequent analysis. Iohexol clearance to measure GFR within 1 week of the scan session | Other: 3 Tesla multiparametric MR<br>* Renal MRI Scan to assess blood flow, perfusion, oxygenation and microstructure (MR T1 relaxation time and diffusion). Each patient will have 3 renal MRI scans.<br>* Other names: Renal MRI Scan;Other: renal histopathology scoring<br>* Blinded fibrosis scoring of renal histopathology (If biopsy performed for clinical indication)<br>Biological: Blood and urine sampling<br>* Blood and urine sampling around scan sessions; this will include routine patient care biochemistry and haematology panel, urine protein and albumin measurements, stored plasma/serum/urine for subsequent analysis<br>Biological: Iohexol clearance test<br>* Iohexol clearance to measure GFR within 1 week of the scan session<br>|
| Acute Kidney Injury<br>AKI stage 2-3 '3 Tesla multiparametric MR: Renal MRI Scan to assess blood flow, perfusion, oxygenation and microstructure (MR T1 relaxation time and diffusion). Each patient will have 3 renal MRI scans. Iohexol clearance test: Blood and urine sampling around scan sessions; this will include routine patient care biochemistry and haematology panel. renal histopathology scoring: Blinded fibrosis scoring of renal histopathology (If biopsy performed for clinical indication) urine protein and albumin measurements, stored plasma/serum/urine for subsequent analysis. Iohexol clearance to measure GFR within 1 week of the scan session | Other: 3 Tesla multiparametric MR<br>* Renal MRI Scan to assess blood flow, perfusion, oxygenation and microstructure (MR T1 relaxation time and diffusion). Each patient will have 3 renal MRI scans.<br>* Other names: Renal MRI Scan;Other: renal histopathology scoring<br>* Blinded fibrosis scoring of renal histopathology (If biopsy performed for clinical indication)<br>Biological: Blood and urine sampling<br>* Blood and urine sampling around scan sessions; this will include routine patient care biochemistry and haematology panel, urine protein and albumin measurements, stored plasma/serum/urine for subsequent analysis<br>Biological: Iohexol clearance test<br>* Iohexol clearance to measure GFR within 1 week of the scan session<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference between volume (mls) MR parameter between healthy volunteers and patients with CKD and AKI | Examining the difference in volume (mls) T1 (ms) between the 3 groups using PRISM, SPSS, Stata and Matlab | 3 years | 
| The difference between T1 (ms) MR parameter between healthy volunteers and patients with CKD and AKI | Examining the difference in T1 (ms) between the 3 groups using PRISM, SPSS, Stata and Matlab | 3 years | 
| The difference between Diffusion weighted imaging MR parameter between healthy volunteers and patients with CKD and AKI | Examining the difference in ADC and D(ms) between the 3 groups using PRISM, SPSS, Stata and Matlab | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlations between structural T1 (ms) and blinded renal biopsy measurements | Sirius red fibrosis scoring (%) Vs T1(ms) | 3 years | 
| Correlations between structural MR measurement: T1(ms) and creatinine(µmols), | T1 (ms) vs creatinine (µmols) | 3 years | 
| Correlations between structural diffusion weighted imaging and blinded renal biopsy measurements | Sirius red fibrosis scoring (%) Vs ADC and D (ms) | 3 years | 
| Correlations between structural MR measurement: diffusion weighted imaging and eGFR mls/min.1.73m | ADC and D (ms) vs eGFR mls/min.1.73m | 3 years |