MRI Technical Development and Applications in Kidney Disease
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cognitive Studies, Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 4/21/2016 |
| Start Date: | April 2015 |
| End Date: | May 2020 |
Magnetic resonance imaging (MRI), as a non-invasive and non-contrast enhanced technique, has
the potential to improve patient health care and management. The overall objective of
proposed project is to:
1. develop, customize, and optimize anatomic and functional MRI methods,
2. explore the use of MRI methods to study CKD and evaluate post-transplant kidneys, and
3. investigate the potential of MRI in the diagnosis, prognosis, and monitoring of the
progression of renal dysfunction.
In addition to direct studies of the kidney, brain MRI studies will also be performed to
identify the cerebrovascular and cognitive effects of chronic renal function deficiency and
medical treatment (e.g. hemodialysis and immunosuppression). The brain and kidneys have
similar vascular bed, and both are susceptible to vascular injury, which provides the
pathological basis for the widely recognized association of reduced renal function with
prevalent cerebrovascular diseases (CVDs) and cognitive impairment (CI). The MRI methods in
the brain will be applied to explore the origins for widely observed CVDs and prevalent
cognitive impairment (CI) in kidney disease patients.
the potential to improve patient health care and management. The overall objective of
proposed project is to:
1. develop, customize, and optimize anatomic and functional MRI methods,
2. explore the use of MRI methods to study CKD and evaluate post-transplant kidneys, and
3. investigate the potential of MRI in the diagnosis, prognosis, and monitoring of the
progression of renal dysfunction.
In addition to direct studies of the kidney, brain MRI studies will also be performed to
identify the cerebrovascular and cognitive effects of chronic renal function deficiency and
medical treatment (e.g. hemodialysis and immunosuppression). The brain and kidneys have
similar vascular bed, and both are susceptible to vascular injury, which provides the
pathological basis for the widely recognized association of reduced renal function with
prevalent cerebrovascular diseases (CVDs) and cognitive impairment (CI). The MRI methods in
the brain will be applied to explore the origins for widely observed CVDs and prevalent
cognitive impairment (CI) in kidney disease patients.
Specific Aims
The overall objective is to develop and validate MRI methods for the evaluation and
monitoring of renal status and associated cerebrovascular effects of renal dysfunction and
treatment. The proposed project include two phases: 1) MRI technical development and
validation with reproducibility studies; 2) clinical pilot studies with two patient
populations (CKD patients and renal transplant recipients) to explore the potential of MRI
in evaluating CKD, post-transplantation renal dysfunction and cerebrovascular
pathophysiology associated with or induced by reduced kidney function and renal replacement
treatment. The ultimate goal is to use MRI as a non-invasive and non-contrast enhanced tool
to facilitate the diagnosis and prognosis of renal dysfunction and associated diseases, and
to assess the efficacy of therapeutic interventions, and monitor disease progress across
time.
Specific Aim 1: Imaging technical development and protocol optimization for renal and
cerebral MRI.
The overall goal is to develop, customize and optimize new MRI methods to overcome
challenges due to physiological motions and facilitate clinical research studies of renal
and cerebral diseases, which will include but not are limited to the following aspects.
Sub-Aim 1.1: Develop imaging methods to improve MRI quality and efficiency for renal disease
studies.
Sub-Aim 1.2: Optimize gas-challenge functional MRI protocols to study cerebral and renal
vascular endothelial dysfunction.
Sub-Aim 1.3: Evaluate the reproducibility of cerebral and renal MRI methods.
Specific Aim 2: Perform pilot studies to evaluate the potential of MRI in CKD patients and
renal transplant recipients.
Sub-Aim 2.1: Evaluate the correspondence of MRI measures with clinical metrics (i.e. eGFR)
and routinely assessed cognitive functions from CKD and ESRD patients.
This will be accomplished by performing both cross-sectional and longitudinal studies, which
will allow us to evaluate the diagnostic and prognostic potential of these non-invasive
imaging methods. The investigators hypothesize that the measurements from cerebral and/or
renal MRI can effectively reflect cerebral and/or renal (anatomic and physiological) changes
induced by CKD or dialysis treatment.
Sub-Aim 2.2: Investigate the potential of MRI methods in the evaluation of post-transplant
kidneys.
This will be accomplished by imaging transplant recipients in three distinct cohorts; those
with good allograft function but coming in for routine protocol biopsy, with stable renal
function, and with unstable renal function due to post-transplant complications. These
patient populations will receive protocol biopsies (i.e. scheduled repeat biopsies) as
standard of care; therefore pathologic results will be available for correlation with MRI
measures. The investigators hypothesize that MRI methods can be a non-invasive surrogate
marker of renal tissue properties and functional changes induced by renal post-transplant
dysfunction (e.g. renal rejection) currently only obtained through biopsy.
The overall objective is to develop and validate MRI methods for the evaluation and
monitoring of renal status and associated cerebrovascular effects of renal dysfunction and
treatment. The proposed project include two phases: 1) MRI technical development and
validation with reproducibility studies; 2) clinical pilot studies with two patient
populations (CKD patients and renal transplant recipients) to explore the potential of MRI
in evaluating CKD, post-transplantation renal dysfunction and cerebrovascular
pathophysiology associated with or induced by reduced kidney function and renal replacement
treatment. The ultimate goal is to use MRI as a non-invasive and non-contrast enhanced tool
to facilitate the diagnosis and prognosis of renal dysfunction and associated diseases, and
to assess the efficacy of therapeutic interventions, and monitor disease progress across
time.
Specific Aim 1: Imaging technical development and protocol optimization for renal and
cerebral MRI.
The overall goal is to develop, customize and optimize new MRI methods to overcome
challenges due to physiological motions and facilitate clinical research studies of renal
and cerebral diseases, which will include but not are limited to the following aspects.
Sub-Aim 1.1: Develop imaging methods to improve MRI quality and efficiency for renal disease
studies.
Sub-Aim 1.2: Optimize gas-challenge functional MRI protocols to study cerebral and renal
vascular endothelial dysfunction.
Sub-Aim 1.3: Evaluate the reproducibility of cerebral and renal MRI methods.
Specific Aim 2: Perform pilot studies to evaluate the potential of MRI in CKD patients and
renal transplant recipients.
Sub-Aim 2.1: Evaluate the correspondence of MRI measures with clinical metrics (i.e. eGFR)
and routinely assessed cognitive functions from CKD and ESRD patients.
This will be accomplished by performing both cross-sectional and longitudinal studies, which
will allow us to evaluate the diagnostic and prognostic potential of these non-invasive
imaging methods. The investigators hypothesize that the measurements from cerebral and/or
renal MRI can effectively reflect cerebral and/or renal (anatomic and physiological) changes
induced by CKD or dialysis treatment.
Sub-Aim 2.2: Investigate the potential of MRI methods in the evaluation of post-transplant
kidneys.
This will be accomplished by imaging transplant recipients in three distinct cohorts; those
with good allograft function but coming in for routine protocol biopsy, with stable renal
function, and with unstable renal function due to post-transplant complications. These
patient populations will receive protocol biopsies (i.e. scheduled repeat biopsies) as
standard of care; therefore pathologic results will be available for correlation with MRI
measures. The investigators hypothesize that MRI methods can be a non-invasive surrogate
marker of renal tissue properties and functional changes induced by renal post-transplant
dysfunction (e.g. renal rejection) currently only obtained through biopsy.
For Specific Aim 1: MRI Technical Development Studies
Inclusion Criteria:
1. Healthy Volunteer
Exclusion Criteria:
1. Ferromagnetic implants
2. Any foreign metal objects in the body
3. History of shrapnel or shot gun injury
4. Cardiac pacemakers
5. Defibrillator
6. Neuronal stimulator
7. Magnetic aneurysm clip
8. Large tattoos on the abdomen or the brain and neck
9. Hip replacement
10. Too large to fit in the magnet (body mass index >= 40, approx.)
11. Severe claustrophobia
12. Women with pregnancy
For Specific Aim 2: Pilot Studies with Patients
Studies for CKD
Inclusion
1. English- speaking as primary language.
2. Age 45 years and older
3. Able to complete an approximately 90 minute cognitive testing battery.
4. Able to sign the informed consent, or allow a caregiver, relative, surrogate, or
witness to sign the informed consent if participant is unable to do so.
5. GFR < 90 ml/min/1.73m2
Exclusion
1. Acute psychiatric illness that would impede cognitive testing
2. Active chemical dependence, such as alcohol, narcotics or other drugs
3. Legally blind or unable to complete cognitive tests due to visual loss or deafness
4. Dialysis dependent or renal transplant recipient at time of screening or baseline
5. Chronic obstructive pulmonary disease
6. Severe CI unable to complete the Modified Mini-Mental State Examination [3MSE]
Studies for Renal Transplantation
Inclusion
1. Able to sign the informed consent, or allow a caregiver, relative, surrogate, or
witness to sign the informed consent if participant is unable to do so.
2. Age 45 years and older
Exclusion
1. Not on dialysis due to allograft failure
2. Chronic obstructive pulmonary disease
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