ADPKD, Chronic Kidney Disease, Nephrolithiasis
Conditions
Keywords
cortico-medullary gradient
Brief summary
The corticomedullary gradient is largely responsible for developing the gradients that are needed to concentrate urine (more solutes and less water). The ability of the kidneys to produce concentrated urine is a major determinant of the ability to survive the warm weather. When temperatures are high, we lose water through sweat, and so the kidneys retain water to maintain fluidity in the blood. The maintenance of a sodium (salt) gradient is required for urine concentration because increased medullary sodium concentration increases the reabsorption of water into the kidney, to be redistributed in the blood. The purpose of this study is to know if the corticomedullary gradient is altered in patients across a wide spectrum of kidney disease using sodium Magnetic Resonance Imaging (MRI), a machine that takes pictures and measures the salt content in the kidneys. 23Na kidney MRI, will provide functional MR of the kidney as a non-invasive tool to describe medullary function to improve management of chronic and kidney disease.
Detailed description
This study is a pilot exploratory study (preliminary project to assess the use of a kidney sodium coil across a wide spectrum of kidney disease). Approximately 200 patients from the London Health Sciences Regional Renal Program will be recruited. This study involves two visits at Robarts Research Institute or St. Joseph's Hospital, London, Ontario depending on scanner availability, lasting approximately 2 hours. At the first study visit participants will undergo a sodium MRI scan of your kidneys. Prior to the scan, participants will have their sitting blood pressure and heart rate measured three times consecutively using a standard automatic blood pressure monitor. In addition to this, participants will be asked to provide a spot urine sample and have blood work done. If participants have been treated for nephrolithiasis, they will be responsible for completing a 24-hour urine volume test sometime the week before the MRI scan.
Interventions
DIAGNOSTIC_TESTSodium-23 MRI
Participants will lay in the MRI bed for approximately 60 minutes during scanning while the MRI technologist takes detailed pictures of their kidneys.
Sponsors
London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age ≥ 18 years * For healthy controls: lack of kidney disease, heart failure, liver cirrhosis and peripheral edema * For CKD stage 1-5: Estimated GFR \< 90 mL/min/1.73m² * For patients on maintenance hemodialysis or peritoneal dialysis: more than 3 months duration of therapy
Exclusion criteria
* Pregnant, breastfeeding or intending pregnancy * Contraindication to MRI * Inability to tolerate MRI due to patient size and/or known history of claustrophobia. * Mechanically implanted, electrically, or magnetically activated device or any metal in their body which cannot be removed, including but not limited to pacemakers, neurostimulators, biostimulators, implanted insulin pumps, aneurysm clips, bioprosthesis, artificial limb, metallic fragment or foreign body, tattoos, shunt, surgical staples (including clips or metallic sutures and/or ear implants.)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Exploratory cortico-medullary gradient measurement | Throughout study visit, on average 2 hours | Exploratory cortico-medullary gradient measurement in a large range of kidney disease by measuring sodium medullary to cortex ratio with23Na kidney MRI in: 1\) stage 1-5 CKD patients 2) transplanted patients 3) dialysis patients 4) ADPKD patients 5) nephrolithiasis patients (characteristically associated with salt loading) 6) healthy controls including kidney donors |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Renal Function | Throughout study visit, on average 2 hours | To evaluate the relationship between sodium medullary to cortex ratio and renal function |
| Native and transplanted kidney | Throughout study visit, on average 2 hours | To compare sodium medullary to cortex ratio between native kidney and transplanted kidney |
| Kidney biopsy | Throughout study visit, on average 2 hours | To compare sodium medullary to cortex ratio between transplanted kidney and kidney biopsy |
| Urinary osmolarity | Throughout study visit, on average 2 hours | To evaluate the relationship between sodium medullary to cortex ratio and urinary osmolarity |
| Nephrolithiasis | Throughout study visit, on average 2 hours | To compare sodium medullary to cortex ratio between healthy control and patients who have nephrolithiasis |
| ADPKD | Throughout study visit, on average 2 hours | To evaluate the ability to measure sodium medullary to cortex ratio in autosomal dominant polycystic kidney disease |
| Clinical practice | Throughout study visit, on average 2 hours | To determinate if measurement of sodium medullary to cortex ratio measurement is meaningful in clinical practice |
| Residual renal function | Throughout study visit, on average 2 hours | To evaluate sodium medullary to cortex ratio in dialysis patients and renal residual function |
Countries
Canada
Contacts
Primary ContactChristopher W McIntyre, MD
Backup ContactSandrine Lemoine, MD
Outcome results
None listed