Kidney tissue characterization using magnetic resonance in HIV infected individuals undergoing kidney biopsy

Banda, Tayanjana

Kidney tissue characterization using magnetic resonance in HIV infected individuals undergoing kidney biopsy

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

BACKGROUND: Kidney disease is a common complication of human immunodeficiency virus (HIV) infection. Kidney biopsy is the gold standard for assessing causation, but being invasive, it carries increased risk in advanced chronic kidney disease (CKD). Magnetic resonance imaging (MRI) is noninvasive and may serve as an alternative to kidney biopsy in a subset of patients. OBJECTIVES: The primary aim of this study was to compare the kidney biopsy Sethi chronicity score and MRI findings. METHODS: This was a prospective pilot study, conducted at Groote Schuur Hospital, Cape Town and the Cape Universities Body Imaging Centre (CUBIC). People with HIV (PWH) >18 years with a clinical indication for kidney biopsy were included. Demographics and other clinical data were documented. Uncontrasted MRI scans were performed between 1-7 days prior to kidney biopsy that included diffusion tensor imaging (DTI), and proton (H1) spectroscopy. The kidney biopsy Sethi chronicity score was compared to MRI-DTI using linear regression modeling as well as with H1 spectroscopy. RESULTS: Sixteen participants were included in the study. Thirty-one percent were female, 47% hypertensive, 6% diabetic, 44% had current tuberculosis, and 56 % were receiving antiretroviral therapy {ART). The most common histology observed on kidney biopsy were granulomatous interstitial nephritis (31%}, hypertensive changes (31%) and HIV associated nephropathy (HIVAN) (25%). Mixed pathology was observed in 25% of participants. There was significant negative correlation with Sethi chronicity score and MRI-DTI findings. Spectroscopy showed an element of cell degradation and inflammation in all participants with highest lipid peaks in participants with HIVAN, and pauci-immune crescentic glomeru!onephritis. CONCLUSION: In this small pilot study Sethi chronicity scores negatively correlated with MRI-DTI findings suggesting that this may potentially be a useful tool to assess chronicity. Further research ls required to corroborate these findings and include BOLD sequence and Tl and T2 parametric mapping.

Keywords

Medicine

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