Noninvasive assessment of pediatric glomerular disease: multimodal ultrasound

Background: Traditional 2-dimensional (2D) ultrasound is a noninvasive method in the assessment of glomerular disease. Ultrasound elastography shows promise in evaluating renal fibrosis, which plays a key role in glomerular disease progression. However, research in pediatric cohorts is limited. This study aimed to assess the diagnostic efficacy of multimodal ultrasound in pediatric patients with glomerular disease.

Methods: Pediatric patients undergoing kidney elasticity examination were recruited. Participants were categorized into a control group, nephritic group, and nephrotic group based on clinical presentation and pediatric nephrologist diagnosis. The nephritic group included cases with hematuria, proteinuria, kidney function impairment, and potentially edema or hypertension. The nephrotic group included cases with nephrotic syndrome. All participants underwent multimodal ultrasound of the right kidney to obtain 2D parameters, hemodynamic parameters, and elasticity values. Sound touch quantification (STQ) is a new shear wave elastography (SWE) technology that has been used in clinical applications in recent years. In this study, it was used to obtain kidney elasticity values. The diagnostic efficacy of multimodal ultrasound was evaluated through receiver operating characteristic (ROC) curve analysis. Logistic regression was further utilized to investigate the combined diagnostic efficacy of multiple parameters.

Results: This study included 154 females and 187 males with ages ranging from 4 to 16 years (mean age: 9.78±3.20 years). Cortical STQ and medullary STQ exhibited lower sensitivity but higher specificity. In logistic regression modeling, multimodal ultrasound showed good diagnostic performance. Between the nephritic group and the control group, the ROC curve yielded an area under the curve (AUC) of 0.71 [95% confidence interval (CI): 0.64-0.77]; sensitivity, 58.10%; specificity, 76.26% (P<0.01). Between the nephrotic group and the control group, the ROC curve yielded an AUC of 0.75 (95% CI: 0.69-0.82); sensitivity, 75.26%; specificity, 62.59% (P<0.01).

Conclusions: Ultrasound elastography demonstrates potential in detecting glomerular disease. Multimodal ultrasound can serve as a noninvasive approach for assessing glomerular disease, exhibiting good diagnostic performance.