# Shear wave elastography as a reliable tool in the prediction of renal histopathological abnormalities

## TL;DR

This study shows that shear wave elastography can non-invasively predict kidney damage and function in chronic kidney disease patients.

## Contribution

The study demonstrates the diagnostic value of SSI elastography for predicting renal histopathological changes.

## Key findings

- Right kidney stiffness correlated with age, eGFR, and interstitial fibrosis in non-lupus nephritis cases.
- An SSI cutoff of 6.9 kPa predicted eGFR < 30 mL/min/1.73 m² with 71% sensitivity and 79% specificity.
- SSI elastography showed potential as a non-invasive alternative to renal biopsy for assessing kidney health.

## Abstract

Chronic kidney disease (CKD) is a global health burden with irreversible progression and cardiovascular risk. Renal biopsy, while the gold standard for assessing kidney pathology, is invasive. Supersonic shear imaging (SSI) elastography is a promising non-invasive tool for quantifying tissue stiffness, potentially reflecting underlying fibrosis. This study aimed to assess the diagnostic value of SSI elastography for predicting renal histopathological abnormalities based on tissue stiffness and to evaluate its correlation with biopsy findings.

This cross-sectional study included 51 adult patients undergoing native kidney biopsy at Mansoura University Hospitals. All patients underwent SSI elastography before biopsy. Renal stiffness was measured in kilopascals in both kidneys. Histopathological findings, including interstitial fibrosis, tubular atrophy, and glomerulosclerosis, were correlated with elastographic data.

Median right and left kidney stiffness were 7 (5.6–8.5) and 7.7 (6.8–10) kPa, respectively. Right kidney stiffness showed significant correlations with age (r = -0.28, p = 0.04) and eGFR (r = 0.288, p = 0.04). In non-lupus nephritis cases, right kidney stiffness correlated negatively with serum creatinine (r = -0.409, p = 0.02) and interstitial fibrosis (r = -0.377, p = 0.03), and positively with eGFR (r = 0.438, p = 0.01). ROC analysis yielded an AUC of 0.706 (p = 0.05) for predicting eGFR < 30 mL/min/1.73 m², with a cutoff of 6.9 kPa (sensitivity 71%, specificity 79%).

Supersonic shear wave elastography (SWE) is a promising non-invasive modality for predicting renal histopathological changes and assessing kidney function in CKD patients.

The online version contains supplementary material available at 10.1186/s12880-025-02137-7.