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

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