Renal shear wave elastography distinguished vasculitic from non-vasculitic acute kidney injury with an AUC of 0.86 (95% CI 0.73-0.97) and an optimal threshold of 6.79 kPa.
Observational
Blinded to clinical information
Does renal shear wave elastography accurately differentiate vasculitic from non-vasculitic acute kidney injury?
Renal shear wave elastography is a promising noninvasive adjunctive tool for differentiating vasculitic from non-vasculitic acute kidney injury.
Effect estimate: AUC 0.86 (95% CI 0.73-0.97)
Absolute Event Rate: 9.5% vs 6.61%
p-value: p=<0.01
Background/Objectives: Early identification of vasculitic acute kidney injury (AKI) is crucial for timely immunosuppression and improved renal outcomes; however, noninvasive adjunctive diagnostic tools remain limited. Renal elastography, a noninvasive technique that quantifies renal cortical stiffness, has been primarily investigated in chronic kidney disease, whereas evidence in acute kidney injury is scarce. This study aimed to evaluate the diagnostic utility of renal shear wave elastography for differentiating vasculitic from non-vasculitic AKI and to explore the association between baseline renal cortical stiffness and vasculitic renal outcomes. Materials and Methods: This prospective observational study included three groups: vasculitic AKI, non-vasculitic AKI, and healthy controls. Renal cortical stiffness was measured at admission using two-dimensional shear-wave elastography (2D-SWE) by radiologists blinded to clinical information. After clinicopathological confirmation of definitive diagnoses, between-group comparisons were performed and the diagnostic performance of elastography was evaluated. Additionally, in a biopsy-confirmed immunoglobulin A vasculitis nephritis (IgAVN) cohort (n = 12), baseline elastography measurements were examined in relation to one-year renal outcomes to explore potential prognostic associations. Results: The vasculitic AKI group exhibited significantly higher mean renal cortical stiffness values (9.5 ± 1.9 kPa) compared with both healthy controls (5.53 ± 0.92 kPa) and the non-vasculitic AKI group (6.61 ± 1.89 kPa) (both p < 0.01). Mean renal cortical stiffness demonstrated good diagnostic performance for distinguishing vasculitic from non-vasculitic AKI (AUC 0.86, 95% CI 0.73–0.97), with an optimal threshold of 6.79 kPa yielding 91% sensitivity and 72% specificity. In the prospective one-year follow-up of the IgAVN subcohort (n = 12), patients with unfavorable renal outcomes tended to have higher baseline renal cortical stiffness compared with those with favorable outcomes median (min–max), 11.2 (10.8–13.3) vs. 9.1 (5.6–11.2), p = 0.046. Conclusions: These findings suggest that renal elastography may aid in distinguishing vasculitic from non-vasculitic acute kidney injury and may provide exploratory information on the relationship between baseline cortical stiffness and renal outcomes in IgAVN.
Yıldırım et al. (2026) conducted an observational in Acute kidney injury. Renal shear wave elastography vs. Non-vasculitic AKI and healthy controls was evaluated on Distinguishing vasculitic from non-vasculitic AKI (AUC 0.86, 95% CI 0.73-0.97, p=<0.01). Renal shear wave elastography distinguished vasculitic from non-vasculitic acute kidney injury with an AUC of 0.86 (95% CI 0.73-0.97) and an optimal threshold of 6.79 kPa.