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Background: Multiparametric MRI provides assessment of functional and structural parameters in kidney allografts. It offers a non‐invasive alternative to the current reference standard of kidney biopsy. Purpose: To evaluate the diagnostic and prognostic utility of MRI parameters in the assessment of allograft function in the first 3‐months post‐transplantation. Study Type: Prospective. Subjects: 32 transplant recipients (54 ± 17 years, 20 females), divided into two groups according to estimated glomerular filtration rate (eGFR) at 3‐months post‐transplantation: inferior graft function (IGF; eGFR<45 mL/min/1.73 m2, n = 10) and superior graft function (SGF; eGFR ≥ 45 mL/min/1.73 m2, n = 22). Further categorization was based on the need for hemodialysis (C1) and decrease in s‐creatinine (C2) at 1‐week post‐transplantation: delayed‐graft‐function (DGF: n = 4 C1, n = 10 C2) and early graft‐function (EGF: n = 28 C1, n = 22 C2). Field Strength/Sequence: 3‐T, pseudo‐continuous arterial spin labeling, T1‐mapping, and diffusion‐weighted imaging. Assessment: Multiparametric MRI was evaluated at 1‐week in all patients and 3‐months after transplantation in 28 patients. Renal blood flow (RBF), diffusion coefficients (ADC, ΔADC, D, ∆D, D*, flowing fraction f), T1 and ∆T1 were calculated in cortex and medulla. The diagnostic and prognostic value of these parameters, obtained at 3‐months and 1‐week post‐transplantation, respectively, was evaluated in the cortex to discriminate between DGF and EGF, and between SGF and IGF. Statistical Tests: Logistic regression, receiver‐operating‐characteristics, area‐under‐the‐curve (AUC), confidence intervals (CIs), analysis‐of‐variance, t‐test, Wilcoxon‐Mann–Whitney test, Fisher's exact test, Pearson's correlation. P‐value<0.05 was considered significant. Results: DGF patients exhibited significantly lower cortical RBF and f and higher D*. The diagnostic value of MRI for detecting DGF was excellent (AUC = 100%). Significant differences between patients with IGF and SGF were found in RBF, ∆T1, and ∆D. Multiparametric MRI showed higher diagnostic (AUC = 95.32%; CI: 88%–100%) and prognostic (AUC = 97.47%, CI: 92%–100%) values for detecting IGF than eGFR (AUC = 89.50%, CI: 79%–100%). Data Conclusion: Multiparametric MRI may show high diagnostic and prognostic value in transplanted patients, yielding better results compared to eGFR measurements. Level of Evidence: 2 Technical Efficacy: Stage 1 [ABSTRACT FROM AUTHOR]

Background: Matrix metalloproteinase-10 (MMP-10) levels increase progressively starting from early diabetic kidney disease (DKD) stages. Vitamin D3 (vitD3) deficit is associated with a higher risk of diabetic microangiopathy. Reduced MMP-10 expression has been observed after exposure to vitD3. Aim: to assess how vitD3 status is related to MMP-10 levels in patients with Type 2 diabetes (T2D). Methods: 256 patients with T2D were included in this cross-sectional study. Demographic, clinical and serum MMP-10 and 25-hydroxyvitamin D3 (25(OH)D3) levels were collected from each patient. The association between MMP-10 and (25(OH)D3) levels was assessed using a correlation analysis and fitting a multivariate linear regression model. Results: Serum MMP-10 levels were inversely correlated with circulating 25(OH)D3 (rho = −0.25; p < 0.001). In the subgroup analysis this correlation was significant in patients with DKD (rho = −0.28; p = 0.001) and in subjects with vitD3 deficit (rho = −0.24; p = 0.005). In the regression model adjusted for kidney function, body adiposity, smoking and vitD supplementation MMP-10 levels were 68.7 pg/mL lower in patients with 25(OH)D3 > 20 ng/mL, with respect to ≤20 ng/mL (p = 0.006). Conclusions: vitD3 repletion status is an independent predictor of MMP-10 levels in T2D patients. Perhaps, high 25(OH)D3 values should be targeted in these patients in order to prevent vascular complications. [ABSTRACT FROM AUTHOR]

Around the world diabetic kidney disease (DKD) is the main cause of chronic kidney disease (CKD), which is characterized by mesangial expansion, glomerulosclerosis, tubular atrophy, and interstitial fibrosis. The hallmark of the pathogenesis of DKD is an increased extracellular matrix (ECM) accumulation causing thickening of the glomerular and tubular basement membranes, mesangial expansion, sclerosis, and tubulointerstitial fibrosis. The matrix metalloproteases (MMPs) family are composed of zinc-dependent enzymes involved in the degradation and hydrolysis of ECM components. Several MMPs are expressed in the kidney; nephron compartments, vasculature and connective tissue. Given their important role in DKD, several studies have been performed in patients with DKD proposing that the measurement of their activity in serum or in urine may become in the future markers of early DKD. Studies from diabetic nephropathy experimental models suggest that a balance between MMPs levels and their inhibitors is needed to maintain renal homeostasis. This review focuses in the importance of the MMPs within the kidney and their modifications at the circulation, kidney and urine in patients with DKD. We also cover the most important studies performed in experimental models of diabetes in terms of MMPs levels, renal expression and its down-regulation effect., Competing Interests: MJS reports conflicts with interest with NovoNordisk, Janssen, Boehringer, Eli Lilly, AstraZeneca, and Esteve. NGF reports conflicts with interest with Boehringer.

Chronic kidney disease (CKD) is widely prevalent worldwide, with a special impact on elderly population. Around half of people aged over 75 meet diagnostic criteria for CKD according to the recent 'Kidney disease improving global outcomes' (KDIGO) 2012 clinical practice guideline on the evaluation and management of CKD. However, geriatric patients have characteristics that may not be addressed by general guidelines. Therefore, it is important to know the natural history of the disease, symptoms, and 'red-flags' that could help in the management of these patients. In this review, a complete approach is presented on the pathophysiology, diagnosis, and treatment of CKD in the geriatric population., (Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)