The corticomedullary gradient is largely responsible for developing the gradients that are needed to concentrate urine (more solutes and less water). The ability of the kidneys to produce concentrated urine is a major determinant of the ability to survive the warm weather. When temperatures are high, we lose water through sweat, and so the kidneys retain water to maintain fluidity in the blood. The maintenance of a sodium (salt) gradient is required for urine concentration because increased medullary sodium concentration increases the reabsorption of water into the kidney, to be redistributed in the blood. The purpose of this study is to know if the corticomedullary gradient is altered in patients across a wide spectrum of kidney disease using sodium Magnetic Resonance Imaging (MRI), a machine that takes pictures and measures the salt content in the kidneys. 23Na kidney MRI, will provide functional MR of the kidney as a non-invasive tool to describe medullary function to improve management of chronic and kidney disease.
This study is a pilot exploratory study (preliminary project to assess the use of a kidney sodium coil across a wide spectrum of kidney disease). Approximately 200 patients from the London Health Sciences Regional Renal Program will be recruited. This study involves two visits at Robarts Research Institute or St. Joseph's Hospital, London, Ontario depending on scanner availability, lasting approximately 2 hours. At the first study visit participants will undergo a sodium MRI scan of your kidneys. Prior to the scan, participants will have their sitting blood pressure and heart rate measured three times consecutively using a standard automatic blood pressure monitor. In addition to this, participants will be asked to provide a spot urine sample and have blood work done. If participants have been treated for nephrolithiasis, they will be responsible for completing a 24-hour urine volume test sometime the week before the MRI scan.
Study Type
OBSERVATIONAL
Enrollment
200
Participants will lay in the MRI bed for approximately 60 minutes during scanning while the MRI technologist takes detailed pictures of their kidneys.
Victoria Hospital, London Health Sciences Centre
London, Ontario, Canada
RECRUITINGExploratory cortico-medullary gradient measurement
Exploratory cortico-medullary gradient measurement in a large range of kidney disease by measuring sodium medullary to cortex ratio with23Na kidney MRI in: 1\) stage 1-5 CKD patients 2) transplanted patients 3) dialysis patients 4) ADPKD patients 5) nephrolithiasis patients (characteristically associated with salt loading) 6) healthy controls including kidney donors
Time frame: Throughout study visit, on average 2 hours
Urinary osmolarity
To evaluate the relationship between sodium medullary to cortex ratio and urinary osmolarity
Time frame: Throughout study visit, on average 2 hours
Renal Function
To evaluate the relationship between sodium medullary to cortex ratio and renal function
Time frame: Throughout study visit, on average 2 hours
Native and transplanted kidney
To compare sodium medullary to cortex ratio between native kidney and transplanted kidney
Time frame: Throughout study visit, on average 2 hours
Kidney biopsy
To compare sodium medullary to cortex ratio between transplanted kidney and kidney biopsy
Time frame: Throughout study visit, on average 2 hours
Residual renal function
To evaluate sodium medullary to cortex ratio in dialysis patients and renal residual function
Time frame: Throughout study visit, on average 2 hours
Nephrolithiasis
To compare sodium medullary to cortex ratio between healthy control and patients who have nephrolithiasis
Time frame: Throughout study visit, on average 2 hours
ADPKD
To evaluate the ability to measure sodium medullary to cortex ratio in autosomal dominant polycystic kidney disease
Time frame: Throughout study visit, on average 2 hours
Clinical practice
To determinate if measurement of sodium medullary to cortex ratio measurement is meaningful in clinical practice
Time frame: Throughout study visit, on average 2 hours
Sandrine Lemoine, MD
CONTACT
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