Background/Aims: Changes in renal oxygenation and perfusion have been identified as common pathways to the development and progression of renal disease. Recently, the sensitivity of hemodynamic response imaging (HRI) was demonstrated; this is a functional magnetic resonance imaging (MRI) method combined with transient hypercapnia and hyperoxia for the evaluation of renal perfusion and vascular reactivity. The aim of this study was to utilize HRI for the noninvasive evaluation of changes in renal hemodynamics and morphology during acute, chronic and acute-on-chronic renal failures. Methods: Renal-HRI maps and true fast imaging with steady-state precession (True-FISP) images were used to evaluate renal perfusion, morphology and corticomedullary differentiation (CMD). MR images were acquired on two mouse models of kidney injury: adenine-induced chronic kidney disease (CKD) and rhabdomyolysis-induced acute kidney injury (AKI). Serum urea was measured from these mice in order to determine renal function. Results: Renal-HRI maps revealed a blunted response to hypercapnia and hyperoxia with evolving kidney dysfunction in both models, reflecting hampered renal vascular reactivity and perfusion. True-FISP images showed a high sensitivity to renal morphological changes, with different patterns characterizing each model. Calculated data obtained from HRI and True-FISP during the evolution of renal failure and upon recovery, with and without protective intervention, closely correlated with the degree of renal impairment. Conclusions: This study suggests the potential combined usage of two noninvasive MRI methods, HRI and True-FISP, for the assessment of renal dysfunction without the potential risk associated with contrast-agents administration. HRI may also serve as a research tool in experimental settings, revealing the hemodynamic changes associated with kidney dysfunction.

Dirkes S: Acute kidney injury: not just acute renal failure anymore? Crit Care Nurse 2011;31:37-49; quiz 50.
Hilton R: Acute renal failure. BMJ 2006;333:786-790.
Hsu CY, Ordonez JD, Chertow GM, Fan D, McCulloch CE, Go AS: The risk of acute renal failure in patients with chronic kidney disease. Kidney Int 2008;74:101-107.
Singh P, Ricksten SE, Bragadottir G, Redfors B, Nordquist L: Renal oxygenation and haemodynamics in acute kidney injury and chronic kidney disease. Clin Exp Pharmacol Physiol 2013;40:138-147.
Evans RG, Ince C, Joles JA, Smith DW, May CN, O'Connor PM, Gardiner BS: Haemodynamic influences on kidney oxygenation: clinical implications of integrative physiology. Clin Exp Pharmacol Physiol 2013;40:106-122.
European Society of Urogenital Radiology: Guidelines on contrast media 2009, version 7.0.
Poff JA, Hecht EM, Ramchandani P: Renal imaging in patients with renal impairment. Curr Urol Rep 2011;12:24-33.
Tan H, Koktzoglou I, Glielmi C, Galizia M, Edelman RR: Optimization of single shot 3D breath-hold non-enhanced MR angiography of the renal arteries. J Cardiovasc Magn Reson 2012;14:30.
Cutajar M, Thomas DL, Banks T, Clark CA, Golay X, Gordon I: Repeatability of renal arterial spin labelling MRI in healthy subjects. MAGMA 2012;25:145-153.
Li LP, Halter S, Prasad PV: Blood oxygen level-dependent MR imaging of the kidneys. Magn Reson Imaging Clin N Am 2008;16:613-625.
Prasad PV: Functional MRI of the kidney: tools for translational studies of pathophysiology of renal disease. Am J Physiol Renal Physiol 2006;290:F958-F974.
Chandarana H, Lee VS: Renal functional MRI: Are we ready for clinical application? AJR Am J Roentgenol 2009;192:1550-1557.
Hofmann L, Simon-Zoula S, Nowak A, Giger A, Vock P, Boesch C, Frey FJ, Vogt B: BOLD-MRI for the assessment of renal oxygenation in humans: acute effect of nephrotoxic xenobiotics. Kidney Int 2006;70:144-150.
Milman Z, Heyman SN, Corchia N, Edrei Y, Axelrod JH, Rosenberger C, Tsarfati G, Abramovitch R: Hemodynamic response magnetic resonance imaging: application for renal hemodynamic characterization. Nephrol Dial Transplant 2013;28:1150-1156.
Barash H, Gross E, Matot I, Edrei Y, Tsarfaty G, Spira G, Vlodavsky I, Galun E, Abramovitch R: Functional MR imaging during hypercapnia and hyperoxia: noninvasive tool for monitoring changes in liver perfusion and hemodynamics in a rat model. Radiology 2007;243:727-735.
Beland MD, Walle NL, Machan JT, Cronan JJ: Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol 2010;195:W146-W149.
Lee VS, Kaur M, Bokacheva L, Chen Q, Rusinek H, Thakur R, Moses D, Nazzaro C, Kramer EL: What causes diminished corticomedullary differentiation in renal insufficiency? J Magn Reson Imaging 2007;25:790-795.
Scheffler K, Lehnhardt S: Principles and applications of balanced SSFP techniques. Eur Radiol 2003;13:2409-2418.
Morita S, Masukawa A, Suzuki K, Hirata M, Kojima S, Ueno E: Unenhanced MR angiography: techniques and clinical applications in patients with chronic kidney disease. Radiographics 2011;31:E13-E33.
Kanki A, Ito K, Tamada T, Noda Y, Yamamoto A, Tanimoto D, Sato T, Higaki A: Corticomedullary differentiation of the kidney: evaluation with noncontrast-enhanced steady-state free precession (SSFP) MRI with time-spatial labeling inversion pulse (time-SLIP). J Magn Reson Imaging 2013;37:1178-1181.
Nechemia-Arbely Y, Barkan D, Pizov G, Shriki A, Rose-John S, Galun E, Axelrod JH: IL-6/IL-6R axis plays a critical role in acute kidney injury. J Am Soc Nephrol 2008;19:1106-1115.
Fischer M, Goldschmitt J, Peschel C, Brakenhoff JP, Kallen KJ, Wollmer A, Grotzinger J, Rose-John S: I. A bioactive designer cytokine for human hematopoietic progenitor cell expansion. Nat Biotechnol 1997;15:142-145.
Okada H: Reversibility of adenine induced renal failure in rats. Clin Exp Nephrol 1999;3:82-88.
Hewitson TD, Ono T, Becker GJ: Small animal models of kidney disease: a review. Methods Mol Biol 2009;466:41-57.
Tanaka T, Doi K, Maeda-Mamiya R, Negishi K, Portilla D, Sugaya T, Fujita T, Noiri E: Urinary L-type fatty acid-binding protein can reflect renal tubulointerstitial injury. Am J Pathol 2009;174:1203-1211.
Rosenberger C, Goldfarb M, Shina A, Bachmann S, Frei U, Eckardt KU, Schrader T, Rosen S, Heyman SN: Evidence for sustained renal hypoxia and transient hypoxia adaptation in experimental rhabdomyolysis-induced acute kidney injury. Nephrol Dial Transplant 2008;23:1135-1143.
Nangaku M: Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol 2006;17:17-25.
Nechemia-Arbely Y, Khamaisi M, Rosenberger C, Koesters R, Shina A, Geva C, Shriki A, Klaus S, Rosen S, Rose-John S, Galun E, Axelrod JH, Heyman SN: In vivo evidence suggesting reciprocal renal hypoxia-inducible factor-1 upregulation and signal transducer and activator of transcription 3 activation in response to hypoxic and non-hypoxic stimuli. Clin Exp Pharmacol Physiol 2013;40:262-272.
Abu-Tair L, Axelrod JH, Doron S, Ovadya Y, Krizhanovsky V, Galun E, Amer J, Safadi R: Natural killer cell-dependent anti-fibrotic pathway in liver injury via Toll-like receptor-9. PLoS One 2013;8:e82571.
Heyman SN, Rosenberger C, Rosen S: Experimental ischemia-reperfusion: biases and myths - the proximal vs. distal hypoxic tubular injury debate revisited. Kidney Int 2010;77:9-16.
Kettritz U, Semelka RC, Brown ED, Sharp TJ, Lawing WL, Colindres RE: MR findings in diffuse renal parenchymal disease. J Magn Reson Imaging 1996;6:136-144.
Chung JJ, Semelka RC, Martin DR: Acute renal failure: common occurrence of preservation of corticomedullary differentiation on MR images. Magn Reson Imaging 2001;19:789-793.
Dupas B, Buzelin MF, Karam G, Vasse N, Meflah K, Bach-Gansmo T: Contrast-enhanced MR imaging of experimental acute tubular necrosis. Acta Radiol 2001;42:74-79.
Liou JT, Lee JK, Heiken JP, Totty WG, Molina PL, Flye WM: Renal transplants: can acute rejection and acute tubular necrosis be differentiated with MR imaging? Radiology 1991;179:61-65.
Semelka RC, Corrigan K, Ascher SM, Brown JJ, Colindres RE: Renal corticomedullary differentiation: observation in patients with differing serum creatinine levels. Radiology 1994;190:149-152.
Inoue T, Kozawa E, Okada H, Inukai K, Watanabe S, Kikuta T, Watanabe Y, Takenaka T, Katayama S, Tanaka J, Suzuki H: Noninvasive evaluation of kidney hypoxia and fibrosis using magnetic resonance imaging. J Am Soc Nephrol 2011;22:1429-1434.
Semelka RC, Shoenut JP, Kroeker MA, MacMahon RG, Greenberg HM: Renal lesions: controlled comparison between CT and 1.5-T MR imaging with nonenhanced and gadolinium-enhanced fat-suppressed spin-echo and breath-hold FLASH techniques. Radiology 1992;182:425-430.
Goldfarb M, Rosenberger C, Abassi Z, Shina A, Zilbersat F, Eckardt KU, Rosen S, Heyman SN: Acute-on-chronic renal failure in the rat: functional compensation and hypoxia tolerance. Am J Nephrol 2006;26:22-33.
Lameire N: The pathophysiology of acute renal failure. Crit Care Clin 2005;21:197-210.
Endre ZH: Renal ischemic preconditioning: finally some good news for prevention of acute kidney injury. Kidney Int 2011;80:796-798.
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