Understanding the value of magnetic resonance imaging (MRI) in Diabetic Kidney Disease (DKD)

As a collaboration between Barts Health NHS Trust, Royal Free London NHS trust, AstraZeneca and Antaros Medical the HEROIC study is designed to identify drivers of DKD. In this study, non-invasive MRI biomarkers are being evaluated longitudinally in parallel with histological and biological measures of DKD to provide insights on markers for diagnosis, prognosis and treatment. The recent paper “HEROIC: a 5-year observational cohort study aimed at identifying novel factors that drive diabetic kidney disease: rationale and study protocol” (BMJ Open 2020) presents the overall design and rationale of the HEROIC study.

Today, Chronic Kidney Disease (CKD) affects around 10% of the world’s population. Diabetes Mellitus (DM) is one of the leading causes of CKD, where around 30-40% of DM patients develop DKD. In its most advanced stage, DKD requires renal replacement therapy (dialysis or kidney transplant) imposing a high burden on both healthcare and the quality of life of patients. With the global increase of DM, the burden of DKD is expected to continue to grow.

Currently used biomarkers for DKD allows estimation of kidney function, but biopsy is necessary to understand disease aetiology. Recent advances in the CKD and DKD field has allowed that treatments for these patients are now on the way. However, there is a huge need to find new, non-invasive biomarkers to guide the further development of drugs in this area. MRI has great potential to non-invasively assess functional and morphologic, including fibrotic, changes in the kidney that may improve diagnosis, prognosis, and treatment monitoring in patients with DKD.

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