الفهرس 
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Abstract
chronic kidney disease (CKD) is a common global public health problem and the average incidence of end-stage renal disease in developing countries is 150 per million populations, which is lower than that in the developed world.
Since renal parenchymal disease is accompanied by renal dysfunction, monitoring renal function permits assessment of disease progression, and periodic assessment of renal function is necessary for optimal management of a patient with suspected/proven renal disease.
Serum creatinine (SCr), blood urea (BU), and estimated glomerular filtration rate (eGFR) derived from creatinine clearance are useful for monitoring renal function; however, these indirect measures of renal filtration are imperfect and cannot assess for early reversible renal damage and cannot be used to measure split renal function, i.e. function of each kidney separately.
The advantages of DW-MRI as indicator of renal function include short time of acquisition, non-invasive nature, and no exposure to ionizing radiation/contrast material, whereas the drawbacks include availability and cost.
The study included renal DWI-MRI at the period from April 2015 to March 2016 for 20 patients (9 males and 11 females ranging in age from 19 to 70 years) complaining from diabetic nephropathy of different stages. Twenty volunteers (10 male, 10 female; age range, 22–50 years) without diabetes mellitus or any renal diseases were enrolled as the control group.
All patients underwent MRI in supine position. Axial diffusion-weighted sequence at b-values of 0 and 500 s/mm2 was done. Regions of interest (ROIs) for quantitative measurement of ADC were placed on a commercial workstation by a single radiologist.
In this study the mean ADC value of renal parenchyma in patients with renal dysfunction was significantly lower than in patients with normal renal function. cut-off ADC of (2.3 (×10−3 mm2/s) may serve as an additional marker for identifying renal dysfunction. A significant inverse correlation was found between ADC values of renal parenchyma and SCr/BU levels. Also, a significant linear correlation was found between renal parenchymal ADC values and eGFR. ADC values showed a statistically significant decreasing trend with increasing stage of CKD.
ADC values may be employed to estimate and monitor the degree of renal dysfunction allowing non-invasive monitoring of parenchymal disease progression.
ADC values may serve as an additional paradigm to identify and estimate the degree of renal dysfunction. This may be especially useful in patients undergoing DW-MRI for other purposes (where it may lead to incidental detection of renal dysfunction) as well as in established CKD patients to monitor disease progression. Assessment of renal dysfunction by DWI may help guide the decision to inject a gadolinium-based contrast into patients not previously known to have renal disease.
Population and protocol-based cut-off ADC values may be established to identify renal dysfunction and distinguish between different stages of CKD, and comparison with the baseline ADC values may enable detection of disease worsening/improvement.
It must be borne in mind that DW-MRI is in no way a substitute to serum markers or renal scintigraphy for assessment of renal dysfunction; rather it is an additional tool, incorporation of which within existing MRI protocols provides additional functional information with minimal increase in imaging time. This functional information provided by DWI, along with morphological information.