Kids Kidney Research

Kidney transplantation is the best form of kidney replacement therapy for children with end stage kidney failure.  Despite improvements in surgery for kidney transplantation, and medications used to prevent kidney transplant recipients rejecting the new kidney, damage is seen in over 95% of cases one year after transplant. Current blood tests are insensitive to early kidney damage, so pre-planned kidney biopsy following transplantation (protocol biopsy) is recommended to detect damage, despite recognised complications (bleeding) and limitations of biopsy.

Biopsy only samples a small part of the kidney; Magnetic Resonance Imaging (MRI) evaluates the entire kidney.  New techniques in MRI quantify how different parts of the kidney use oxygen (BOLD) and how water molecules within the kidney are affected by the body’s attempt to reject the transplanted kidney (Diffusion Tensor Imaging (DTI)).  The MRI is non invasive as these parameters do not require the injection of any contrast agent.

We believe that non-invasive functional MRI may provide sensitive markers of early damage of the transplanted kidney.  The principal objective is to establish the relationship between the new functional MRI measurements (BOLD & DTI) and biopsy findings of transplanted kidneys. If successful this may establish MRI as a non-invasive test of renal damage.  Sequential changes on MRI within transplanted kidneys will be analysed to see if, in each patient, the trend of these changes offers the possibility of understanding the sub-clinical disease pathway and how treatment may alter this trajectory

This project will study children undergoing renal transplantation at Great Ormond Street Hospital NHS Trust. Timed renal biopsy at 2 and 12 months will be undertaken post-transplantation; we propose MRI between 10-20 days and 2, 6, 9 and 12 months post-transplantation. The parent donor will undergo MRI prior to and following kidney removal, thus functional MRI from both the transplanted kidney and the parent’s remaining kidney will be recorded before and following transplantation.

If successful non-invasive MRI will be a new biomarker of renal function and may alter patient management by allowing timed renal biopsies.