Renal MRI and ultrasound biomarkers predict kidney failure independently of eGFR

MRI and ultrasound biomarkers—cortical R2*, apparent diffusion coefficient (ADC), arterial spin labeling (ASL), and shear-wave elastography (SWE)—predict kidney failure progression independently of eGFR, revealing damage before lab changes.

• Imaging detects chronic kidney disease in autosomal dominant polycystic kidney disease decades before eGFR decline, enabling early therapy.
• AI-augmented radiomics, photoacoustic oxygen mapping, and H-scan ultrasound show promise for early detection of graft fibrosis in kidney transplantation.
• Most quantitative kidney imaging methods lack standardized protocols and comprehensive validation, limiting current clinical integration.

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