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  • Clinical Research Article
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Shear-wave elastography in renal stiffness in children with hematuria and/or proteinuria

Pediatric Research volume 97, pages 678–686 (2025)Cite this article

Abstract

Background

We sought to evaluate renal stiffness in children with hematuria and/or proteinuria using shear wave elastography (SWE) and to investigate the clinical value of renal stiffness in children with hematuria and/or proteinuria.

Methods

According to the results of urinary occult blood and urinary protein tests, 349 pediatric patients were categorized into one of four groups: pure hematuria (HU), pure proteinuria (PU), concomitant hematuria and proteinuria (HUPU), or control (non-HUPU). Patient demographic data, laboratory test results, and renal ultrasound data were collected.

Results

There were significant differences in cortical/medullary elasticity among the four groups (the most sensitive cutoff value between HU and PU was 1.72) (P < 0.05). We found that hematuria and proteinuria interacted with renal cortical elasticity (P < 0.05) but that hematuria and proteinuria did not interact with renal medullary elasticity or cortical/medullary elasticity (P > 0.05). Renal elasticity values correlated with sex, age, body surface area, body mass index, qualitative urinary protein, urine N-acetyl-β-D-glucosaminidase, 24-hour urinary protein quantity, renal volume, and renal cortical thickness (P < 0.05).

Conclusions

SWE can be used to detect changes in renal stiffness in children with hematuria and/or proteinuria. SWE is beneficial for the early detection of glomerular disease in children with abnormal urine test results.

Impact

  • This study evaluated the utility of shear wave elastography for the assessment of renal elasticity in pediatric patients presenting with hematuria and/or proteinuria.

  • Children with pure proteinuria had significantly higher renal cortical/medullary elasticity values than those with pure hematuria.

  • An interaction effect between hematuria and proteinuria on renal cortical stiffness was observed.

  • Shear wave elastography can be used as a tool to assess early renal injury in children with urinalysis abnormalities.

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Fig. 1: Routine ultrasound and elasticity data were obtained for the right kidney.
Fig. 2: Ultrasound elastography in non-HUPU, HU, PU, and HUPU patients.
Fig. 3
Fig. 4: Relationships between renal elasticity and several variables.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to all staff members, doctors, and statistical consultants who were involved in this study.

Funding

This research was supported by the Wenzhou Science & Technology Bureau (Project No. Y20210223), and the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China (Grant No. LHDMY24H280003).

Author information

Author notes

  1. These authors contributed equally: Xingyu Chen, Xinxin Huang.

Authors and Affiliations

  1. Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Xingyu Chen, Xinxin Huang, Xiuyun Li, Ping Chi, Xiaoying Cui, Maosheng Xu, Liang Wang & Chunpeng Zou

  2. Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Yinghua Lin

  3. Key Laboratory of Pediatric Anesthesiology, Ministry of Education Wenzhou Medical University, Wenzhou, China

    Yinghua Lin

  4. Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, China

    Yinghua Lin

  5. Wenzhou Key Laboratory of Structural and Functional Imaging, Wenzhou, China

    Chunpeng Zou

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  1. Xingyu Chen
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Contributions

C.Z. and L.W. designed the study and M.X. collected and analysed the study data. X.L. and P.C. supervised the data collection and the conduct of the study. Y.L. and Xiaoying Cui provided statistical advice on study design and data collection. Xingyu Chen and X.H. wrote the original draft. All authors reviewed and edited. C.Z. takes responsibility for the paper as a whole.

Corresponding authors

Correspondence to Maosheng Xu, Liang Wang or Chunpeng Zou.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by the Medical Ethics Committee of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University (Approval No.: 2022-K-314-02).

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Chen, X., Huang, X., Li, X. et al. Shear-wave elastography in renal stiffness in children with hematuria and/or proteinuria. Pediatr Res 97, 678–686 (2025). https://doi.org/10.1038/s41390-024-03363-5

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