Renal sonographic changes in heterogeneity index and echogenicity in children with hypertension: a novel assessment

The kidneys are thought to contribute to the pathogenesis of primary hypertension, but hypertension is also known to cause target organ damage in the kidney. Noninvasive methods to capture possible changes in the kidney related to hypertension are limited. A new program that has been used to quantify the heterogeneity and percent echogenicity in renal ultrasound images was implemented to assess patients with hypertension. Children and adolescents <21 years with primary hypertension diagnosed by ambulatory blood pressure monitoring were compared with normotensive age- and sex-matched controls. Renal ultrasound images were evaluated by a technique that measured pixels of gray-scale images and transformed them into a binary map, which was converted to a heterogeneity index (HI) and percent echogenicity score. This study included 99 children with hypertension and 99 control subjects. Body mass index (BMI) was greater in the hypertension group. Average HI for hypertension was significantly higher than in controls (1.37 ± 0.19 vs. 1.2 ± 0.23, P = .001), while echogenicity scores were not different (26.6 ± 8.9 vs. 25.9 ± 10, P = .8). In regression analysis adjusting for BMI z-score and race, hypertension was associated with greater HI compared with controls (β = 0.11, 95% confidence interval 0.03-0.18, P = .005). In a model adjusted for age, sex, and BMI z-score in the hypertension group only, no ambulatory blood pressure monitoring measures were associated with HI or echogenicity scores (P > .05).HI was significantly greater in the hypertension group compared with normotensive controls. HI may be a novel method to detect changes in the kidney related to hypertension.