Recipient organisationUniversity Hospitals of Derby and Burton NHS Foundation TrustSource-published name: University Hospitals of Derby and Burton NHS Foundation Trust
Funding£2.0M
PeriodSept 2020 — Feb 2027
In plain English
AI plain-English summary
A single multiparametric MRI scan could replace invasive kidney biopsies for millions of people with chronic kidney disease (CKD). The AFiRM study will test whether this non-invasive imaging technique can reliably measure kidney structure and function—including inflammation, fibrosis, oxygenation, and blood flow—in a single 45-minute session. This matters because CKD affects 10% of the global population, costs the NHS over £1.4 billion annually, and current imaging cannot distinguish between different types of kidney injury. Doctors often rely on biopsies, which carry bleeding risks and sample only a tiny fraction of the organ. The study will recruit 450 patients across nine UK centres, scan them at baseline and two years, then track kidney failure events via the UK Renal Registry for up to a decade. A sub-study of 45 patients will directly compare MRI results against tissue from routine biopsies. If successful, multiparametric renal MRI could transform how clinicians assess CKD progression, stratify patients for treatment, and test new drugs—enabling earlier detection of drug effects and reducing reliance on invasive procedures. The infrastructure built through the UKRIN-MAPS network makes this large-scale clinical validation possible for the first time.
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Research question: Can multiparametric renal MRI provide structural and functional assessment of the kidneys to deliver prognostic information and guide treatment options in chronic kidney disease (CKD)? Aims: 1. Establish a multiparametric renal MRI protocol in CKD cohorts 2. Use multiparametric MRI to characterise people with and without CKD progression 3. Compare multiparametric renal MRI with ‘gold-standard’ renal biopsy to determine pathological processes of CKD progression that are detectable by MRI Background: Global burden of kidney disease. 10% of the world’s population have CKD, which can progress to kidney failure, increases cardiovascular risk and costs the NHS >£1.4billion annually. Better imaging methods to determine cause and prognosis of kidney diseases are required for improved patient stratification and targeting of current treatments, to underpin new drug development and identify those most likely to respond to candidate therapeutics. What can MRI offer? Current imaging techniques for the kidney are limited and cannot determine type or extent of renal injury. Renal MRI has emerged as a versatile technique. Whole kidney structural and functional MRI measurements can be performed in a single multiparametric scan to assess multiple aspects of pathology that contribute to CKD progression, including altered tissue microstructure (inflammation/fibrosis), oxygenation and perfusion. Building on previous investment. In Sept 2018, the MRC Partnership grant UKRIN-MAPS commenced to develop UK-wide, harmonised renal MRI capability across all major research centres with centralised image upload and storage, analysis and quality assurance. We propose to exploit UKRIN-MAPS infrastructure to perform the first large-scale multicentre clinical study of functional renal MRI in people with CKD. Methods: Stage 1: 45 people with CKD from 9 UKRIN centres will undergo multiparametric MRI to test patient tolerance, data completeness and central data collection processes. Stage 2: A multicentre, prospective cohort study of 450 people with CKD, collecting multiparametric renal MRI at baseline and 2 years. Long-term outcomes will be determined with efficient tracking of kidney failure events via the UK Renal Registry at 5 and 10 years. Stage 3: A mechanistic sub-study of 45 patients (from Stage 2) who have had a routine renal biopsy. Detailed comparisons will be made between multiparametric MRI and histopathological changes. Tissue blocks will undergo quantitative analysis of fibrosis, capillary density and inflammation using immunohistochemistry techniques. Timelines: Sept 2020: Grant commences Aug 2021: Stage 1 complete, review Stop/Go criteria Sept 2021: Stage 2 and 3 commence Feb 2027: Last study visit complete Feb 2028/33: Outcomes via UK Renal Registry at 5 and 10 years Impact: This study will build on UK investments in renal MRI to generate robust, generalisable data that will advance the translation of renal MRI to clinical practice. Outputs will substantially broaden research activity, underpin improvements in patient care and lay foundations for industry collaborations. Multiparametric renal MRI has the potential to transform novel drug development to reduce CKD progression by identifying mechanisms of progression appropriate to the drug being tested, and measuring response earlier than currently possible. Dissemination: Will target clinicians, academia, industry, patients and the public.
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