 Good morning everyone. I'm Dr. Roshweta Jain, JR3, Department of Radio Diagnosis, Subharti Medical College. And today I'm going to be presenting my paper on the topic, Advanced Renal Care Assessment of Renal Failure by Shia V. Blastograppi. I would like to thank my co-authors, Dr. Mahesh Kumar Mittal Sir, Professor in HOD, Department of Radio Diagnosis, and Dr. Roly Jain, Senior Resident, Department of Medicine. Introduction. Chronic kidney disease assessment necessitates dependable markers, whether histological or biochemical. Reliable and consistent imaging assessment methods are crucial in addition to traditional markers. Various imaging modalities have been explored for quantifying renal perfusion, including contrast enhance ultrasound, ultra sensitive Doppler techniques, MRI, and CT. Blastograppi emerges as another imaging method with the potential to assess the properties of renal tissue. Blastograppi, an ultrasound-based technique, assesses tissue elasticity by measuring speed of shear waves generated into the tissue through an external stimulus. Commonly used for non-invasive assessment, Blastograppi has been applied in various medical contexts such as liver fibrosis, spleen stiffness, thyroid nodules, prostate lesions, focal liver lesions. Previous studies utilizing ARFI Blastograppi reported that kidney shear wave speed measurements in CKD are not so only influenced by fibrosis. Shear wave speed decreases with the progression of renal disease, exhibiting a pattern opposite to that of liver, where stiffness increases as liver disease progresses. Chronic kidney disease with diabetes mellitus as a primary cause affects 40% of CKD patients. This study aims to analyze the role of point shear wave in CKD patients and identify factors influencing kidney shear wave speed in these patients. Methodology. This study will be a retrospective case series enrolling patients diagnosed with renal failure and undergoing a routine ultrasound examination at our institution. The inclusion criteria will be informed consent, ages more than 18 years, confirmed diagnosis of renal failure based on EGFR, less than 60 ml per minute per 1.73 m2 for at least 3 months, availability of both, B mode and shear wave blastograppi data of the kidneys. Exclusion criteria will be uncontrolled diabetes and hypertension, presence of renal tumors or cysts, primary renal interventions like surgery or ablation and acute kidney injury. So ultrasonic graphic assessment, first we place the patients in lateral decubitus position, then we do the routine conventional ultrasound. In both kidneys we measure the bipolar length, the long diameter that is the maximum longitudinal and the kidney cortical thickness. Imaging focused on long axis view of kidneys, here we place the transducer panel, we apply no pressure, we instruct the patients to hold their breath, we stabilize image, we place the ROI in renal cortex and we exclude medulla and sinus, we measure shear wave blastograppi estimates of renal Young's modulus in KPA. And then we see the effective stiffness measurements, we measure five times at mid region of each kidney, shear wave travel perpendicular to radially arranged tubular system and then we record mean value for each kidney. Here is an example of the imaging and the shear wave blastograppi taken of the kidney in chronic kidney disease patient. We'll use a correlation calculation method that suggests Pearson's correlation coefficient to assess the relationship between these values. Let's calculate the correlation between EGFR and median stiffness values using this. Pearson's correlation coefficient, that is R, measures the renewal relationship between two variables. In this case, EGFR and median stiffness values, the coefficient ranges from minus one to one, where one indicates a perfect positive linear relationship and minus one indicates perfect negative linear relationship and zero indicates no linear relationship. So I have taken eight cases and then I've taken the EGFRs and the median stiffness. So the results in interpretation, according to Pearson's formula, the statistical calculation applied states that there is a strong negative correlation between X and Y values, that is X, the renewal stiffness and Y, EGFR, which means high X variable scores goes with low variable scores. Correlation between EGFR and median stiffness, the correlation analysis revealed a strong negative linear relationship between estimated low-marital filtration rate and median stiffness values measured by a shear wave blastograppi in the studied cases. The Pearson's correlation coefficient calculated between EGFR and median stiffness was minus 0.8693, that is the power equal to 0.05, indicating a statistically significant inverse correlation. The negative correlation coefficient suggests that as EGFR values increased, median stiffness tended to decrease. This relationship was statistically significant, suggesting that higher EGFR values were associated with lower median stiffness values among the examined cases. Conclusion. Investigation focused on EGFR and denial tissue stiffness by shear wave blastograppi in a case series. There was a strong negative correlation found as the EGFR dropped, denial tissue stiffness raised. Higher median stiffness values observed with declining renal function, significant inverse correlation underscores, shear wave blastograppi's potentials, clinical use, shear wave blastograppi could non-invasively assess renal tissue stiffness in varying renal impairments. Understanding EGFR stiffness linked AIDS and disease progression insights. It offers potential for improved clinical decisions in renal pathology management. Limitations. There were several limitations that should be considered when interpreting these findings. The study's small sample size, that is n is equal to 8, limits the generalizability of the result and calls for caution in extrapolating these findings to broader populations. Additionally, the study lacks diversity in terms of patient demographics, comorbidities and disease etiologies, which might impact the universality of the observed correlation. Furthermore, while the significant negative correlation between EGFR and median stiffness was established, causality cannot be inferred due to cross-sectional nature of the study. Longitudinal studies are warranted to elucidate the temporal relationship between changes in renal function and alterations in renal tissue stiffness over time. Finally, variations in the measurement technique or potential conforming factors not accounted for in this study might influence the observed correlation. Addressing these limitations through larger scale studies with diverse populations and comprehensive data collection methods would strengthen the validity and applicability of these findings. In chronic kidney disease is a global health concern with high incidence catalyzed by fibrosis, tubular interstitial atrophy, and glomerular compartment sclerosis. Histological examination through kidney myopsis is the current clinical method for evaluating renal fibrosis, but it is invasive with associated risks. Shearwave blastography is a non-invasive method that measures tissue stiffness and studies suggest a correlation between shearwave blastography and CKD or fibrosis presence. The study focuses on reviewing CKD diagnosis using shearwave blastography technique aiming to provide evidence for its future application. Median analysis and different studies reveal shearwave blastography sensitivity and specificity in assessing these tissues stiffness, indicating its potential value in evaluating chronic kidney fibrosis. Shearwave blastography demonstrates a strong correlation with EGFR, serum creatinine, and urea, supporting its diagnostic relevance. Limitations include the inability of shearwave blastography to accurately and quantitatively assess renal fibrosis, potentially leading to increased falls negatives and decreased falls positives. Studies show a positive correlation between kidney stiffness and CKD stage, emphasizing the need for extensive analysis and subgroup assessments in future research. Petrogenity in meta-analysis studies result may stem from different CKD staging, study designs, patient characteristics, and threshold variations among individuals. Here are the references that I have taken from different articles. Thank you so much.