 Good morning, everybody. I am Dr. Chaitanya Kiste, a junior resident from Topiwala National Medical College in Nair Hospital, Mumbai, and the topic for my paper presentation is shear wave elastography in patients with chronic kidney disease. So, I will start with the aim, the introduction, the methods that I have used, the results and followed by the discussion. So, the aim of my study is to explore the use of shear wave elastography as a non-invasive biomarker that can distinguish normal renal parankyma tissue from disease kidneys. As we all know, chronic kidney disease is a progressive loss of kidney function whose cause is mainly due to hypertension, diabetes, and primary renal disorders. Now, CKD in its advanced stages is associated with increased mortality and morbidity. Currently, we use EGFR, which is derived from serum creat to stage CKD. However, there are many limitations to this technique, including confounding by race, gender, and muscle mass. Now, there are also clinical situations where EGFR results may become inconsistent and misleading, such as during acute changes in kidney function, high dietary protein intake, and extreme body size severe liver disease. Intra renal fibrosis is a final common pathway and pathological end stage for all CKD patients, and the degree of fibrosis can be correlated with disease severity. This is a principle that is used, and for a long time, renal biopsy was the only known method used to detect the intra renal fibrosis. However, there were significant disadvantages, like it is expensive. Being invasive, there are more chances of complication, and it is also subjected to sampling errors. So, there is a huge interest in developing non-invasive methods to accurately evaluate nephropathy. The parankymal ecogenicity, using BE mode, is a commonly used marker for nephropathy currently. However, this marker is subjective, not quantitative, and often fails to detect renal abnormality. Shear wave elastography is an emerging ultrasound technique used to measure tissue stiffness. First, we look at the principle of shear wave elastography. Elastography can be strain elastography or shear elastography. The source of source in shear wave elastography are short durations, strong focus acoustic pulses. These generate something called the shear waves. The shear waves are induced perpendicular in direction to the dynamic force. Ultrasound system via multiple sound pulses records these shear waves, and the energy is generated in kilobascals. The method used in my study includes, for cases, patients of all age groups referred from nephrology, internal medicine, urology to the department of radio diagnosis with chronic kidney disease were taken. And as controls, I selected patients with other comorbidities subjected to abdominal ultrasound without chronic kidney disease. Patients with renal cortical thickness less than 10 mm and not the patients not willing to give written informed consent were excluded from my study. The data that was obtained was entered into Microsoft Excel and mean and standard deviation was calculated. So, after taking my informed consent, the first step was to do a B mode analysis of renal length, width and cortical thickness. Then the patient was taken into subjected to lateral recubus stress and asked to hold his breath. The ROI box was placed in the renal cortex parallel to the medullary pyramids and five readings excluding the pools were taken. Then the elastography values were obtained, creatinine report was collected and EJFR calculated and the values were compared with the control group. These are the results of my study. The creatinine right kidney length, left kidney length, the right kidney width, left kidney width and the parankimal thickness of right and left kidneys has been recorded and the mean values have been calculated. The shear wave elastography values obtained in the case group was 9.6 and in the control group was 3.4. The median estimated young's modulus was significantly high in cases that is 9.6 as compared to control that was 3.4. The intrasubject variability was also higher in CKD patient as compared to normal control patients. The mean length of right kidney was 9.8 and left kidney was 9.7 in control group whereas in the case group it was 7.9 and 7.7 centimeter respectively. Then the mean parankimal thickness was 1.56 and 1.45 centimeter in control group whereas it was 1.3 centimeter and 1.32 centimeter in case group and the serum creatinine of control group was 0.62 milligram per deciliter and of case group was 3.43 milligram per deciliter. These are some representative cases so the first case is of a 51 year old male patient with history of hypertension and on dialysis. We can see the B mode analysis in the first picture and the elastography that was taken and the second is of a control group 34 year old male patient with headache and vomiting and this is the representative images. SWE can detect renal fibrosis at an early stage allowing for timely intervention and management. It provides a non-invasive method for monitoring changes in renal tissue stiffness over time helping to track disease progression. Now of course there will be there are some tissues micro's environment factors such as inflammation that make unfound SWE estimates of tissue young's modulus. This is known to be the case in liver disease as well where hepatic inflammation has been shown to increase the tissue stiffness. However despite this the clinical utility of elastography for liver fibrosis staging is now well established and SWE is used to clinically differentiate early as well as advanced liver fibrosis without biopsy. Now same can be anticipated in the in case of renal as well. So SWE may similarly have great utility in diffuse renal disease as it has the potential port to reduce the biopsy and to permit repeated non-invasive direct estimates of renal paranchymal disease severity. Ultimately such a tool could potentially be used to track renal fibrosis progression and permit therapy individualized in a manner that is presently not possible. Now while SWE is a promising tool it is essential to interpret the results in conjunction with other clinical and imaging findings for a comprehensive assessment of CQD. Thank you.