Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and clinical use of renal MRI biomarkers. This position paper lays out PARENCHIMA's vision on key clinical questions that MRI must address to become more widely used in patients with kidney disease, first within research settings and ultimately in clinical practice. We then present a series of practical recommendations to accelerate the study and translation of these techniques.

5th Department of Medicine University Medical Center Mannheim Medical Faculty Mannheim of the University Heidelberg Mannheim Germany

Academic Nephrology Unit Department of Infection Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK

Antaros Medical BioVenture Hub Mölndal Sweden

Center for Medical Physics and Biomedical Engineering MR Centre of Excellence Medical University of Vienna Vienna Austria

Centre for Kidney Research and Innovation University of Nottingham UK

Department of Clinical Medicine University of Bergen Bergen Norway

Department of Health and Functioning Western Norway University of Applied Sciences Norway

Department of Medical Imaging and Radiation Sciences Radiology Division European Institute of Oncology Milan Italy

Department of Nephrology and Medical Intensive Care Charité Universitätsmedizin Berlin Berlin Germany

Department of Nephrology Transplant Centre Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Radiology Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital Cambridge Biomedical Campus Cambridge UK

Department of Radiology Haukeland University Hospital Bergen Norway

Department of Renal Medicine Salford Royal Hospital and Division of Cardiovascular Sciences University of Manchester Manchester UK

Departments of Renal and Clinical Medicine Aarhus University Hospital Aarhus Denmark

Division of Cardiovascular Sciences School of Medical Sciences Faculty of Biology Medicine and Health The University of Manchester Manchester UK

Faculty of Medicine University of Novi Sad Center of Radiology Clinical Centre of Vojvodina Serbia

Great Ormond Street Institute of Child Health University College London London UK

HFR Fribourg Hôpital Cantonal Fribourg Switzerland

Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK

Institute of Neurology University College London Queen Square London UK

Institute of Pathology and Department of Nephrology RWTH University Aachen Germany

IRCCS Istituto di Ricerche Farmacologiche Mario Negri Bergamo Italy

Leeds Imaging Biomarkers Group Department of Biomedical Imaging Sciences University of Leeds Leeds UK

Nephrology and Hypertension IIS Fundacion Jimenez Diaz UAM Madrid Spain

Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands

QMRI Tech iSrl Piazza dei Martiri Pennesi 20 Pescara Italy

Radiology Department Geneva University Hospital and University of Geneva Geneva Switzerland

Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte Centre Hospitalier Universitaire de Bordeaux Place Amelie Raba Leon Bordeaux France

Service de Néphrologie Transplantation Dialyse Aphérèse Centre Hospitalier Universitaire de Bordeaux Bordeaux France

Service of Nephrology and Hypertension Department of Medicine University Hospital of Lausanne Lausanne Switzerland

Service of Nephrology Clinica Universidad de Navarra Pamplona Spain

Service of Nephrology Department of Medicine Specialties University Hospital of Geneva Geneva Switzerland

University of Bern Inselspital Bern Switzerland

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Nephrol Dial Transplant. 2018 Sep 1;33(suppl_2):ii1-ii3. doi: 10.1093/ndt/gfy181. PubMed

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