AUTHOR=Kutek Marcin L. , Witkowski Jacek M. M.
  
TITLE=Beyond biochemistry: multiparametric ultrasound parameters and their molecular correlates in cardio-renal-metabolic syndrome
  
JOURNAL=Acta Biochimica Polonica
  
VOLUME=Volume 73 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/acta-biochimica-polonica/articles/10.3389/abp.2026.16873
  
DOI=10.3389/abp.2026.16873
  
ISSN=1734-154X
  
ABSTRACT=Cardio-renal-metabolic syndrome (CRMS)—characterized by the pathological interplay of visceral adiposity, insulin resistance, chronic kidney disease, and cardiovascular disease—affects over 90% of US adults across its staging spectrum, yet its multi-organ burden remains difficult to assess non-invasively at the point of care. This narrative mini review examines whether multiparametric ultrasound within a single examination can serve as an integrated imaging biomarker set complementary to established molecular markers of CRMS. A narrative search of PubMed (2015–2026) was conducted using PICO-structured queries. The hepatic controlled attenuation parameter and liver stiffness measurement correlate directly with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), CRP, and adipokine dysregulation, with pooled CAP cutoffs of 268–313 dB/m and elastography thresholds of 8.2–13.6 kPa for fibrosis staging in MASLD. Epicardial adipose tissue thickness correlates with circulating IL-17A (r = 0.308), hs-CRP (r = 0.666), and HOMA-IR (r = 0.567–0.580), independently predicting left ventricular diastolic dysfunction beyond BMI. Carotid intima-media thickness tracks eGFR decline longitudinally and predicts cardiovascular mortality in CKD populations. Renal resistive index, with a validated threshold of ≥0.70, independently predicts GFR decline and cardiovascular mortality across diabetic and hypertensive populations. Renal shear wave elastography distinguishes fibrotic from non-fibrotic parenchyma, with 93.1% sensitivity against biopsy. Cross-compartmental correlations and composite imaging-biochemistry models consistently outperform single-parameter approaches. Two critical gaps remain: specific ultrasound values have not been associated with AHA/ACC CKM stages, and no outcome study has validated a multiorgan protocol. Multiparametric ultrasound provides a clinically feasible, evidence-based CRMS assessment that remains to be validated in prospective trials.