Association of the Renal Resistive Index with Microvascular Complications in type 2 Diabetic Subjects

N. D. Ozmen; U. Mousa; Y. Aydin; T. Deren; E. B. Unlu

doi:10.1055/s-0034-1390448

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2015; 123(02): 112-117
DOI: 10.1055/s-0034-1390448

Article

Association of the Renal Resistive Index with Microvascular Complications in type 2 Diabetic Subjects

N. D. Ozmen

¹Burhan Nalbantoglu Hospital, Department of Internal Medicine, Nicosia, Cyprus

,

U. Mousa

²Burhan Nalbantoglu Hospital, Department of Endocrinology and Metabolism, Nicosia, Cyprus

,

Y. Aydin

³Duzce University Faculty of Medicine, Department of Endocrinology and Metabolism, Turkey

,

T. Deren

⁴Ankara Numune Hospital, Department of Radiology, Ankara, Turkey

,

E. B. Unlu

⁵Ankara Numune Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey

› Institutsangaben

Abstract

Chronic complications are the leading causes of morbidity and mortality in the diabetic population. The intrarenal resistive index (RI) has been reported to be increased in hypertensive subjects with microalbuminuria and limited data is present for diabetic subjects. 101 subjects with Type 2 Diabetes Mellitus were included in the study. We grouped the study population according to the urinary albumin excretion (UAE). Group 1: UAE<30 mg/day (n=36); Group 2: UAE 30–300 mg/day (n: 37); Group 3: UAE>300 mg/day (n: 28). We also grouped the study population according to the intrarenal RI value. Group I consisted of subjects with RI≥0.70 and group II<0.70. The mean intrarenal RI values of patients in group 3 were higher than those of group 1 and group 2 (0.72 vs. 0.69 p=0.048; 0.72 vs. 0.69; p=0.048 respectively). The duration of diabetes, hip circumference, and hs-CRP levels were statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70 (p:<0.001, 0.048 and 0.0148 respectively). Presence of retinopathy and neuropathy was statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70. RI may predict the development of microvascular complications in diabetic subjects.

Key words

diabetes mellitus - albuminuria - retinopathy - neuropathy - resistive index

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References
1 Grundy SM, Cleeman Ji, Merz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 2004; 4; 44: 720-732 Review
2 Fabre J, Balant LP, Dayer PG et al. The kidney in maturity onset diabetes mellitus: clinical study of 510 patients. Kidney Int 1982; 21: 730-738
3 Platt JF, Rubin JM, Ellis JH et al. Intrarenal arterial Doppler Sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. AJR 1990; 154: 1223-1227
4 Platt JF. Distinction between obstructive and nonobstructive pyelocaliectasis with Duplex Doppler disease. AJR 1989; 153: 997-1000
5 Tessari P, Kiwanuka E, Barazzoni R et al. Diabetic nephropathy is associated with increased albumin and fibrinogen production in patients with type 2 diabetes. Diabetologia 2006; 49: 1955-1961
6 Pontremoli R, Viazzi F, Martinoli C et al. Increased renal resistive index in patients with essential hypertension: a Marker of target organ damage. Nephrol Dial Transplant 1999; 14: 360-365
7 Derchi LE, Martinoli C, Saffioti S et al. Ultrasonographic imaging and Doppler analysis of renal changes in non-insulin-dependent diabetes mellitus. Acad Radiol 1994; 1: 100-105
8 Ljubic S, Brkljacic B, Metelko Z et al. Renal resistance index in type 2 diabetes. Diabetologia Croatica 2006; 35: 7-13
9 Zucchelli PC. Hypertension and Atherosclerotic Renal Artery Stenosis: Diagnostic Approach. J Am Soc Nephrol 2002; 13: 184-186
10 Dyck PJ, Kratz KM, Karnes MS et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population based cohort: The Rochester Diabetic Neuropathy Study. Neurology 1993; 43: 817-824
11 Schiemann U, Kaiser HC, Götzberger M et al. Determination of Intrarenal Resistive Index in patients with multiple myeloma. Eur J Med Res 2010; 15: 210-213
12 Hanamura K, Akihiro T, Kinugasa S et al. The Resistive index is a marker of Renal Function, Pathology, Prognosis and Responsiveness to steroid therapy in chronic kidney disease patients. Int J Nephrol 2012; 2012: 139565 Epub 2012 Dec 16
13 Pignoli P, Tremoli E, Poli A et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399-1406
14 Nosadini R, Velussi M, Brocco E et al. Increased renal arterial resistance predicts the course of renal function in type 2 diabetes with microalbuminuria. Diabetes 2006; 55: 234-239
15 Brkljacic BB, Mrzljak V, Drinkovic I et al. Renal vascular resistance in diabetic nephropathy: Dublex Doppler US evaluation. Radiology 1994; 192: 549-554
16 Yoshimura T, Suzuki E, Ito I et al. Impaired peripheral circulation in lower-leg arteries caused by higher arterial stiffness and greater vascular resistance associates with nephropathy in type 2 diabetic patients with normal ankle-brachial indices. Diabetes Res Clin Pract 2008; 80: 416-423
17 Arai T, Numata K, Tanaka K et al. Ocular arterial flow hemodynamics in patients with diabetes mellitus. J Ultrasound Med 1998; 17: 675-681
18 Romero P, Salvat M, Fernandez J et al. Renal and retinal microangiopathy after 15 years of follow-up study in a sample of Type 1 diabetes mellitus patients. J Diabetes Complications 2007; 21: 93-100
19 AL-Maskari F, El-Sadig M. Prevalence of risk factors for diabetic foot complications. BMC Fam Pract 2007; 10: 8-59
20 Nejad D, Jafari B, Alpour P. Arterial resistive index in type II diabetic nephropathy stages and healthy controls. Iran J Radiol 2009; 6: 29-32
21 Becker JA. Evaluation of renal function. Radiology 1991; 179: 337-338
22 Derchi LE et al. Mild renal dysfunction and renal vascular resistance in primary hypertension. Am J Hypertens 2005; 18: 966-971
23 Soldo D, Brkljacic B, Bozikov V et al. Diabetic Nephropathy Comparison of conventional and duplex Doppler ultrasonographic findings. Acta Radialogica 1997; 38: 296-302
24 Mostbeck GH, Kain R, Mallek R et al. Duplex Doppler Sonography in Renal Parenchymal Disease Histopathologic Correlation. J.Ultrasound Med 1991; 10: 189-194
25 Pontremoli R et al. Microalbuminuria is an early marker of target organ damage in essential hypertension. Am J Hypertens 1998; 11 (4 Pt 1) 430-438
26 Tanıwaki H, Ishimura E, Matsumoto N et al. Relations Between ACE Gene and ecNOS Gene Polymorphisms and Resistive Index in Type 2 Diabetic Patients With Nephropathy. Diabetes Care 2001; 24: 1653-1660
27 Lamacchia O, Nicastro V, Camarchio D et al. Waist circumference is strongly associated with renal resistive index in normoalbuminuric patients with type 2 diabetes. Amj Nephrol 2008; 28: 54-58
28 Afsar BL, Elsurer R. Comparison of renal resistive index among patients with Type 2 diabetes with different levels of creatinine clearance and urinary albumin excretion. Diabet Med 2012; 29: 1043-1046