Color Doppler Sonographic Dynamic Tissue Perfusion Measurement Demonstrates Significantly Reduced Cortical Perfusion in Children with Diabetes Mellitus Type 1 without Microalbuminuria and Apparently Healthy Kidneys

Abstract

Motivation: With respect to the devastating consequences of the increasing prevalence of diabetes mellitus, the main reason for end stage renal disease and dialysis in industrialized countries, and the very limited diagnostic and therapeutic possibilities to predict, monitor and prevent diabetic nephropathy (DN), new concepts for early recognition and quantification of the prevailing microvascular changes in DN are urgently needed.

Materials and Methods: We present the first study of renal cortical tissue perfusion measurement by means of standardized color Doppler sonographic videos evaluated with the PixelFlux software 1 for Dynamic Tissue Perfusion Measurement (DTPM) in 92 patients with DM1 without MA compared to 71 healthy probands.

Results: DTPM reveals a highly significant diminution of cortical perfusion in patients with DM1 compared to healthy probands by 31 %, most pronounced in the distal hemicortex (reduction by 50 %) compared to 21 % within the proximal hemicortex.

Conclusion: Thus, DTPM offers a novel means of numerically describing the state of the renal microvasculature in DM in a patient-friendly, non-invasive, non-ionizing manner.

Zusammenfassung

Motivation: Die schwerwiegenden Folgen der zunehmenden Prävalenz des Diabetes mellitus, der Hauptursache terminalen Nierenversagens in den Industrieländern und die noch sehr begrenzten Möglichkeiten, die diabetische Nephropathie (DN) vorherzusehen, zu überwachen und zu verhindern verlangen nach neuen Konzepten der Früherkennung und Quantifizierung mikrovaskulärer Veränderungen.

Material und Methoden: Wir legen die erste Untersuchung zur standardisierten dynamischen farbdopplersonografischen Gewebsperfusionsmessung (DTPM) des renalen Kortex mit der PixelFlux-Software bei 92 Kindern mit Diabetes mellitus Typ 1 (DM1) ohne Mikroalbuminurie (MA) im Vergleich zu 71 gesunden Probanden vor.

Ergebnisse: Dabei fanden wir eine signifikante Perfusionsminderung bei Patienten mit DM1 im Vergleich zu Gesunden um 31 %. Sie war im distalen Hemikortex mit 50 % stärker als im proximalen Hemikortex (21 %) ausgeprägt.

Schlussfolgerung: Mit der DTPM kann die Schädigung kleinster renalen Gefäße bei DM patientenschonend quantifiziert werden.

Key words

ultrasound color Doppler - dynamic tissue perfusion measurement - kidney - diabetes mellitus

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