This first study in early stages of diabetic chronic kidney disease shows that the role of serum fetuin-A may be far more complex than previously described. During predialysis stage of DN, there is a direct relationship between serum fetuin-A levels and CAC score. The reasons for this association in the presence of nephropathy are unclear, but may be secondary to proatherogenic insulin resistance.
This first such study of nondialyzed individuals with DN suggests that, unlike ESRD patients, the high CAC burden seen at earlier stages of diabetic chronic kidney disease is probably unrelated to disordered mineral metabolism. The relationship between the severity of hypertension and CAC burden provides a probable target for intervention in the predialysis phase of DN.
A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means of routinely imaging the intracranial contents in infants younger than one year of age. Correlation between ultrasound and CT images was excellent, showing both normal and pathological anatomy. This technique is most helpful in the detection of hydrocephalus and other "fluid lesions" (subdural hygroma or hematoma, Dandy-Walker cyst, porencephalic cyst) and in evaluation of response to therapy. Because small amounts of intraventricular and subependymal hemorrhage cannot be detected by ultrasound, CT remains the procedure of choice when these conditions are suspected. The water-delay method is accurate and inexpensive, rarely requires patient sedation, and avoids exposure to ionizing radiations.
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