Early changes in renal hemodynamics in children with diabetes: Doppler sonographic findings

Pelliccia, Piernicola; Sereno, Alessandra; Cecamore, Cristina; Primavera, Alessandra; Schiavone, Cosima; Chiarelli, Francesco

doi:10.1002/jcu.20457

Cited by 16 publications

(14 citation statements)

References 27 publications

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“…ROC curve revealed that RI showed a sensitivity of 100% in the prediction of DN. Our results are in agreement with the results seen in type 1 diabetic patients of many previous studies that demonstrated increased resistivity indices early in the course of DN in the pre albuminuric stage [4, 16, 17]. Also, Masulli et al [18] reported similar results but in type 2 diabetic patients as they found that high RI is associated with features of DN and its progression over time, independent of albuminuria.…”

Section: Discussionsupporting

confidence: 93%

Follow Up of Value of the Intrarenal Resistivity Indices and Different Renal Biomarkers for Early Identification of Diabetic Nephropathy in Type 1 Diabetic Patients

Dayem

Bohy

Hamed

et al. 2017

Open Access Maced J Med Sci

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AIM:To evaluate intrarenal resistivity index (RI) and different biomarkers of diabetic nephropathy (DN) with clinical signs of DN and its progression over time as early detection of DN.PATIENTS AND METHODS:This longitudinal study included 48 type 1 diabetic patients who were studied at baseline and after three years. A blood sample was taken for assessment of glycosylated haemoglobin (HbA1), lipid profile and a urine sample was taken for assessment of albumin/creatinine ratio, Neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid binding protein (L-FABP) and kidney injury molecule-1 (Kim-1) at baseline and after three years. Forty diabetic patients did renal Doppler at baseline & after three years.RESULTS:HbA1, waist/hip ratio, albumin/creatinine ratio, lipid profile, NGAL, KIM-1, L-FABP and resistivity index (RI) were significantly increased in follow-up. Twenty patients (41.7%) showed progression to albuminuria. RI showed a significant increase in follow-up study. ROC curve showed that RI and NGAL had the highest sensitivity (100%), followed by L-FABP (90%) and lastly KIM-1 (63.6%) in the prediction of DN.CONCLUSION:High RI, NGAL, KIM-1 & L-FABP can be considered as early markers of diabetic nephropathy in type 1 diabetics and are associated with its progression over time, independent of albuminuria.

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Section: Discussionsupporting

confidence: 93%

Follow Up of Value of the Intrarenal Resistivity Indices and Different Renal Biomarkers for Early Identification of Diabetic Nephropathy in Type 1 Diabetic Patients

Dayem

Bohy

Hamed

et al. 2017

Open Access Maced J Med Sci

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“…The International Diabetic Nephropathy Study Group showed a correlation between higher blood pressures within the normal range and mesangial expansion in normoalbuminuric patients with DM1 [32]. Such subtle increases in arterial pressure may be of clinical importance in a condition like DM that results in abnormal autoregulation of pressure and flow in the kidney [33]. In the present study pubertal diabetics had higher blood pressure compared to pre-pubertal patients.…”

Section: Discussionsupporting

confidence: 53%

“…The renal Doppler RIs also correlated positively with diabetes duration. They concluded that Doppler sonography can be used to detect early changes in the hemodynamics of pediatric diabetics before any clinical indicators of kidney problems are evident [54]. An important finding was the positive and significant correlation between NO levels and the RIs which represent the early hemodynamic intrarenal changes.…”

Section: Discussionmentioning

confidence: 99%

Serum and Urinary Nitrites and Nitrates and Doppler Sonography in Detection of Early Diabetic Complications

Asrar¹,

Adly²,

El-Hadidi³

et al. 2011

JDM

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Objective: to evaluate serum and urinary nitrite and nitrate concentrations as an index of nitric oxide (NO) production in type1diabetes mellitus (T1DM) and to investigate the possible alteration and correlation with intra renal Doppler resistive indexes (RIs). Design:The study included 90 children and adolescent with T1DM divided into 2 groups: Group 1: included 45 prepubertal type1 diabetics who were defined as Tanner stage1. Their age ranged between 8-14 years. Group 2: included 45 pubertal type diabetics who were defined as Tanner stages 2-5. Their ages ranged between 15-19 years. They were compared to 45 age and sex matched healthy controls. Clinical examination was done. Laboratory investigations included; post-prandial blood glucose (PPBG), glycosylated heamoglobin (HbA1C), Fundus examination, urinary microalbumin and measurement of serum and urinary nitrite and nitrate levels. Doppler ultrasonographic registration of intrarenal RIs were performed.Results: Compared to controls, both diabetic groups had significantly increased concentrations of serum (P=0.001) and urinary NO (P=0.008).Doppler RIs values were significantly elevated in both diabetic groups compared to controls (P <0.001).A significant positive correlation was found between serum and urinary NO levels (P<0.001). Serum NO was positively correlated with Doppler RIs (P=0.002), HbA1c (P=0.012), PPBG (P=0.000) and diabetes duration (P=0.004). Doppler RIs were positively correlated with mean HbA1c (P=0.025), PPBG (P=0.001) and diabetes duration (P=0.000). Conclusion:In type 1 diabetes chronic hyperglycemia may act through a mechanism that involves increased NO production or action and contributes to generating intrarenal hemodynamic abnormalities which could be detectable by Doppler ultrasonography even before overt clinical nephropathy. Further follow up studies are needed to document the usefulness of Doppler ultrasound in detection of preclinical nephropathy.

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“…However a strong correlation was identified to GFR (r = −0.2, p ≤ 0.01). Savino et al (18) mentioned that intrarenal hemodynamic abnormalities are detectable by Doppler ultrasonography even in early diabetic nephropathy before microalbuminuria appears and in a recent study by Pelliccia et al (29) they concluded that early changes in renal hemodynamics are detectable on Doppler sonography in children with diabetes without any evidence of renal dysfunction and may suggest a preclinical stage of diabetic nephropathy. In a study conducted on type 2 diabetic children by Mac Isaac et al (30) they concluded that subjects with type 2 diabetes and reduced glomerular filtration rate had similar degrees of intrarenal vascular disease, as measured by the intrarenal arterial resistance index, regardless of their albumin excretion rates status.…”

Section: Discussionmentioning

confidence: 99%

Renal Doppler indices in diabetic children with insulin resistance syndrome

et al. 2010

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End-stage renal failure is still a leading cause of mortality among type 1 diabetes patients. Insulin resistance plays a larger role in type 1 diabetes disease process than is commonly recognized. Detection of diabetic nephropathy as early as possible currently offers the best chance of delaying or possibly preventing progression to end-stage disease. Renal resistive index (RI) and pulsatility index (PI), measured using renal Doppler ultrasonography, reflect intrarenal vascular resistance. The present work aimed at examining renal Doppler indices (RI and PI) in type 1 diabetic children and their relation to features of insulin resistance and other established parameters of early diabetic nephropathy as microalbuminuria. One hundred diabetic children with a mean age of 13.4 ± 2.9 yr and an average diabetes duration of (7.2 ± 2.5 yr) were included. Thirty healthy children served as controls. All renal Doppler indices were significantly higher in children with type 1 diabetes mellitus (p ≤ 0.01). The worst parameters were observed in children diagnosed with insulin resistance syndrome (IRS) (38%), hypertensive (12%), and obese (4%) children. Resistive index showed a significant correlation to blood pressure (r = 0.2, p = 0.04), waist-hip ratio (r = 0.5, p = 0.02), insulin dose (r = 0.2, p = 0.02) and estimated glucose disposal rate (r = -0.5, p = 0.01). No correlation was noted to microalbuminuria, HbA1c, or duration of diabetes. The present work concluded that renal Doppler indices are worse in diabetic children and particularly those with IRS. These children appear to be at graver risk for diabetic nephropathy. In these patients adding renal Doppler assessment to their work up, might diagnose diabetic nephropathy at a prealbuminuric stage.

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Early changes in renal hemodynamics in children with diabetes: Doppler sonographic findings

Abstract: Early changes in renal hemodynamics are detectable on Doppler sonography in children with diabetes without any evidence of renal dysfunction and may suggest a preclinical stage of diabetic nephropathy.

Cited by 16 publications

References 27 publications

Follow Up of Value of the Intrarenal Resistivity Indices and Different Renal Biomarkers for Early Identification of Diabetic Nephropathy in Type 1 Diabetic Patients

Follow Up of Value of the Intrarenal Resistivity Indices and Different Renal Biomarkers for Early Identification of Diabetic Nephropathy in Type 1 Diabetic Patients

Serum and Urinary Nitrites and Nitrates and Doppler Sonography in Detection of Early Diabetic Complications

Renal Doppler indices in diabetic children with insulin resistance syndrome

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