Early renal involvement in diabetes mellitus: comparison of renal Doppler US and radioisotope evaluation of glomerular hyperfiltration.

Ma, Marzano; Pompili, Maurizio; Rapaccini, Gian Ludovico; Covino, Marcello; Cotroneo, P; Manto, Andrea; Todaro, L; Ghirlanda, Giovanni; Gasbarrini, Giovanni

doi:10.1148/radiology.209.3.9844680

Cited by 17 publications

(12 citation statements)

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“…RI was determined as follows: the peak systolic velocity minus the end diastolic velocity divided by the peak systolic velocity. The usefulness of RI as a noninvasive hemodynamic assessment of the transplanted kidney was previously pointed out (7)(8)(9)(10). Our technique for CDU to evaluate RI is reproducible (coefficient of variation [CV], 3-5%) and precise.…”

Section: Clinical Follow-upmentioning

confidence: 92%

“…Initially, diabetic nephropathy encompasses both functional changes (i.e., reduced renal vasodilatory reserve and reduced ability to respond to pathogen) and slight morphological alterations (with basal membrane thickness). Finally, diabetic nephropathy results in clear morphological alterations (3,9,10).…”

Section: Preliminary Data On Nos Kidney Expressionmentioning

confidence: 99%

“…Since RI assessment is easy to obtain, this method is frequently preferred in clinical applications (35,36). However, an abnormal RI produced by diabetic nephropathy (9,37) can be indistinguishable from one resulting from other pathologic processes that also increase renal arterial resistance (36).…”

Section: Preliminary Data On Nos Kidney Expressionmentioning

confidence: 99%

“…Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7)(8)(9)(10).…”

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confidence: 99%

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Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

et al. 2005

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OBJECTIVE -Diabetes, hypertension, infections, and nephrotoxicity of certain immunosuppressive drugs (i.e., calcineurin inhibitors) can reduce functional survival of the kidney graft. Our aim was to evaluate survival, hypertrophy, and vascular function of the kidney graft in end-stage renal disease (ESRD) type 1 diabetic patients after transplant. RESEARCH DESIGN AND METHODS -The study population consisted of 234 ESRD type 1 diabetic patients who underwent kidney-pancreas (KP; 166 patients), successful kidney-islet (KI-s; 24 patients), and kidney (KD; 44 patients) transplant. Kidney size, graft survival, vascular function, and microalbuminuria were evaluated prospectively yearly for 6 years. Sixty-eight protocol kidney biopsies were performed routinely between 1993 and 1998 cross-sectionally (3.2 Ϯ 0.3 years from kidney transplant).RESULTS -The KP and KI-s groups had better cumulative kidney graft survival at 6 years than did the KD group (KP: 73%; KI-s: 86%; KD: 42%, P Ͻ 0.01). The KP group but not the KI-s/KD groups showed a persistent kidney graft hypertrophy up to 6 years of follow-up. A significant increase in creatinine levels from baseline to year 6 was evident in the KD group (1.58 Ϯ 0.08 to 2.78 Ϯ 0.44 mg/dl, P Ͻ 0.05) but not in the KP/KI-s groups. The KP/KI-s groups only showed a reduction of renal resistance index from baseline to year 6 (KP at baseline: 0.74 Ϯ 0.01 to 0.68 Ϯ 0.01%, P Ͻ 0.01; KI-s at baseline: 0.72 Ϯ 0.02 to 0.69 Ϯ 0.02%, P Ͻ 0.05). At year 6, an increase from baseline in urinary albumin excretion was observed only in the KD group (31.4 Ϯ 9.0 to 82.9 Ϯ 33.6 mg/l, P Ͻ 0.05). Preliminary data suggested that graft nitric oxide (NO) expression was higher in the KP/KI-s groups than in the KD group (data not shown).CONCLUSIONS -In ESRD type 1 diabetic patients, KP and KI-s compared with KD resulted in enhanced kidney graft survival, hypertrophy, and vascular function. Diabetes Care 28:1303-1310, 2005N ephropathy is one of the most common and most serious complications in type 1 diabetes (1,2). Glomerular hyperfiltration is the first feature of renal involvement and can be observed soon after diabetes onset, accompanied by a loss of renal functional reserve (3). Microalbuminuria appears later, as do morphological changes such as thickening of the glomerular basement membrane and mesangial expansion (4).Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7-10).Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(1...

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Section: Clinical Follow-upmentioning

confidence: 92%

Section: Preliminary Data On Nos Kidney Expressionmentioning

confidence: 99%

Section: Preliminary Data On Nos Kidney Expressionmentioning

confidence: 99%

mentioning

confidence: 99%

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Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

et al. 2005

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“…The intrarenal RI has also found adherents as a useful marker of diabetic nephropathy (Frauchiger et al, 2000;Soldo et al, 1997). In contrast, other studies have suggested that Doppler US provides little more than serum creatinine levels and creatinine clearance rates in patients with early diabetic nephropathy and normal renal functions (Marzano et al, 1998;Okten et al, 1999;Sari et al, 1999). The intrarenal RI is significantly greater in pregnant patients with pyelonephritis than in pregnant women without pyelonephritis (Keogan et al, 1996b).…”

Section: Renal Medical Diseasesmentioning

confidence: 96%

The Evaluation of Renal Hemodynamics with Doppler Ultrasonography

Kaya¹

2012

Hemodynamics - New Diagnostic and Therapeutic Approaches

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

Pelliccia¹,

Sereno²,

Cecamore³

et al. 2008

J of Clinical Ultrasound

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Early renal involvement in diabetes mellitus: comparison of renal Doppler US and radioisotope evaluation of glomerular hyperfiltration.

Abstract: Both RI and renal volume showed correlation with GFR, but neither parameter is sufficiently sensitive in screening for hyperfiltration in IDDM patients.

Cited by 17 publications

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Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

The Evaluation of Renal Hemodynamics with Doppler Ultrasonography

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

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