Intrarenal arteriosclerosis and impairment of kidney function in NIDDM subjects

• Published in: Diabetologia Vol. 41; no. 1; pp. 121 - 124
• Main Authors: BOERI, D, DERCHI, L. E, MAIELLO, M, MARTINOLI, C, SIMONI, G, SAMPIETRO, L, STORACE, D, PONTE, L, CALVI, C, REPETTO, M, ROBAUDO, C
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-01-1998
• Subjects: Arteriosclerosis - blood; Arteriosclerosis - physiopathology; Biological and medical sciences; Blood Pressure; Body Mass Index; Cholesterol, LDL - blood; Creatinine - metabolism; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - blood; Diabetic Angiopathies - physiopathology; Diabetic Nephropathies - blood; Diabetic Nephropathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - analysis; Humans; Kidney - anatomy & histology; Kidney - blood supply; Kidney - physiopathology; Male; Medical sciences; Middle Aged; Renal Artery - diagnostic imaging; Ultrasonography, Doppler, Duplex; Endocrinopathy; Doppler ultrasound study; Human; Pathophysiology; Albumin; Cardiovascular disease; Exploration; Non insulin dependent diabetes; Kidney; Vascular disease; Urinary system; Atherosclerosis; Macroangiopathy; Proteinuria
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s001250050877

It is currently under debate whether the pathogenesis of end-stage renal failure in non-insulin-dependent diabetes mellitus (NIDDM) is a consequence of microangiopathy alone. The aim of this study was to investigate intrarenal arteriosclerosis and its correlation with kidney function in NIDDM. In 36 diabetic subjects, and in 10 age- and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography. Clinical and metabolic parameters, renal function and vascular sequelae of the disease were also evaluated. In diabetic subjects resistive index (median 0.72, range 0.54-0.79) was higher than in control subjects (median 0.62, range 0.57-0.66) (2p < 0.002). Kidney volume and resistive index correlated with age (p < 0.004), body mass index (p < 0.001), mean blood pressure (p < 0.001), total and LDL cholesterol (p < 0.01) and creatinine clearance (p < 0.001 and < 0.01, respectively). Kidney volume also correlated with HbA1 (p < 0.01) and resistive index with uric acid (p < 0.01). Lower body macroangiopathy was associated with increased resistive index and reduced kidney volume (2p < 0.05), while upper body macroangiopathy and microangiopathy were not. Our data suggest that macroangiopathy rather than microangiopathy is mainly responsible for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteriosclerosis and can be used as a non-invasive, easily available parameter of its evolution.