ROLE OF INTRARENAL RESISTIVITY INDEX BY DUPLEX ULTRASONOGRAPHY IN DIABETIC NEPHROPATHY AND ITS CLINICO BIOCHEMICAL CORRELATION
Diabetic nephropathy is among the common causes of end stage renal disease. Conventional ultrasound and colour Doppler provide easily available, affordable noninvasive follow up method for evaluation of kidneys in diabetic nephropathy. In diabetic nephropathy, the glomerulosclerosis and interstitial fibrosis causes alteration in intrarenal hemodynamics causing raised intrarenal vascular resistance reflected by increased intrarenal resistivity index (IRI).
The aim of the study is to evaluate intrarenal resistivity index by duplex ultrasonography in diabetic nephropathy patients and correlating them with clinical and biochemical parameters.
This was a cross sectional study carried out over 2 years period from September 2013 to September 2015.Patients of Type 2 diabetes as per WHO criteria having nephropathy were included.
A total of 96 patients of diabetic nephropathy were studied and divided into two groups based on IRI.Group I (n=54) with IRI > 0.70 and group II (n=42) with IRI ≤ 0.70. Group I patients had significantly higher mean age and mean duration of diabetes compared to group II. Group I patients also had higher blood urea and serum creatinine 3.91 ± 1.63 vs 1.34 ± 0.85 mg/dl) compared to group II. Around 83.33 % patients in group II were in early stage of nephropathy where as 85.18 % in group I were in established stage of nephropathy. Among the complications of diabetes, presence of retinopathy correlates well with advanced diabetic nephropathy (IRI>0.70).
Intrarenal resistivity index (IRI) by duplex USG is a non-invasive parameter that can be correlated with clinico biochemical parameters of diabetic renal dysfunction and hence can be used as a prognostic indicator in follow up of diabetic nephropathy.
a. Harrison’s Principles of Internal Medicine, 18th ed. United States of America: The
b. McGraw-Hill companies.
. ^ a b c Wild S, Roglic G, Green A, Sicree R, King H (2004). "Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030". Diabetes Care 27 (5): 1047–53. doi:10.2337/diacare.27.5.1047. PMID 15111519.https://doi.org/10.2337/diacare.27.5.1047
. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. On behalf of the ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-India Diabetes (ICMR- INDIAB) Diabetologia 2011;54:3022-7.https://doi.org/10.1007/s00125-011-2291-5
. Joel F. Platt, James H. Ellis, Jonathan M. Rubin, Michael A. Dipietro, Aileen B. Sedman. Intrarenal arterial Doppler sonography in patients with non-
obstructive renal disease: correlation of resistive index with biopsy findings. AJR 1990 June; 154: 1223-1227. https://doi.org/10.2214/ajr.154.6.2110732
. Carol M. Rumack, Stephanie R. Wilson, J. William Charboneau. Diagnostic ultrasound Vol 1, 4th edition. Elsevier Mosby publishers; 2011.
. Joel F Platt, Jonathan M. Rubin et al. The Inability to Detect Kidney Disease on the Basis of Echogenicity. AJR 1988 August; 151: 317-319
. Joel F. Platt, MD, Jonathan m. Rubin, MD et al. Diabetic Nephropathy:
a. Evaluation with Renal Duplex Doppler US. Radiology 1994; 190; 343-346.https://doi.org/10.1148/radiology.190.2.8284379
. Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, Maekawa K, et al. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int. 1997;51(6):1920-1927.https://doi.org/10.1038/ki.1997.261
. Nosadini R., Velussi M., Brocco E., Abaterusso C., Carraro A., Piarulli F., Morgia G., Satta A., Faedda R., Abhyankar A., Luthman H., Tonolo G. (2006): Increased renal arterial resistance predicts the course of renal function in type 2 Diabetes with microalbuminuria. Diabetes; 55: 234–239.
. Milovanceva-Popovska M, Dzikova S. Progression of diabetic nephropathy: value of intrarenal resistive index (RI). Prilozi. 2007;28(1):69-79.
. Tushar P Patil, Tushar B Patil, Rajashree S Khot, Kiran M Sargar, Mangesh B Patil, Yogendra v Bansod : Clinical profile of Diabetic Nephropathy and correlation with Intra renal Resistivity Index by
a. Duplex ultrasonography. World J Nephrol Urol . 2012; 1(4-5): 107-114
. Chuahirun T, Wesson DE. Cigarette smoking predicts faster progression of type 2 established diabetic ne-phropathy despite ACE inhibition. Am J Kidney Dis. 2002;39(2):376-382.https://doi.org/10.1053/ajkd.2002.30559
. Biesenbach G, Grafinger P, Janko O, Zazgornik J. Influ¬ence of cigarette-smoking on the progression of clini¬cal diabetic nephropathy in type 2 diabetic patients. Clin Nephrol. 1997;48(3):146-150.
. Gambaro G, Bax G, Fusaro M, Normanno M, Manani SM, Zanella M, Dangelo A, et al. Cigarette smoking is a risk factor for nephropathy and its progression in type 2 diabe¬tes mellitus. Diabetes Nutr Metab. 2001;14(6):337-342.
. Aryal M, Jha B. Assessment of proteinuria as a marker of nephropathy in type 2 diabetes mellitus. Nepal Med Coll J. 2006;8(4):250-253.
. Jude EB, Anderson SG, Cruickshank JK, Srivatsa A, Tentolouris N, Chandrasekaran R, Gokal R, et al. Natu¬ral history and prognostic factors of diabetic nephropa¬thy in type 2 diabetes. QJM. 2002;95(6):371-377.https://doi.org/10.1093/qjmed/95.6.371
. Majdan M, Kurowska M, Orlowska-Kowalik G, Drop A. [Ultrasonographic evaluation of kidneys in type-2 diabetes patients without overt nephropathy and with chronic renal failure]. Wiad Lek. 2005;58(1-2):25-28.
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