title: Decrease in glomerular filtration rate in Japanese patients with type 2 diabetes is linked to atherosclerosis.
abstract: OBJECTIVE
  We assessed the effects of atherosclerosis on the glomerular filtration rate (GFR) in patients with type 2 diabetes and who had micro- or normoalbuminuria.
  
  
  METHODS
  A total of 61 Japanese patients with type 2 diabetes were recruited from inpatients of Osaka City University Hospital. They ranged in age from 40 to 69 years (28 men and 33 women). Each subject collected a 24-h urine sample for quantitative analysis of albumin. Absence of albuminuria was defined as a urinary albumin excretion level of <30 mg/24 h (n = 36) and microalbuminuria as a level of 30-300 mg/24 h. The GFR was estimated using 99mTc diethylenetriamine pentaacetic renogram method. As indexes of atherosclerosis, we measured the intimal-medial thickness (IMT) and distensibility of the carotid artery using high-resolution B-mode ultrasonagraphy and an echo-tracking system. We measured the resistance index (RI) of the renal interlobar arteries by pulsed Doppler sonography.
  
  
  RESULTS
  The clinical characteristics of type 2 diabetic patients with and without microalbuminuria did not differ except for duration of diabetes, which was longer in the patients with microalbuminuria. GFR also did not differ between the patients with and without microalbuminuria. GFR was significantly correlated with the patient's age (r = -0.256, P < 0.05), carotid IMT (r = -0.326, P < 0.05), carotid stiffness beta (r = -0.449, P < 0.001), and renal arterial RI (r = -0.365, P < 0.05). In multiple regression analysis, independent factors associated with GFR were carotid IMT (R2 = 0.108, P = 0.0102), carotid stiffness beta (R2 = 0.208, P = 0.0003), and renal artery RI (R2 = 0.130, P = 0.0043).
  
  
  CONCLUSIONS
  The decline in GFR in type 2 diabetic patients in the early stages of nephropathy may be due in part to atherosclerosis.
authors.affiliation: Second Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Taniwaki
authors.forename: Y
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: T
authors.initials: T
authors.lastname: Kawagishi
authors.forename: E
authors.initials: E
authors.lastname: Ishimura
authors.forename: M
authors.initials: M
authors.lastname: Emoto
authors.forename: T
authors.initials: T
authors.lastname: Okamura
authors.forename: Y
authors.initials: Y
authors.lastname: Okuno
authors.forename: H
authors.initials: H
authors.lastname: Morii
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis; D001161:Arteriosclerosis / Q000175:diagnosis / Q000209:etiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D007668:Kidney / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate; D014463:Ultrasonography; D014655:Vascular Resistance
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate