title: Increased renal arterial resistance predicts the course of renal function in type 2 diabetes with microalbuminuria.
abstract: Type 2 diabetic patients often die because of end-stage renal failure, but no definitive reliable factor predicting long-term renal outcome has been identified. We tested whether a renal arterial resistance index (R/I) > or =80, using Doppler ultrasound technique, was predictive of worsening renal function. The primary end points of the study were 1) the course of glomerular filtration rate (GFR) and 2) the albumin excretion rate in 157 microalbuminuric, hypertensive, type 2 diabetic patients after a 7.8-year follow-up period (range 7.1-9.2). Kaplan-Meier curves for the primary end point (decrease of GFR > or = -3.0 ml/min per 1.73 m(2) per year) was two to three times more frequently observed in patients with R/I > or =80. Four- to fivefold fewer patients showed a regression to normoalbuminuria during the follow-up period from baseline microalbuminuria in the cohort with R/I > or =80. Overt proteinuria did develop in 24% of patients with R/I > or =80 and in 5% of patients with R/I <80 (P < 0.01). In conclusion, intrarenal arterial resistance appears to play a nontrivial role in deteriorating renal function in type 2 diabetic patients. R/I is a noninvasive diagnostic procedure, which strongly predicts the outcome of renal function in type 2 diabetic patients, even when GFR patterns are still normal.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, University of Sassari, Sassari, Italy. noscia@tin.it
authors.forename: Romano
authors.initials: R
authors.lastname: Nosadini
authors.forename: Mario
authors.initials: M
authors.lastname: Velussi
authors.forename: Enrico
authors.initials: E
authors.lastname: Brocco
authors.forename: Cataldo
authors.initials: C
authors.lastname: Abaterusso
authors.forename: Andrea
authors.initials: A
authors.lastname: Carraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Piarulli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.forename: Andrea
authors.initials: A
authors.lastname: Satta
authors.forename: Rossana
authors.initials: R
authors.lastname: Faedda
authors.forename: Avinash
authors.initials: A
authors.lastname: Abhyankar
authors.forename: Holgher
authors.initials: H
authors.lastname: Luthman
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tonolo
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000503:physiopathology*; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology*