Radionuclide staging of renal function in type 1 diabetes mellitus.
OBJECTIVE
The aim of this study was to assess renal function in different stages of type 1 diabetes mellitus by radionuclide methods. Additionally, glomerular and tubular functions were correlated with urinary albumin (UAER) and N-acetyl-beta-D-glucosaminidase (NAGA) excretion rates.


METHODS
Fifty-three patients with diabetes mellitus were classified into four groups: normoalbuminuric (NA, 18 patients), microalbuminuric (MiA, 12 patients), macroalbuminuric (MaA, 13 patients), and chronic renal failure group (CRF, 10 patients). Glomerular filtration rate (GFR) was estimated by diethylenetriamine pentaacetic acid-technetium 99m ((99m)Tc-DTPA) clearance rate while tubular function was calculated as a percentage of net injected activity fixed in both kidneys, 4 h after intravenous injection of dimercaptosuccinate acid-technetium 99m ((99m)Tc-DMSA). Additionally, (99m)Tc-DTPA clearance was correlated with estimated GFR (eGFR) by using modified Modification of Diet in Renal Disease (MDRD) Study Group formula.


RESULTS
(99m)Tc-DTPA clearance and (99m)Tc-DMSA fixation were found significantly higher in normoalbuminuric group (p < 0.05 and p < 0.02, respectively), unchanged in microalbuminuric group (p > 0.05, p > 0.05), and decreased in both macroalbuminuric (p < 0.0001, p < 0.00001) and chronic renal failure group (p < 0.0001, p < 0.00001). Renal function was denoted as normal, increased (hyperfunction), or decreased (hypofunction). It was found normal in a high percentage of patients with normalbuminuria (filtration 44.4%, fixation 72.2% pts) and microalbuminuria (66.7% and 66.7%). Renal hyperfunction was not only found frequent in normalbuminuric group (55.6% and 27.8%), but was also recorded in microalbuminuric group (8.3% and 8.3%). Renal hypofunction was present in all macroalbuminuric patients and in one-quarter of those with microalbuminuria as well. Such distribution of renal function conditions indicated normalbuminuric and microalbuminiric groups functionally heterogeneous. Regression analysis showed a significant correlation between (99m)Tc-DTPA clearance and eGFR in MaA and CRF groups only. Although urinary NAGA excretion rate was shown as a less sensitive staging parameter, being significantly increased when compared to control group only in MaA and CRF groups (p < 0.05), it significantly correlated with (99m)Tc-DTPA clearance rate (r = -0.485, p = 0.0004) and (99m)Tc-DMSA tubular fixation (r = -0.526, p = 0.0002).


CONCLUSIONS
The results of this study favor the performance of radionuclide studies together with the determination of urinary albumin excretion rate in patients with type 1 diabetes mellitus in order to achieve more reliable staging of diabetic kidney disease. The demonstration of glomerular hyperfiltration and tubular hyperfunction by radiopharmaceuticals contributes to the early detection of diabetic kidney disease, while the quantification of renal function enables the follow-up of the progressive function loss in the later course of the disease.
Rajic
Milena
M
Department of Nuclear Medicine, Clinical Center and Faculty of Medicine, University of Nis, Serbia. mrajic@EUnet.yu
Ilic
Slobodan
S
Vlajkovic
Marina
M
Antic
Slobodan
S
Velickovic
Ljubinka
L
Stefanovic
Vladisav
V
D000118:Acetylglucosaminidase / Q000652:urine; D000419:Albuminuria; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000652:urine; D003928:Diabetic Nephropathies / Q000000981:diagnostic imaging* / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000652:urine; D007684:Kidney Tubules / Q000503:physiopathology; D008297:Male; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016284:Technetium Tc 99m Pentetate
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D000118:Acetylglucosaminidase; D016284:Technetium Tc 99m Pentetate