Large kidneys predict poor renal outcome in subjects with diabetes and chronic kidney disease.
BACKGROUND
Renal hypertrophy occurs early in diabetic nephropathy, its later value is unknown. Do large kidneys still predict poor outcome in patients with diabetes and Chronic Kidney Disease (CKD)?


METHODS
Seventy-five patients with diabetes and CKD according to a Glomerular Filtration Rate (GFR, by 51Cr-EDTA clearance) below 60 mL/min/1.73 m2 or an Albumin Excretion Rate above 30 mg/24 H, had an ultrasound imaging of the kidneys and were cooperatively followed during five years by the Diabetology and Nephrology departments of the Centre Hospitalier Universitaire de Bordeaux.


RESULTS
The patients were mainly men (44/75), aged 62 +/- 13 yrs, with long-standing diabetes (duration:17 +/- 9 yrs, 55/75 type 2), and CKD: initial GFR: 56.5 (8.5-209) mL/min/1.73 m2, AER: 196 (20-2358) mg/24 H. Their mean kidney lenght (108 +/- 13 mm, 67-147) was correlated to the GFR (r = 0.23, p < 0.05). During the follow-up, 9/11 of the patients who had to start dialysis came from the half with the largest kidneys (LogRank: p < 0.05), despite a 40% higher initial isotopic GFR. Serum creatinine were initially lower (Small kidneys: 125 (79-320) micromol/L, Large: 103 (50-371), p < 0.05), but significantly increased in the "large kidneys" group at the end of the follow-up (Small kidneys: 129 (69-283) micromol/L, Large: 140 (50-952), p < 0.005 vs initial). The difference persisted in the patients with severe renal failure (KDOQI stages 4,5).


CONCLUSIONS
Large kidneys still predict progression in advanced CKD complicating diabetes. In these patients, ultrasound imaging not only excludes obstructive renal disease, but also provides information on the progression of the renal disease.
Rigalleau
Vincent
V
Nutrition-Diabétologie, Centre Hospitalier de Bordeaux and Université de Bordeaux 2-Victor Segalen, Bordeaux 33000, France. vincent.rigalleau@chu-bordeaux.fr
Garcia
Magalie
M
Lasseur
Catherine
C
Laurent
François
F
Montaudon
Michel
M
Raffaitin
Christelle
C
Barthe
Nicole
N
Beauvieux
Marie-Christine
MC
Vendrely
Benoit
B
Chauveau
Philippe
P
Combe
Christian
C
Gin
Henri
H
D000368:Aged; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors; D014463:Ultrasonography
D003404:Creatinine