Renal Doppler Ultrasound for the prediction of non-diabetic kidney disease in diabetic patients
Renal Doppler Ultrasound for the prediction of non-diabetic kidney disease in diabetic patients
Min Hoan Moon, M.D., Department of Radiology, Seoul National University Seoul Metropolitan Government Boramae Medical Center
This study was conducted to assess the role of renal Doppler ultrasound (US) in predicting non-diabetic kidney disease (NDKD) in diabetic patients by using histologic findings as the reference standard.
Fifty-nine consecutive diabetic patients who underwent renal Doppler US and native kidney biopsy were included in this retrospective, single-institutional study. Based on the histologic findings, patients were divided into diabetic nephropathy (DN) and NDKD. Renal Doppler US findings, including cortical echogenicity, corticomedullary differentiation, and resistive index (RI), were compared between DN and NDKD. Subgroup analysis according to chronic kidney disease (CKD) was also performed.
Flow diagram of study population. US=ultrasound
Cortical echogenicity and corticomedullary differentiation showed no significant difference between DN and NDKD (p=0.8867 and p=1.0000), whereas RI was significantly higher in DN than NDKD (p=0.0323). Subgroup analysis revealed that RI between DN and NDKD was significantly different in diabetic patients with CKD (p=0.0103) but not different in those without CKD (p=0.7128). When limited to diabetic patients with CKD, RI had an AUC value of 0.759, sensitivity of 57.1%, specificity of 81.0%, positive likelihood ratio (LR) of 3.0, and negative LR of 0.5 in the prediction of NDKD, using a cutoff value of ≤0.69.
Renal Doppler US of diabetic patients with CKD. (A) RI obtained in 42-year-old man with biopsy-proven DN shows increased RI of 0.76. (B) RI obtained in 54-year-old man with biopsy-proven MPGN shows normal RI of 0.57. (C) RI obtained in 62-year-old man with biopsy-proven MCD superimposed on DN shows normal RI of 0.68. CKD=chronic kidney disease, RI=resistive index, DN=diabetic nephropathy, MPGN=membranoproliferative glomerulonephritis, MCD=minimal change disease
Renal Doppler US of diabetic patients with CKD. (A) RI obtained in 42-year-old man with biopsy-proven DN shows increased RI of 0.76. (B) RI obtained in 54-year-old man with biopsy-proven MPGN shows normal RI of 0.57. (C) RI obtained in 62-year-old man with biopsy-proven MCD superimposed on DN shows normal RI of 0.68. CKD=chronic kidney disease, RI=resistive index, DN=diabetic nephropathy, MPGN=membranoproliferative glomerulonephritis, MCD=minimal change disease
Renal Doppler US of diabetic patients with CKD. (A) RI obtained in 42-year-old man with biopsy-proven DN shows increased RI of 0.76. (B) RI obtained in 54-year-old man with biopsy-proven MPGN shows normal RI of 0.57. (C) RI obtained in 62-year-old man with biopsy-proven MCD superimposed on DN shows normal RI of 0.68. CKD=chronic kidney disease, RI=resistive index, DN=diabetic nephropathy, MPGN=membranoproliferative glomerulonephritis, MCD=minimal change disease
Renal Doppler US may be helpful in predicting NDKD in diabetic patients with CKD.
