Thukral Anubhav, Mishra Manish, Srivastava Vaibhava, Kumar Hemant, Dwivedi Amit Nandan Dhar, Shukla Ram Chandra, Tripathi Kamlakar
Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
Int J Vasc Med. 2011;2011:656030. doi: 10.1155/2011/656030. Epub 2011 Jun 12.
Aims and Objectives. Metabolic dysregulation has failed to explain clinical variability of patients with diabetic nephropathy and hence a renewed interest emerged in haemodynamic factors as determinant of progression and development of diabetic nephropathy. We therefore studied for various factors which can correlate with raised renal vascular resistance in diabetic nephropathy. Material and Methods. Renal vascular resistance was measured in patients with established and incipient diabetic nephropathy and compared with controls using noninvasive color Doppler examinations of intrarenal vasculature. Results. Renal vascular resistance correlated with age, duration of disease, GFR, serum creatinine, and stage of retinopathy. Renal vascular resistance was significantly reduced in patients on treatment with RAAS inhibitors and insulin, than those on OHA and antihypertensives other than RAAS inhibitors. Conclusion. The study implies that renal vascular resistance may help identify diabetics at high risk of developing nephropathy, and these set of patients could be candidates for RAAS inhibition and early insulin therapy even in patients without albuminuria.
目的。代谢失调未能解释糖尿病肾病患者的临床变异性，因此，作为糖尿病肾病进展和发展的决定因素，血流动力学因素重新引起了人们的兴趣。因此，我们研究了与糖尿病肾病中肾血管阻力升高相关的各种因素。材料与方法。对已确诊和初发糖尿病肾病患者的肾血管阻力进行测量，并通过肾内血管系统的无创彩色多普勒检查与对照组进行比较。结果。肾血管阻力与年龄、病程、肾小球滤过率、血清肌酐和视网膜病变分期相关。与使用口服降糖药（OHA）和除肾素-血管紧张素-醛固酮系统（RAAS）抑制剂以外的抗高血压药治疗的患者相比，使用RAAS抑制剂和胰岛素治疗的患者肾血管阻力显著降低。结论。该研究表明，肾血管阻力可能有助于识别有发生肾病高风险的糖尿病患者，即使在无蛋白尿的患者中，这组患者也可能是RAAS抑制和早期胰岛素治疗的候选者。
