Shirin M, Sharif M M, Gurung A, Datta A
Bangladesh Med Res Counc Bull. 2015 Dec;41(3):125-130. doi: 10.3329/bmrcb.v41i3.29888.
Diabetes mellitus is one of the systemic diseases affecting the kidneys. Diabetic nephropathy is a serious microvascular complication of diabetes mellitus. It is the most important,cause of death in type I diabetic patients, of whom 30%-40% eventually develop end-stage renal failure and 40% of type II diabetics are at risk of developing diabetic nephropathy. So, diagnosis of diabetic nephropathy is paramount for the survivability of the diabetic patients not only because of the consequences of renal progression but also because of the strong association with the risk of developing cardiovascular disease. A total number of 53 subjects were enrolled in this present cross sectional study in the department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration of Nephrology and Medicine of the same institution during two years (2011-13) aim to evaluate the diagnostic usefulness of renal resistive index (RI) by duplex Doppler ultrasonography for detection of renal dysfunction in diabetic patients. Clinically diagnosed diabetic patients having diabetic nephropathy referred to the department of Radiology and Imaging in BSMMU for ultrasonography of Kidneys, Ureters and Bladder (KUB) region or whole abdomen were selected as sample. Biochemical reports (Serum creatinine and Urinary albumin) and the RI value of intrarenal artery were correlated and analyzed. Only those patients biochemically were diagnosed as having diabetic nephropathy was included. Those with incomplete data, hydro nephrosis and renal calculus were excluded. Both the kidneys were visualized by commercially available real time scanner (GE Voluson) equipped with a curvilinear transducer operating at 3.5 MHz First Gray scale ultrasonography was done followed by Color Doppler of intra renal artery and then RI was measured. Majority (45.3%) patients were in 6th decade with the mean age was of 52.66±7.4 years and ranging from 38 to 65 years in patients. Male was found to be 54.7% of diabetic patients with male to female ratio 1.2:1. Resistive index of (≥ 0.7) was found in 73.6% patients with diabetes with the mean resistive index of 0.71±0.04. Positive correction between resistive index with serum creatinine (r=0.581, p<0.01) and albuminuria (r-0.725, p<0.01) were observed. It can be concluded that Resistive Index measured by duplex Doppler ultrasonography is useful diagnostic modality for detection of renal dysfunction in diabetic nephropathy patients. Resistive Index has value in identifying diabetic patients who are developing nephropathy and can be used as an additional diagnostic tool. Also it is well correlated with Serum Creatinine and Albuminuria which are the biochemical parameters to diagnose diabetic nephropathy.
糖尿病是影响肾脏的全身性疾病之一。糖尿病肾病是糖尿病严重的微血管并发症。它是I型糖尿病患者最重要的死亡原因，其中30%-40%最终会发展为终末期肾衰竭，40%的II型糖尿病患者有患糖尿病肾病的风险。因此，糖尿病肾病的诊断对于糖尿病患者的生存至关重要，这不仅是因为肾脏病变进展的后果，还因为它与心血管疾病发生风险密切相关。在两年（2011-2013年）期间，孟加拉国谢赫·穆吉布医学大学（BSMMU）放射学与影像学系与该机构的肾脏病学和医学部门合作，开展了一项横断面研究，共纳入53名受试者，旨在评估双功多普勒超声测量肾阻力指数（RI）对检测糖尿病患者肾功能不全的诊断价值。将临床诊断为患有糖尿病肾病并转诊至BSMMU放射学与影像学系进行肾脏、输尿管和膀胱（KUB）区域或全腹部超声检查的患者作为样本。对生化报告（血清肌酐和尿白蛋白）与肾内动脉的RI值进行相关性分析。仅纳入那些生化诊断为患有糖尿病肾病的患者。排除数据不完整、肾积水和肾结石患者。使用配备3.5MHz曲线探头的商用实时扫描仪（GE Voluson）对双侧肾脏进行成像。首先进行灰阶超声检查，然后对肾内动脉进行彩色多普勒检查，随后测量RI。大多数（45.3%）患者处于第六个十年，平均年龄为52.66±7.4岁，患者年龄范围为38至65岁。发现男性占糖尿病患者的54.7%，男女比例为1.2:1。73.6%的糖尿病患者肾阻力指数（≥0.7），平均阻力指数为0.71±0.04。观察到阻力指数与血清肌酐（r=0.581，p<0.01）和蛋白尿（r=0.725，p<0.01）之间呈正相关。可以得出结论，双功多普勒超声测量的阻力指数是检测糖尿病肾病患者肾功能不全的有用诊断方法。阻力指数在识别正在发生肾病的糖尿病患者方面具有价值，可作为一种辅助诊断工具。此外，它与诊断糖尿病肾病的生化参数血清肌酐和蛋白尿密切相关。
