Laursen Jens Christian, Søndergaard-Heinrich Niels, Haddock Bryan, Rasmussen Ida Kirstine Bull, Hansen Christian Stevns, Larsson Henrik Bo Wiberg, Groop Per-Henrik, Bjornstad Petter, Frimodt-Møller Marie, Andersen Ulrik Bjørn, Rossing Peter
Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
Department of Clinical Medicine, the Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
Clin Kidney J. 2022 May 20;15(11):2072-2080. doi: 10.1093/ckj/sfac145. eCollection 2022 Nov.
We used magnetic resonance imaging (MRI) to study kidney energetics in persons with and without type 1 diabetes (T1D).
In a cross-sectional study, 15 persons with T1D and albuminuria and 15 non-diabetic controls (CONs) underwent multiparametric MRI (3 Tesla Philips Scanner) to quantify renal cortical and medullary oxygenation (R*, higher values correspond to higher deoxyhaemoglobin concentration), renal perfusion (arterial spin labelling) and renal artery blood flow (phase contrast). Analyses were adjusted for age, sex, systolic blood pressure, plasma haemoglobin, body mass index and estimated glomerular filtration rate (eGFR).
Participants with T1D had a higher median (Q1; Q3) urine albumin creatinine ratio (UACR) than CONs [46 (21; 58) versus 4 (3; 6) mg/g; < .0001] and a lower mean ± SD eGFR (73 ± 32 mL/min/1.73 m versus 88 ± 15 mL/min/1.73 m; = .12), although not significantly. Mean medullary R* was lower in T1D (34 ± 6/s versus 38 ± 5/s; < .01) corresponding to a higher oxygenation. R* was not different in the cortex. Cortical perfusion was lower in T1D (163 ± 40 versus 224 ± 49 mL/100 g/min; < .001). Renal artery blood flow was lower in T1D than in CONs (360 ± 130 versus 430 ± 113 mL/min; = .05). In T1D, lower cortical oxygenation and renal artery blood flow were both associated with higher UACR and lower eGFR ( < .05).
Participants with T1D and albuminuria exhibited higher medullary oxygenation than CONs, despite lower cortical perfusion and renal artery blood flow. This might reflect perturbed kidney energetics leading to a higher setpoint of medullary oxygenation in T1D. Lower cortical oxygenation and renal artery blood flow were associated with higher UACR and lower eGFR in T1D.
我们使用磁共振成像（MRI）研究1型糖尿病（T1D）患者和非T1D患者的肾脏能量代谢情况。
在一项横断面研究中，15名患有T1D且有蛋白尿的患者和15名非糖尿病对照者（CONs）接受了多参数MRI检查（3特斯拉飞利浦扫描仪），以量化肾皮质和髓质氧合（R*，值越高表示脱氧血红蛋白浓度越高）、肾脏灌注（动脉自旋标记）和肾动脉血流（相位对比）。分析针对年龄、性别、收缩压、血浆血红蛋白、体重指数和估计肾小球滤过率（eGFR）进行了校正。
T1D患者的尿白蛋白肌酐比值（UACR）中位数（Q1；Q3）高于CONs[46（21；58）对4（3；6）mg/g；<0.0001]，且平均±标准差eGFR较低（73±32 mL/min/1.73 m²对88±15 mL/min/1.73 m²；P = 0.12），尽管差异不显著。T1D患者的平均髓质R较低（34±6/s对38±5/s；P<0.01），这对应着较高的氧合水平。皮质的R无差异。T1D患者的皮质灌注较低（163±40对224±49 mL/100 g/min；P<0.001）。T1D患者的肾动脉血流低于CONs（360±130对430±113 mL/min；P = 0.05）。在T1D患者中，较低的皮质氧合和肾动脉血流均与较高的UACR和较低的eGFR相关（P<0.05）。
患有T1D和蛋白尿的患者尽管皮质灌注和肾动脉血流较低，但髓质氧合高于CONs。这可能反映了肾脏能量代谢紊乱，导致T1D患者髓质氧合设定点较高。T1D患者中较低的皮质氧合和肾动脉血流与较高的UACR和较低的eGFR相关。
