Abstract
Abstract Background and Aims Diabetic nephropathy is the leading cause of chronic kidney disease in modern world. Timely diagnosis is of paramount importance, especially after the recent introduction of novel therapies. The presence of an already altered renal haemodynamic profile was investigated in all patients referred with suspected diabetic nephropathy, upon their initial presentation to our renal department. Method During the past seven years, from January 2015 to December 2022, 578 patients were referred to the Renal Department for ultrasound assessment. Additionally to their standard assessment, they underwent renal ultrasound and triplex examination. Diabetic nephropathy (DN) was diagnosed in 149 patients. A group of patients with an estimated GFR> 60 ml/min, without diabetic nephropathy, was randomly selected from the same pull of patients for comparison reasons (control group). Renal haemodynamics assessment, including renal arteries, aorta and intrarenal resistive indexes (RI) of both kidneys, estimated glomerular filtration rate (CKDEPI) and 24h albuminuria, were evaluated in all patients. Results The mean age of the patients was 72.5 ±10.4 vs 65.8 ±6.9 years, for the DN and control group respectively. Renal length was comparable in both groups, renal diameter of left kidney was 10.61 ±1.28 vs. 10.59 ±1.44 cm and renal diameter of right kidney was 10.53 ±1.38 vs. 9.85 ±2.89 cm for DN group and control respectively. The estimated GFR was significantly lower in the DN group, 42.1±23.6 vs. 82.7 ±11.3 ml/min (p<0.05). Both renal arteries presented higher velocity values in the DN group, 53.4 ±22.2 vs. 21.7 ±28.9 cm/sec (p<0.0001) and 52.4 ±23.9 vs. 24.8 ±32.3 (p<0.0001), for the left and right renal artery. DN patients showed RI values above upper normal limit of 0.70, being at the same time significantly higher compared to control group, 0.73 ±0.06 vs. 0.61 ±0.17 (p<0.0001) and 0.72 ±0.06 vs. 0.59 ±0.20 (p<0.0001), for the left and right kidney respectively. Conclusion The presence of significantly increased renal artery velocity in diabetic nephropathy patients compared to control patients has not been described earlier to the best of our knowledge. It represents a new finding that is mainly attributed to the presence of arteriopathy. Evaluation of renal haemodynamics using triplex ultrasound, represents a non – invasive, readily available, inexpensive examination. When performed at initial patient presentation, constitutes an invaluable tool, timely assisting to diagnosis and treatment of diabetic patients.
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