Analyse of influence elements in the process of dynamic renal imaging to measure glomerular filtration rate and effective renal plasma flow in patients with type 2 diabetes mellitus

Abstract

Objective To detect the changes and clinical influence elements of radionuclide renal dynamic imaging to measure glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) in patients with type 2 diabetes mellitus (T2DM). Methods One hundred and eight patients with T2DM were divided into 4 groups according to the values of urinary albumin excretion rate ( UAER ): Group Ⅰ: UAER＜20μg·min-1, 31 cases. Group Ⅱ: UAER 20～200μg·min-1, 28 cases. Group Ⅲ: UAER ＞200μg ·min-1,serum creatinine(SCr)＜105μmol/L, 26 cases. GroupⅣ: UAER＞200μg·min-1, SCr≥ 105μmol/L, 23 cases.99Tcm-diethylenetriamine pentaacetic acid and 99Tcm-ethylenedicysteine renal dynamic imaging were performed in all patients. GFR, ERPF and renogram were derived simultaneously. The levels of blood creatinine, blood urea nitrogen, urine albumin, blood press, fasting blood insulin, glycosylated hemoglobin, fasting blood glucousewere measured in the four groups. Results With the evolvement of diabetes nephropathy ( DN ),UAERs were gradually ascended and the values of GFR and ERPF was gradually descended, the former offered remarkable inverse correlation with the two latters(r1= -0.497, P＜0.05; r2=-0.215, P＜0.05). The values of GFR and ERPF in four groups patients with hypertension was lower than without hypertension (t1=1.8, t2=2.1, t3=1.9, P＜0.05; t4=3.2, P＜0.01). Multielement stepwise regression analyses assumed that age, systolic pressure, glycosylated hemoglobin and insulin resistance index offered inverse correlationwith GFR and ERPF (coefficient of regression factor: -0.507、 -0.874, -0.528、 -0.587, -0.336、 -0.697, -0.348、 -0.371, P＜0.01). Conclusion GFR and ERPF were sensitive index reflecting the changes of DN.Hypertension and insulin resistance were independence risk factors to make the value of GFR and ERPF decreased in patients with DN. Key words: Diabetes mellitus, type 2; Diabetic nephropathies; Glomerular filtration rate; Renal plasma flow, effective; Tomography, emission-computed, single-photon; Technetium Tc 99m pentetate; 99Tcm-ethylenedicysteine