Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?

  1. Richard J. MacIsaac, BSC(HONS), PHD, MBBS, FRACP1,
  2. Sianna Panagiotopoulos, BSC(HONS), PHD1,
  3. Karen J. McNeil, MBBS, FRACP, MPH+TM1,
  4. Trudy J. Smith, BSC, MAPPSC1,
  5. Con Tsalamandris, MBBS1,
  6. Huming Hao, MD, DMU2,
  7. P. Geoffrey Matthews, MBBS, PHD, DDU, FRACP2,
  8. Merlin C. Thomas, MBCHB, FRACP, PHD3,
  9. David A. Power, FRACP, PHD4 and
  10. George Jerums, MBBS, FRACP, MD1
  1. 1Endocrine Centre and Department of Medicine, University of Melbourne, Austin Health, Heidelberg West, Victoria, Australia
  2. 2Vascular Laboratory, Austin Health, Heidelberg, Victoria, Australia
  3. 3Danielle Alberti Memorial Centre for Diabetic Complications, Baker Institute, Melbourne, Victoria, Australia
  4. 4Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
  1. Address correspondence and reprint requests to R.J. MacIsaac, Endocrine Centre, Austin Health, Heidelberg Repatriation Hospital, Waterdale Road, Heidelberg West, Victoria 3081, Australia. E-mail: r.macisaac{at}unimelb.edu.au

Abstract

OBJECTIVE—To investigate the role of intrarenal vascular disease in the pathogenesis of nonalbuminuric renal insufficiency in type 2 diabetes.

RESEARCH DESIGN AND METHODS—We studied 325 unselected clinic patients who had sufficient clinical and biochemical information to calculate an estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease six-variable formula, at least two estimations of urinary albumin excretion rates (AER), and a renal duplex scan to estimate the resistance index of the interlobar renal arteries. The resistance index, measured as part of a complications surveillance program, was compared in patients with an eGFR < or ≥60 ml/min per 1.73 m2 who were further stratified into normo- (AER <20), micro- (20–200), or macroalbuminuria (> 200 μg/min) categories.

RESULTS—Patients with an eGFR <60 ml/min per 1.73 m2 had a higher resistance index of the renal interlobar arteries compared with patients with an eGFR ≥60 ml/min per 1.73 m2. However, the resistance index was elevated to a similar extent in patients with an eGFR <60 ml/min per 1.73 m2 regardless of albuminuric status (normo- 0.74 ± 0.01, micro- 0.73 ± 0.01, and macroalbuminuria resistance index 0.75 ± 0.11). Multiple regression analysis revealed that increased age (P < 0.0001), elevated BMI (P = 0.0001), decreased eGFR (P < 0.01), and decreased diastolic blood pressure (P < 0.01), but not an increased AER, were independently associated with an elevated resistance index in patients with impaired renal function.

CONCLUSIONS—Subjects with type 2 diabetes and reduced glomerular filtration rate had similar degrees of intrarenal vascular disease, as measured by the intrarenal arterial resistance index, regardless of their AER status. The pathological mechanisms that determine the relationship between impaired renal function and AER status in subjects with type 2 diabetes remain to be elucidated.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted April 14, 2006.
    • Received September 22, 2005.
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  1. doi: 10.2337/dc05-1788 Diabetes Care July 2006 vol. 29 no. 7 1560-1566
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