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Can renal resistive indeks be a usefule marker of early renal impairment in children with type 1 diabetes

Objective: The aim of this study was to determine the Renal resistive index measured by the Doppler ultrasound method in children with type 1 diabetes who are normoalbuminuric and in normal age-matched controls. Renal resisitve index is an indicator of increased vasculature intrarenal resistance. Subjects and methods:. In this cross-sectional study 76 health children and 76 children with type 1 diabetes age 10-18 years were included, with a disease duration of 2-10 years with normal renal function and normoalbuminuria . The Doppler renal resistive index was measured in subjects in both groups. In a study group a blood sample was taken for glycated hemoglobin and in both groups blood samples for creatinine, lipids, serum uric acid and first-morning urine samples for albumin/creatinine ratio were taken. Results: Lower serum creatinin (<0.001) and serum uric acid (0.014) and higher albumin/creatinin ratio (p=0.004) were observed in type 1 diabetes group. Higher estimated glomerular filtration was also observed in type 1 diabetic group although not statistically significant. Higher renal resisitive index was found in type 1 diabetes group (p <0.001. No differences were found in age, gender distribution, blood pressure or pubertal development. An unsupervised machine learning approach was used to identify a possible marker for renal impairment within the diabetic group. With the expectation maximization method 2 groups were identified, the so-called clusters of patients with common characteristics. Common features of Cluster 2, compared to Cluster 1, are higher renal resisitve index values, albumin/creatinin ratio, estimated glomerular filtration, lower serum creatinin and lower diastolic blood pressure. Conclusion: Renal resistive index is increased early in type 1 diabetes mellitus and it may be helpful as an early marker in diagnosing preclinical stage of diabetic nephropathy in normoalbuminuric children with type 1 diabetes mellitus.

Doppler renal resistive index, Diabetes Mellitus Type 1, children

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