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Increased renal resistive index as a marker of early stage of diabetic nephropathy in normoalbuminuric children with type 1 diabetes mellitus

Aim: The aim of this study was to compare the Renal resistive index (RI) measured by the Doppler ultrasound method in children with type 1 diabetes (T1D) who are normoalbuminuric and in normal, age- matched controls. RI is an indicator of increased vasculature intrarenal resistance, that occurs in the impaired renal function of patients suffering from T1D. Increased intrarenal RI could be useful as a marker when diabetic nephropathy is being developed. Materials and methods: In this cross-sectional study 76 healthy children and 76 children with T1D age 10-18 were included, with a disease duration from 2 to 10 years with normal renal function and normoalbuminuria. The Doppler RI was measured in subjects in both groups. In the study group a blood sample was taken for HbA1C and in both groups blood samples for serum creatinine, serum lipids and first-morning urine samples for albumin / creatinine ratio were taken. Results: Statistically significant differences were found in mean RI (mRI), p <0.001, which was significantly higher in the diabetic group (0.6 ± 0.04), compared to the control group (0.58 ± 0.04). An unsupervised machine learning approach was used to identify a possible marker for renal impairment within the diabetic group. With the expectation maximization (EM) 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 RI values and albumin/creatinine ratio in first- morning urine samples, elevated glomerular filtration and HDL cholesterol, lower serum creatinine and urine, lower diastolic pressure values. Conclusion: Renal RI is increased early in T1D and it may be helpful as an early marker in diagnosing preclinical stage of diabetic nephropathy in normoalbuminuric children with T1D.

Doppler renal resistive index, Diabetes Mellitus Type 1, children

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