INTRARENAL ARTERIOSCLEROSIS AND IMPAIRMENT OF KIDNEY-FUNCTION IN NIDDM SUBJECTS

It is currently under debate whether the pathogenesis of end-stage ren al failure in non-insulin-dependent diabetes mellitus (NIDDM) is a con sequence of microangiopathy alone. The aim of this study was to invest igate intrarenal arteriosclerosis and its correlation with kidney func tion in NIDDM, In 36 diabetic subjects, and in 10 age-and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography, Clinica l and metabolic parameters, renal function and vascular sequelae of th e disease were also evaluated. In diabetic subjects resistive index (m edian 0.72, range 0.54-0.79) was higher than in control subjects (medi an 0.62, range 0.57-0.66) (2p < 0.002). Kidney volume and resistive in dex correlated with age (p < 0.004), body mass index (p < 0.001), mean blood pressure (p < 0.001), total and LDL cholesterol (p < 0.01) and creatinine clearance (p < 0.001 and < 0.01, respectively). Kidney volu me also correlated with HbA(1) (p < 0.01), and resistive index with ur ic acid (p < 0.01). Lower body macroangiopathy was associated with inc reased resistive index and reduced kidney volume (2p < 0.05), while up per body macroangiopathy and microangiopathy were not. Our data sugges t that macroangiopathy rather than microangiopathy is mainly responsib le for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteri osclerosis and can be used as a non-invasive, easily available paramet er of its evolution.