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Diabetologia
Published in: Diabetologia 9/2011

01-09-2011 | Article

Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes

Authors: R. M. Bruno, E. Daghini, L. Landini, D. Versari, A. Salvati, E. Santini, I. Di Paco, A. Magagna, S. Taddei, L. Ghiadoni, A. Solini

Published in: Diabetologia | Issue 9/2011

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Abstract

Aim/hypothesis

Renal resistive index is a useful measure for quantifying alterations in renal blood flow. In the present study we evaluated resistive index at baseline and after vasodilation induced by nitroglycerine in normoalbuminuric patients with type 2 diabetes or essential hypertension, relating the values to indices of systemic vascular dysfunction.

Methods

Newly diagnosed treatment-naïve type 2 diabetic (n = 32) and hypertensive patients (n = 49) were compared with 27 age- and sex-matched healthy controls. Renal resistive index was obtained by duplex ultrasound at baseline and after 25 μg sublingual nitroglycerine. Endothelium-dependent (flow-mediated dilation) and -independent (response to nitroglycerine) vasodilation in the brachial artery was assessed by computerised edge detection system. Carotid–femoral pulse-wave velocity and augmentation index were assessed by applanation tonometry. Nitrotyrosine levels, an index of oxidative stress, were also measured.

Results

Resistive index was higher in diabetic than in hypertensive patients and controls (p < 0.001), while changes in resistive index induced by nitroglycerine were lower in hypertensive patients compared with controls (p < 0.01), and were further reduced in type 2 diabetic patients. Hypertensive and diabetic patients showed significantly increased arterial stiffness, nitrotyrosine levels and reduced endothelial function than controls (p < 0.05). Changes in resistive index induced by nitroglycerine were independently related to serum glucose, reactive hyperaemia and aortic pulse-wave velocity in the overall population.

Conclusions/interpretation

These results support the dynamic evaluation of renal resistive index as an early detector of renal vascular alterations in the presence of type 2 diabetes and hypertension, even before the onset of microalbuminuria.
Literature
1.
Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187PubMedCrossRef
2.
Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605PubMedCrossRef
3.
Virdis A, Ghiadoni L, Versari D, Giannarelli C, Salvetti A, Taddei S (2008) Endothelial function assessment in complicated hypertension. Curr Pharm Des 14:1761–1770PubMedCrossRef
4.
Ghiadoni L, Bruno RM, Stea F, Virdis A, Taddei S (2009) Central blood pressure, arterial stiffness, and wave reflection: new targets of treatment in essential hypertension. Curr Hypertens Rep 11:190–196PubMedCrossRef
5.
de Zeeuw D (2007) Albuminuria: a target for treatment of type 2 diabetic nephropathy. Semin Nephrol 27:172–181PubMedCrossRef
6.
Bakker SJ, Gansevoort RT, de Zeeuw D (2009) Albuminuria: what can we expect from the determination of nonimmunoreactive albumin? Curr Hypertens Rep 11:111–117PubMedCrossRef
7.
Futrakul N, Sridama V, Futrakul P (2009) Microalbuminuria—a biomarker of renal microvascular disease. Ren Fail 31:140–143PubMedCrossRef
8.
Ruilope LM, Segura J (2009) Kidney protection: a key target in the management of patients with diabetes. J Hypertens 27(Suppl 1):S15–S18CrossRef
9.
Weir MR (2009) Hypertension and the kidney: perspectives on the relationship of kidney disease and cardiovascular disease. Clin J Am Soc Nephrol 4:2045–2050PubMedCrossRef
10.
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G (2004) Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care 27:195–200PubMedCrossRef
11.
Ikee R, Kobayashi S, Hemmi N et al (2005) Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis 46:603–609PubMedCrossRef
12.
Krumme B (2006) Renal Doppler sonography—update in clinical nephrology. Nephron Clin Pract 103:c24–c28PubMedCrossRef
13.
Derchi LE, Leoncini G, Parodi D et al (2005) Mild renal dysfunction and renal vascular resistance in primary hypertension. Am J Hypertens 18:966–971PubMedCrossRef
14.
Hamano K, Nitta A, Ohtake T, Kobayashi S (2008) Associations of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients. Diabetes Care 31:1853–1857PubMedCrossRef
15.
Radermacher J, Chavan A, Bleck J et al (2001) Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 344:410–417PubMedCrossRef
16.
Platt JF, Ellis JH, Rubin JM (1991) Examination of native kidneys with duplex Doppler ultrasound. Semin Ultrasound CT MR 12:308–318PubMed
17.
Frauchiger B, Nussbaumer P, Hugentobler M, Staub D (2000) Duplex sonographic registration of age and diabetes-related loss of renal vasodilatory response to nitroglycerine. Nephrol Dial Transplant 15:827–832PubMedCrossRef
18.
Ghiadoni L, Penno G, Giannarelli C et al (2008) Metabolic syndrome and vascular alterations in normotensive subjects at risk of diabetes mellitus. Hypertension 51:440–445PubMedCrossRef
19.
Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612PubMed
20.
Ghiadoni L, Huang Y, Magagna A, Buralli S, Taddei S, Salvetti A (2001) Effect of acute blood pressure reduction on endothelial function in the brachial artery of patients with essential hypertension. J Hypertens 19:547–551PubMedCrossRef
21.
Gemignani V, Bianchini E, Faita F et al (2008) Ultrasound measurement of the brachial artery flow-mediated dilation without ECG gating. Ultrasound Med Biol 34:385–391PubMedCrossRef
22.
Plantinga Y, Ghiadoni L, Magagna A et al (2007) Supplementation with vitamins C and E improves arterial stiffness and endothelial function in essential hypertensive patients. Am J Hypertens 20:392–397PubMedCrossRef
23.
Jerums G, Panagiotopoulos S, Premaratne E, MacIsaac RJ (2009) Integrating albuminuria and GFR in the assessment of diabetic nephropathy. Nat Rev Nephrol 5:397–406PubMedCrossRef
24.
Keogan MT, Kliewer MA, Hertzberg BS, DeLong DM, Tupler RH, Carroll BA (1996) Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology 199:165–169PubMed
25.
Platt JF, Ellis JH, Rubin JM (1991) Renal transplant pyelocaliectasis: role of duplex Doppler US in evaluation. Radiology 179:425–428PubMed
26.
Platt JF, Marn CS, Baliga PK, Ellis JH, Rubin JM, Merion RM (1992) Renal dysfunction in hepatic disease: early identification with renal duplex Doppler US in patients who undergo liver transplantation. Radiology 183:801–806PubMed
27.
Florczak E, Januszewicz M, Januszewicz A et al (2009) Relationship between renal resistive index and early target organ damage in patients with never-treated essential hypertension. Blood Press 18:55–61PubMedCrossRef
28.
Ishimura E, Nishizawa Y, Kawagishi T et al (1997) Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int 51:1920–1927PubMedCrossRef
29.
Pontremoli R, Viazzi F, Martinoli C et al (1999) Increased renal resistive index in patients with essential hypertension: a marker of target organ damage. Nephrol Dial Transplant 14:360–365PubMedCrossRef
30.
Lim SC, Caballero AE, Smakowski P, LoGerfo FW, Horton ES, Veves A (1999) Soluble intercellular adhesion molecule, vascular cell adhesion molecule, and impaired microvascular reactivity are early markers of vasculopathy in type 2 diabetic individuals without microalbuminuria. Diabetes Care 22:1865–1870PubMedCrossRef
31.
McVeigh GE, Brennan GM, Johnston GD et al (1992) Impaired endothelium-dependent and independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 35:771–776PubMed
32.
Henry RM, Ferreira I, Kostense PJ et al (2004) Type 2 diabetes is associated with impaired endothelium-dependent, flow-mediated dilation, but impaired glucose metabolism is not: the Hoorn Study. Atherosclerosis 174:49–56PubMedCrossRef
33.
Roman MJ, Devereux RB, Kizer JR et al (2007) Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 50:197–203PubMedCrossRef
34.
Ohta Y, Fujii K, Arima H et al (2005) Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler sonography. J Hypertens 23:1905–1911PubMedCrossRef
35.
Safar ME, Lacolley P (2007) Disturbance of macro- and microcirculation: relations with pulse pressure and cardiac organ damage. Am J Physiol Heart Circ Physiol 293:H1–H7PubMedCrossRef
36.
Zoungas S, de Galan BE, Ninomiya T et al (2009) Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: new results from the ADVANCE trial. Diabetes Care 32:2068–2074PubMedCrossRef
37.
Leoncini G, Martinoli C, Viazzi F et al (2002) Changes in renal resistive index and urinary albumin excretion in hypertensive patients under long-term treatment with lisinopril or nifedipine GITS. Nephron 90:169–173PubMedCrossRef
38.
Arnlov J, Evans JC, Meigs JB et al (2005) Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 112:969–975PubMedCrossRef
Metadata
Title
Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes
Authors
R. M. Bruno
E. Daghini
L. Landini
D. Versari
A. Salvati
E. Santini
I. Di Paco
A. Magagna
S. Taddei
L. Ghiadoni
A. Solini
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 9/2011
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-011-2148-y

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