Usefulness of Resistive Index and Pulsatility Index in Patient with Diabetic Nephropathy as Early Markers.
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Keywords:
Pulsatility index
Resistive index
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Resistive index
Doppler sonography
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Objective To evaluate the predicative significance of combined detection of ankle brachial index(ABI) and carotid intima-media thickness(IMT) in early diabetic nephropathy.Methods Two hundred and ten cases of diabetes mellitus in our hospital (between March 2011 to September 2012) were enrolled,ABI and IMT were tested and analyzed for evaluating the detection rate of early diabetic nephropathy.Results With the levels of ABI decreasing and IMT increasing,the morbidity rate of early diabetic nephropathy increased,and combined detection of ABI and IMT can greatly increase the detection rate of early diabetic nephropathy.Conclusions ABI and IMT in patients with early diabetic nephropathy can be used as the early diagnosis indicators,and combined detection is more valuable in the diagnosis of early diabetic nephropathy.
Key words:
Diabetes; Ankle brachial index; Carotid intima-media thickness; Early nephropathy
Predicative expression
Intima-media thickness
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Background: Chronic hyperglycemia causes oxidative stress, impairs endothelial function, facilitates monocyte adhesion to endothelial cells and thickens intima media contributing to development of atherosclerosis. The resistive index and intima-media thickness (IMT) of the carotid artery are sonographic parameters that depend on the degree of atherosclerosis. Aim: The aim of this study was to evaluate the association of carotid arterial resistive index, IMT with glycemic status in type 2 diabetic patients. Materials and methods: Thirty five type 2 diabetic patients with more than 5 year diabetic duration in the age group of 35 to 60 years were selected for this study, 20 age matched healthy individuals were selected as control group. Common carotid artery resistive index, IMT and glycated hemoglobin (HbA1C) were analyzed by conventional standardized methods. Results: The mean levels of Carotid arterial resistive index, IMT are significantly increased in diabetic patients. Common carotid artery resistive index and intima media thickness positively correlated with HbA1c. Conclusion: Evaluation of Carotid arterial resistive index and IMT could be potentially useful diagnostic markers for the assessment of atherosclerotic changes and endothelial dysfunction as a consequence of chronic hyperglycemia in diabetic patients.
Intima-media thickness
Glycated hemoglobin
Resistive index
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Pulsatility index (PI) is defined as the difference between the peak systolic flow and minimum diastolic flow velocity, divided by the mean velocity recorded throughout the cardiac cycle. It is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography. It was first introduced in 1974 by Gosling and King and is also known as the Gosling Index. PI as a method of examining macrocirculation has a variety of clinical applications. For instance, in diabetic patients, it has been measured on the common carotid, middle cerebral or renal arteries to help predict complications such as cerebrovascular disease or nephropathy. In hypertensive patients, it has been used to assess complications and assess the chronicity of the disease. To our knowledge, despite the diverse use of this ultrasonographic parameter, there is a deficiency in reports that would comprehensively summarize its clinical applications. Based on our extensive review of the literature and the gathered information, we conclude that pulsatility index (PI) is an easy to obtain parameter with a broad range of both, research and clinical applications. It has been widely used in the assessment of macrocirculation in highly prevalent chronic medical conditions, such as hypertension, both type 1 and type 2 diabetes and thyroid disorders.
Pulsatility index
Cardiac cycle
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Background: Renal and ocular vessels are some of the major vessels affected in patients with diabetes, and the involvement of these vessels is independent risk factors for other complications. Hemodynamic flow in arteries may be assessed by using measures such as resistive index, which is a non-invasive measure of the resistance in vessels. The association between retinopathy and nephropathy has been conflicting. This study assessed the relationship between resistive index of the central retinal artery and indices of nephropathy in type 2 diabetes. Method: This cross-sectional study examined 74 Nigerian diabetics who were selected consecutively from the out-patient diabetic clinic of a tertiary hospital in South-West Nigeria. Doppler ultrasound was used to determine the resistive index of the central retinal artery along with the right renal artery. The urinary and serum biochemical parameters were also done to determine the urinary albumin excretion and the glomerular filtration rate. Results: The mean age of participants was 59.62 ± 9.55 years. The mean central retinal artery resistive index (CRARI) was 0.77 ± 0.06, with 65 (87.8%) of the participants having elevated CRARI. There was no statistical difference between patients with normal CRARI and elevated CRARI in respect of their urinary albumin excretion (p = 0.796). There was no significant correlation between CRARI and estimated glomerular filtration rate (r = 0.120; p = 0.309) and right renal artery resistive index (r = 0.068; p = 0.564). Conclusion: This study demonstrates that central retinal artery resistive index (CRARI) may not be a predictor of renal function in diabetics.
Central retinal artery
Retinal Artery
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Abstract Purpose: To provide insight into the factors by which obesity in itself may directly lead to early arterial damage, we aimed to determine early sonographic markers of obesity‐related vascular dysfunction in young obese males. Methods: Thirty‐five young obese males and 23 age‐matched healthy male volunteers were recruited into the study. Common carotid artery pulsatility index and resistance index were calculated from blood flow velocities curves obtained by pulsed Doppler ultrasonography. Results: The mean pulsatility index, resistance index, body mass index, waist circumference, systolic and diastolic blood pressure, homeostasis model assessment for insulin resistance, plasma fasting glucose, insulin, C‐peptide, triglycerides, low‐density lipoprotein cholesterol, and high‐sensitivity C‐reactive protein were statistically higher in obese subjects than in healthy controls. Conclusions: Our results suggest that depressed vessel compliance and increased vascular resistance are features of young, obese, normotensive subjects independently of and in addition to cardiovascular risk factors. As changes in arterial wall properties may be incipient in young obese subjects, future studies will be required to demonstrate whether early intervention such as diet and exercise in this population can improve vascular functions. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012© 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012
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Hyperlipidemia
Pulsatility index
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Objective To explore the clinical value of renal arterial blood flow change for the diagnosis of diabetic nephropathy.Methods 24-hour urinary albumin protein excretion rate(UAER) was used as the diagnosis index of diabetic nephropathy.54 patients of Type 2 diabetes and 20 healthy people as normal control were examined by color doppler flow imaging(CDFI).Results There were significant difference in the levels of decreased diastolic blood flow velocity and increased resistance index between diabetes group and normal control group.There was a close correlationship between increased arterial blood flow intro-renal resistance index and impairment of renal function.Conclusion The degree of diabetic nephropathy can be reflected by using CDFI in the patients of diabetes,which method has an important clinical value for the diagnosis of diabetic nephropathy.
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Diabetes mellitus is the most common chronic disorder of carbohydrate metabolism, which leads to progressive atherosclerosis and failure of multiple internal organs, which in turn results in an early and severe disability. Diabetic nephropathy is one of the main microvascular complications of this disease. The article explores the usefulness of abdominal Doppler ultrasonography to validate the early changes of renal hemodynamics in patients with diabetes mellitus.
Abdominal ultrasonography
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The traditional ultrasound approach in the field of diabetic nephropathy provides only partial clinical information; moreover, the data obtained are merely descriptive, in particular regarding the involvement of the intrarenal arteries, which is however the area mainly involved. The aim of our study was to assess the data provided by Doppler ultrasound and in particular the role of the Resistive Index (RI) in a population of 160 type 2 diabetics (NIDDM), divided into 4 groups according to the severity of diabetic nephropathy. The assessment of RI has enabled us to detect among patients in the early stages of diabetic nephropathy (64 patients of group 1), a subgroup of 28 subjects (43.8%) showing RI values equal to or above the threshold value of 0.7. The determination of renal size and of renal parenchyma echogenicity proved to be of little value. The most relevant clinical information is provided by the RI, a parameter that will allow the early detection of patients affected by NIDDM, who show renal vascular involvement without however any other alterations of the traditional ultrasound parameters.
Echogenicity
Doppler ultrasound
Resistive index
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