Hemodynamic alteration in diabetic nephropathy measured by renal Doppler ultrasonography: does it predict the outcome of the disease?

We read the article by Dr. Futrakul et al. with interest [1]. They searched for a parameter that was more sensitive than microalbuminuria for early detection of diabetic nephropathy and compared creatinine clearence, fractional excretion of magnesium and intrarenal hemodynamics by renal scintigraphic evaluation. For this purpose, they calculated peritubular capillary flow, efferent arteriolar resistance, glomerular hydrostatic pressure and filtration coefficient of glomerular capillary with 99mTc-labelled DTPA (diethylene triamine pentaacetic acid) and 131I-labelled hippuran renal scintigraphy. Accordingly, we have designed a study to examine the intrarenal hemodynamic abnormalities in different stages of nephropathy and further measured the intrarenal resistive index (RI) and pulsatility index of interlobar arteries detected by renal Doppler ultrasonography (USG) for each kidney. For our ongoing prospective randomized trial, we included 20 healthy, non-diabetic patients as a control group; 26 type-2 diabetic patients with microalbuminuria and 19 type-2 diabetic patients with albuminuria as study groups. The clinical characteristics of the control and diabetic subjects with their mean RI values are reported in Table 1.