Isotopic renal study within diabetic nephropathy

Material and methods: 125 patients (IDDM:10, NIDM:115), including 62 men, ages 18-84 years, were studied. In all cases GF (Cr 51 EDTA), ERPF (I-hippuran), kidney split function (obtained from the mTc-MAG3 renogram) and basal serum creatinine (SC) were evaluated at the beginning of the study and patients were clinically followed up for 5 years by SC. Ultrasound and/or intravenous digital angiography were performed in 120 patients. Results: In patients with decreased ERPF (76 patients) the SC increased progressively during the 5 years, in both those with elevated PC (N = 54) as well as those with normal baseline (SC (n=22). In patients with normal ERPF, the SC did not change significantly during the study. An asymmetric split function (KSF < 40% in one kidney) was found in the renogram of 42 patients; in 32 of them, the ERPF was decreased. Of these, ultrasonography was normal in 9 and vascular and/or obstructive pathology was demonstrated by ultrasonography or digital angiography in only 6 patients. Conclusion: The ERPF becomes altered earlier than serum creatinine in patients with diabetic nephropathy. ERPF and split function calculation, and FG seems to have higher prognostic value than ultrasounds in the management of diabetic nephropathy. Radionuclides seem to be an accurate test than the ultrasonography to detect renal function abnormalities in patients with diabetic and thus can be an examination of choice in these patients.