Diyabetik nefropatide konvansiyonel ve renkli doppler ultrasonografi bulgularının tanıya katkısı

Abstract

ÖZET Haziran 1997-Mart 1998 tarihleri arasında 63 diyabet ve 28 kontrol olgu su konvansiyonel ve renkli Doppler US ile araştırıldı. Kontrol grubunda 14 erkek (% 50), 14 kadın (% 50) toplam 28 olgu vardı (Ortalama yaş 45±10.5 yıl). Diyabetik olgular nefropati gelişmemiş (normoalbuminürik) erken diyabetik nefropati tesbit edilen (mikroalbuminürik) ve yerleşmiş diyabetik nef- ropatisi olanlar (makroalbuminürik) şeklinde alt gruplara ayrıldı. Normoalbuminürik grupta 8 erkek (% 36.4) ve 14 kadın (% 63.6) toplam 22 olgu vardı (Ortalama yaş 52.1±8.7 yıl, ortalama diyabet süresi 7.2±7.6 yıl idi). Mikroalbuminürik grupta 9 erkek (% 42.9) ve 12 kadm (% 57.1) toplam 21 olgu vardı (Ortalama yaş 55.0±11.8 yıl, ortalama diyabet süresi 11.5±8.3 yıl idi). Makroalbuminürik grupta 9 erkek (% 45) ve 11 kadın (% 55) toplam 20 olgu vardı (Ortalama yaş 59.5±9.1 yıl, ortalama diyabet süresi 14.2±5.7 yıl72 idi). Konvansiyonel US incelemesinde böbrek uzunluğu, parankim kalınlığı ve böbrek hacmi yönünden tüm olgu grupları arasında istatistiksel olarak an lamlı farklılık bulunmadı. Kortikal eko skoru makroalbuminürik diyabet olgularında, kontrol ve normoalbuminürik diyabet olgularına göre istatistiksel olarak anlamlı daha yüksek bulundu. Makroalbuminürik olgulardaki kortikal eko skoru artışının literatür bulguları ışığında parankimal tutulumla paralellik gösterdiği ancak diyabete özgü olmadığı sonucuna varıldı. Renkli Doppler incelemede normoalbuminürik olgularda ortalama Rİ 0.67+0.04, ortalama Pİ 1.23±0.05 bulundu. Dört olguda (% 18) Rİ 0.70'ten, 1 olguda (% 4.5) ise Pİ 1.50'den büyük değerdeydi. Mikroalbuminürik olgularda ortalama Rİ 0.74±0.06, ortalama Pİ 1.57±0.31 idi. Rİ 17 olguda (% 80.9), Pİ 16 olguda (% 76.2) 0.70 ve 1.50'den büyük değer deydi. Makroalbuminürik olgularda ortalama Rİ 0.81±0.07, ortalama Pİ 1.97± 0.47 idi. Olguların tamamında Rİ 0.70'in üzerindeydi. Onyedi olguda (% 85) Pİ 1.50'nin üzerindeydi. Kontrol olgularında ortalama Rİ 0.63±0.03, ortalama Pİ 1.12±0.12 idi. Erken diyabetik nefropati dönemindeki olguların tanı ve takibinde Rİ ve Pİ değerlerinin diğer laboratuar bulgularıyla kullanılabileceği sonucuna va rıldı.

SUMMARY Sixty three patients with diabetes mellitus and 28 patients as a control group are evaluated by conventional and color Doppler sonographic examination in Erciyes University Hospital between June 1997 and March 1998. Control group included 14 males (50 %) and 14 females (50 %). The mean age was 45±10.5 years. Diabetic cases were classified into three groups according to the clinical stage of renal disease: Group 1 patients had no nephropathy (clinically asymptomatic, normoalbuminuric group), group 2 had early diabetic nephropathy (microalbuminuric group, serum BUN values were < 23 mg/dL or > 23 mg/dL, serum creatinine values were <1.6 mg/dL), group 3 had well- established nephropathy (macroalbuminuric group, serum BUN values were < 23 mg/dL or > 23 mg/dL, serum creatinin values were < 1.6 mg/dL or > 1.6 mg/dL. The normoalbuminuric group (n=22) consisted of 8 males (36.4 %) and 14 females (63.6 %). Mean age was 52.1±8.7 years and the average time period since the diagnosis was 7.2±7.6 years. The microalbuminuric group (n=21) consisted of 9 males (42.9 %) and 12 females (57.1 %). Mean age was 55±11.8 years. The average time period since74 the diagnosis was 11.5±8.3 years. The macroalbuminuric group (n=20) consisted of 9 males (45 %) and 11 females (55 %). Mean age was 59.5+9.1 years, and the average time period since the diagnosis was 12.4±5.7 years. In conventional sonographic examination, there was no statistically difference between the groups in kidney length, parenchymal thickness and volume. Renal cortical echo score was found to be higher in macroalbuminuric group than the control and the normoalbuminuric groups. However this finding is not specific for diabetic nephropathy. In the normoalbuminuric group mean RI value was 0.67±0.04 and mean PI value was 1.23±0.15. In 4 cases (18 %) RI was over than 0.70 and one case (4.5 %) PI was over than 1.50. In microalbuminuric group mean RI value was 0.74±0.06 and mean PI value was 1.57+0.31. RI values were over normal value in 17 cases (80.9 %) whereas PI values were high in 16 cases (76.2 %). In macroalbuminuric group, mean RI value was 0.81+0.07 and mean PI value was 1.97+0.47. In all cases, RI values were over 0.70. In 17 cases (85 %) PI values were over 1.50. The mean values for RI and PI in the control group were 0.63±0.03 and 1.12±0.12 respectively. As a result, RI and PI measurements, together with clinical and laboratory findings can be used in the diagnosis and follow up of the cases with early diabetic nephropathy.