الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
iabetic microvascular complications are often asymptomatic during their early stages, and once symptoms develop, there is little to be done to cure them. Therefore, screening needs to be started early during adolescence. Renewed attention has been given to renal resistive index to detect early renal impairment .
In the present study, we aimed to assess the Renal arterial resistance (Renal resistive index) in children and adolescents with Type 1 diabetes mellitus and it’s relationship to diabetic microvascular complications (nephropathy, retinopathy and sensory neuropathy) as well as to various clinical and laboratory parameters of diabetes.
The study was conducted on 100 children and adolescents with Type 1 DM. They were recruited randomly from regular attendants at Pediatric Diabetes Clinic,Children‘s Hospital, Ain Shams University in the period from October 2013 to July 2014 .They were further subdivided into two subgroups :
Group 1 included 50 patients with type1 DM and normo-albuminuria .
Group 2, included 50 patients with type1 DM and increased urinary albumin excretion (UAE) > 30mg /24 hours..
D
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They were 37(37 %) males and 63 females (63 %); their mean age was 13.6 ± 2.53 years (range 10-19) and mean disease duration was 8.867±2.260 years (range 5-13).
Fifty age and sex matched healthy individuals served as a control group . They were 27 males (54%) and 23 females (46% ); their mean age was 13.48 ± 2.29 years (range 10-18) .
from the course of this study we found that the following parameters were higher in diabetic patients than the control group with a significant value:
- Serum triglycerides
- Left renal resistive index
- Mean renal resistive index
While the following parameters were significantly different in microalbuminuric patients (group 1B) than non - microalbuminuric patients (group 1A):
- Higher systolic blood pressure
- Higher mean renal resistive index
- Lower serum HDL
- Serum triglycerides and HbA1c had borderline values (p= 0.053 , p= 0.057 respectively) .
In a comparison done between the patients and the control group, analysis of the Receiver Operating characteristic (ROC) curve to detect a cut off for the mean resistive index value that can
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discriminate between the two groups showed that value of mean RI > 0.53 has sensitivity=83.67 %, specificity=44.9%, positive predictive value = 75.2%, negative predictive values=57.9 %.
At this cut off level of mean RI (0.53) we found that none of the clinical parameters or the laboratory investigations showed positive predictive value to renal resistive index.
Comparatively, analysis of the Receiver Operating characteristic (ROC) curve done between microalbuminuric (group 1B) and non microalbuminuric diabetic patients (group 1A) showed cut off level of mean RI at > 0.58 has sensitivity=60.0 %, specificity=72.9%, positive predictive value = 69.8%, negative predictive values=63.6 % .
At this cut off level of mean RI (0.58) we found that only serum glycated hemoglobin (HbA1c) showed positive predictive value to renal resistive index with a significant p value (<0.003) .
Relations between renal resistive index & different clinical & biochemical parameters in each patients group showed that RI is correlated positively with serum triglycerides (r=0.363, p=0.01) .
Regarding the occurrence of microvascular complications in diabetic patients , we found that there is a significant relation between the occurrence of peripheral neuropathy and increased mean renal resistive index (p<0.05) .
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The following parameters had a positive predictor relation with increased urinary albumin excretion (UAE):
- Disease duration more than 10 years
- Body weight at 5th- 95th percentile
- Body height 5th- 95th percentile
- Systolic blood pressure 75th-90th percentile
- Early puberty (Tanner stage 2,3)
- Serum HbA1c more than 7.5 % .
While the following parameters had a positive predictor relation with increased renal resistive index (RI) :
- Disease duration above 10 years .
- Serum HbA1c at a level above 7.5 % .
- Early puberty (Tanner stage 2, 3).
In conclusion, this study has showed a positive relation between increased renal resistive index (RI) and diabetic micro-vascular complications (nephropathy and sensory neuropathy) over long disease duration and bad glycemic control.
These results may suggest the use of renal resistive index (RI) as a useful complementary test for the evaluation of functional alterations in renal hemodynamics in early stages of diabetic nephropathy and possible concurrent microvascular diabetic