History Renal hypertrophy occurs early in diabetic nephropathy its later value is unknown. Hospitalier Universitaire de Bordeaux. Results The patients were mainly men (44/75) aged 62 ± 13 yrs with long-standing diabetes (duration:17 ± 9 yrs 55 type 2) and CKD: initial GFR: 56.5 (8.5-209) mL/min/1.73 m2 AER: 196 (20-2358) mg/24 H. Their mean kidney lenght (108 ± 13 mm 67 was correlated to the GFR (r = 0.23 p < MK-2048 0.05). During the follow-up 9 of the patients who had to start dialysis came from the half with the largest kidneys (LogRank: p < 0.05) despite a 40% higher initial isotopic GFR. Serum creatinine were initially lower (Small kidneys: 125 (79-320) μmol/L Large: 103 (50-371) p < 0.05) but significantly increased in the "large kidneys" group at the end of the follow-up (Small kidneys: 129 (69-283) μmol/L Large: 140 (50-952) p < 0.005 vs initial). The difference persisted in the patients with severe renal failure (KDOQI stages 4 5 Conclusions Large kidneys still predict progression in advanced CKD complicating diabetes. In these patients ultrasound imaging not only excludes obstructive renal disease but also provides information on the progression of the renal disease. Background One third of patients with diabetes have kidney damage [1]. The screening of Chronic Kidney Disease (CKD) in patients with diabetes is based on the Albumin excretion rate MK-2048 (AER threshold: 30 mg/24 H) and the estimated Glomerular Filtration Price (e-GFR threshold: 60 mL/min/1.73 m2) [2]. Additional phenomena occur previously throughout diabetic nephropathy such as for example glomerular hyperfiltration [3 4 renal hypertrophy [5] and renal histologic lesions [6] but their evaluation in day-to-day medical practice can be inconvenient: renal biopsies are intrusive GFR determinations are expensive and GFR estimations are not useful for diagnosis of hyperfiltration [7 8 Ultrasound allows non-invasive renal imaging at moderate expense and it is recommended for the first line Rabbit polyclonal to ACPT. evaluation of CKD [9] although the discovery of obstructive renal disease or tumors is rare [10]. The overal dimensions of the kidneys can also be determined by ultrasonic imaging [11]. Zerbini et al have recently shown that renal hypertrophy predicts microalbuminuria in patients with type 1 diabetes and normal renal function [12]. Whether kidney size still predicts the progression in more advanced cases when ultrasound imaging is indicated in clinical practice is unknown. In 75 patients with diabetes and CKD we measured the AER the GFR by 51Cr-EDTA clearance and kidney length by ultrasound. The patients were then enrolled in a structured collaborative care program involving diabetologists and nephrologists and followed up for 5 years to determine whether their outcome (number of dialysis onset serum creatinine and e-GFR) differed according to initial kidney size. Methods Subjects Seventy-five patients (44 men mean age 62 ± 13 yrs) were recruited from the Nutrition-Diabetology and Nephrology departments of the Centre Hospitalier Universitaire de Bordeaux. The inclusion criteria were: 1 Twenty patients had type 1 diabetes 55 type 2 2 according to an AER above 30 mg/24 MK-2048 H or a GFR below 60 mL/min/1.73 m2 not requiring renal replacement therapy at inclusion 3 ultrasound imaging MK-2048 with measurement of the length from the kidneys (Two additional individuals were excluded because they just had one kidney). The individuals gave written educated consent to take part to the analysis which was authorized by the honest committee of our organization. This scholarly study was supported with a clinical research program in the Bordeaux University Hospital. Analytical strategies The AER was established on two 24 H urine collections during a short hospitalization with an immunonephelometric analyzer (Behring Nephelometer 2) using an appropriate kit (Nantiserum VO human albumin Dade Behring). Serum creatinine was decided on a multiparameter analyzer (Olympus AU 640: Olympus Optical Tokyo Japan) using the Jaffé method with bichromatic measurements according to the manufacturer’s specifications and daily calibration of the analyzer. This procedure did not change in our laboratory during the study. The GFR was estimated from serum creatinine by the Mayo clinic quadratic equation [13]. Clearance of the radionucleide marker was measured after intravenous injection of 51Cr-EDTA (Cis Industries Gif/Yvette France). All patients were studied in the morning at 9 am after a light breakfast. After a single bolus of 100 μCi (3.7 MBq) of 51Cr-EDTA four.