Background・Aim: "Diabetic kidney disease" (DKD) is a collective term for all types of renal insufficiency in type 2 diabetes mellitus (T2DM). Although its introduction has facilitated diagnosis, the underlying pathophysiological mechanisms remain unclear; therefore, we recently proposed the term "metabolic syndrome nephropathy" (MetS-N). Herein, we present a new diagnostic approach for DKD/MetS-N.
Methods and Results: This retrospective analysis included 353 men with T2DM with full-house MetS (fMetS), that is, obesity, hypertension, dyslipidemia, and hyperglycemia, and were classified into the following groups: non-proteinuric without renal insufficiency, G-X (n=137), non-proteinuric with renal insufficiency, G-Y (n=169), and proteinuric with apparent kidney damage (n = 47). The current diagnostic method, which is based only on albuminuria and estimated glomerular filtration rate, was compared with a new method that combines the resistive index (RI) and renal plasma flow (RPF), which are ultrasound-determined surrogate markers of renal arteriosclerosis. The use of the new method increased the diagnosis of patients with fMetS-N from 55.2% to 95.4%, which enabled the prediction of fMetS-N progression and clarified the relationship between systemic and renal arteriosclerosis.
Conclusions: The combined use of ultrasound-determined surrogate markers of renal arteriosclerosis (RI and RPF) facilitated the diagnosis and progression of fMetS-N and its relationship with arteriosclerosis. Because of the profound influence of MetS on T2DM, analyzing RI and RPF measurements is imperative for DKD diagnosis. This new diagnostic approach may enable optimization of the management of patients with T2DM and MetS, potentially contributing to the prevention of end-stage renal failure and cerebrocardiovascular complications.
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