Nephrology Dialysis Transplantation, Vol 13, Issue 3 630-634, Copyright © 1998 by Oxford University Press
H Baumgartl, G Sigl, P Banholzer, M Haslbeck and E Standl
Background: Approximately 10-30% of IDDM patients
develop diabetic nephropathy depending on the metabolic control. Previous
examinations on the significance of the kidney size prior to the
manifestation of nephropathy produced varying results.
Methods: The present study, therefore, was designed to
assess the correlation between sonographically determined kidney size and
kidney function over 8 years in a follow-up examination, and to evaluate a
potential risk pattern. Data could be collected from 73 (66%) of 110 IDDM
patients with initially normal serum creatinine whose sonographically
determined kidney volume (cm3=L cm x W cm x D cm x
&pgr;/6) and kidney function (creatinine, albuminuria,
{beta}2-microglobulin in serum) had been examined in 1986, and who had a
diabetes duration of 1 month to 25 years at that time.
Results: 30% (11 of 37) patients with large kidneys
(<170 cm3) reached at lest one serious renal
end-point (increase of serum creatinine by more than 50%, requirement of
dialysis or kidney transplantation, or death in end-stage renal disease)
versus one of 36 patients with normal kidney size
(P<0.002). As many as 42% of patients with large kidneys developed
abnormal creatinine values (>106 &mgr;mol/l) in contrast to only
20% of the patients with normal kidney volume (P<0.05). Six of seven
patients with a more than 50% increase of serum creatinine from baseline
showed large kidneys in 1986, but had a normal serum creatinine, and four
also a normal urine albumin excretion. Furthermore all five patients with
more severe endpoints (two deaths in end-stage renal disease and three
patients presently requiring dialysis) exhibited either an increased serum
creatinine or large kidneys at baseline; four of these, however, were still
in the normoalbuminuric state in 1986. Conclusions:
These results indicate that large kidneys might be a morphological marker
for subsequent diabetic nephropathy, and as a consequence, renal
insufficiency. Key words: nephropathy; ultrasound;
kidney size
ORIGINAL ARTICLES
On the prognosis of IDDM patients with large kidneys
Diabetes Research Institute, 3rd Medical Department, City Hospital Munich Schwabing, Kolner Platz 1, D-80804 Munchen, Germany; Corresponding author
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