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Use of Contrast-Enhanced Ultrasound to Study Relationship between Serum Uric Acid and Renal Microvascular Perfusion in Diabetic Kidney Disease.

Wang L, Cheng JF, Sun LP, Song YX, Guo LH, Xu JM, Wu TF, Mohan C, Peng A, Xu HX, Liu XY - Biomed Res Int (2015)

Bottom Line: DKD patients with low urinary uric acid (UUA) excretion had significantly higher AUC2 compared to DKD patients with normal UUA (P < 0.05).Hyperuricemia in DKD patients was associated with a renal ultrasound image suggestive of microvascular hyperperfusion.The CEUS parameter AUC1 holds promise as an indicator for renal microvascular hyperperfusion, while AUC2 might be a useful indicator of declining glomerular filtration rate in DKD patients with decreased excretion of uric acid.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, Zhabei District, Shanghai 200072, China.

ABSTRACT

Purpose: To investigate the relationship between uric acid and renal microvascular perfusion in diabetic kidney disease (DKD) using contrast-enhanced ultrasound (CEUS) method.

Materials and methods: 79 DKD patients and 26 healthy volunteers were enrolled. Renal function and urine protein markers were tested. DKD patients were subdivided into two groups including a normal serum uric acid (SUA) group and a high SUA group. Contrast-enhanced ultrasound (CEUS) was performed, and low acoustic power contrast-specific imaging was used for quantitative analysis.

Results: Normal controls (NCs) had the highest levels of AUC, AUC1, and AUC2. Compared to the normal SUA DKD group, high SUA DKD patients had significantly higher IMAX, AUC, and AUC1 (P < 0.05). DKD patients with low urinary uric acid (UUA) excretion had significantly higher AUC2 compared to DKD patients with normal UUA (P < 0.05).

Conclusion: Hyperuricemia in DKD patients was associated with a renal ultrasound image suggestive of microvascular hyperperfusion. The CEUS parameter AUC1 holds promise as an indicator for renal microvascular hyperperfusion, while AUC2 might be a useful indicator of declining glomerular filtration rate in DKD patients with decreased excretion of uric acid.

No MeSH data available.


Related in: MedlinePlus

Representative serial contrast-enhancement images in groups. NC, normal control; UUA, urinary uric acid; DKD, diabetic kidney disease. All the subjects went through 6 stages including “start to enhance,” “cortical enhancement,” “cortical peak,” “started fading,” “continued fading,” and “wash-out phase.” The image of cortical peak in low UUA DKD group was brighter than normal UUA DKD, and low UUA DKD group reached the “wash-out phase” slower than the normal UUA DKD group but faster than the NC group.
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fig4: Representative serial contrast-enhancement images in groups. NC, normal control; UUA, urinary uric acid; DKD, diabetic kidney disease. All the subjects went through 6 stages including “start to enhance,” “cortical enhancement,” “cortical peak,” “started fading,” “continued fading,” and “wash-out phase.” The image of cortical peak in low UUA DKD group was brighter than normal UUA DKD, and low UUA DKD group reached the “wash-out phase” slower than the normal UUA DKD group but faster than the NC group.

Mentions: In our study, NC had similar level of UUA as normal SUA, but DKD patients in high SUA group had significantly lower levels of UUA than the other two groups (P < 0.05, Table 1). Thus, DKD patients were further classified into normal UUA and low UUA group and reanalyzed. The clinical characteristics of these two groups with different excretion of UUA are listed in Supplemental Table 2. Representative serial contrast-enhancement images and curves in NC, normal UUA, and low UUA DKD groups are shown in Figures 4 and 5. Quantitative analysis indicated that DKD patients with low UUA had significantly higher level of AUC, especially AUC2, than patients with normal UUA (P < 0.05, Table 4). As before, AUC, AUC1, and AUC2 were increased significantly in NC compared to the other groups (P < 0.05, Table 4). However, there was no difference among DKD groups in IMAX, RT, TTP, and mTT (Table 4). Moreover, eGFR in the low UUA group (69.98 ± 7.06) trended to be lower than in normal UUA group (82.29 ± 6.08), but the difference did not reach statistical significance (P > 0.05). The larger AUC, especially AUC2 in the low UUA DKD patients, together with their lower eGFR, may represent stronger renal perfusion with decreased clearance.


Use of Contrast-Enhanced Ultrasound to Study Relationship between Serum Uric Acid and Renal Microvascular Perfusion in Diabetic Kidney Disease.

Wang L, Cheng JF, Sun LP, Song YX, Guo LH, Xu JM, Wu TF, Mohan C, Peng A, Xu HX, Liu XY - Biomed Res Int (2015)

Representative serial contrast-enhancement images in groups. NC, normal control; UUA, urinary uric acid; DKD, diabetic kidney disease. All the subjects went through 6 stages including “start to enhance,” “cortical enhancement,” “cortical peak,” “started fading,” “continued fading,” and “wash-out phase.” The image of cortical peak in low UUA DKD group was brighter than normal UUA DKD, and low UUA DKD group reached the “wash-out phase” slower than the normal UUA DKD group but faster than the NC group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig4: Representative serial contrast-enhancement images in groups. NC, normal control; UUA, urinary uric acid; DKD, diabetic kidney disease. All the subjects went through 6 stages including “start to enhance,” “cortical enhancement,” “cortical peak,” “started fading,” “continued fading,” and “wash-out phase.” The image of cortical peak in low UUA DKD group was brighter than normal UUA DKD, and low UUA DKD group reached the “wash-out phase” slower than the normal UUA DKD group but faster than the NC group.
Mentions: In our study, NC had similar level of UUA as normal SUA, but DKD patients in high SUA group had significantly lower levels of UUA than the other two groups (P < 0.05, Table 1). Thus, DKD patients were further classified into normal UUA and low UUA group and reanalyzed. The clinical characteristics of these two groups with different excretion of UUA are listed in Supplemental Table 2. Representative serial contrast-enhancement images and curves in NC, normal UUA, and low UUA DKD groups are shown in Figures 4 and 5. Quantitative analysis indicated that DKD patients with low UUA had significantly higher level of AUC, especially AUC2, than patients with normal UUA (P < 0.05, Table 4). As before, AUC, AUC1, and AUC2 were increased significantly in NC compared to the other groups (P < 0.05, Table 4). However, there was no difference among DKD groups in IMAX, RT, TTP, and mTT (Table 4). Moreover, eGFR in the low UUA group (69.98 ± 7.06) trended to be lower than in normal UUA group (82.29 ± 6.08), but the difference did not reach statistical significance (P > 0.05). The larger AUC, especially AUC2 in the low UUA DKD patients, together with their lower eGFR, may represent stronger renal perfusion with decreased clearance.

Bottom Line: DKD patients with low urinary uric acid (UUA) excretion had significantly higher AUC2 compared to DKD patients with normal UUA (P < 0.05).Hyperuricemia in DKD patients was associated with a renal ultrasound image suggestive of microvascular hyperperfusion.The CEUS parameter AUC1 holds promise as an indicator for renal microvascular hyperperfusion, while AUC2 might be a useful indicator of declining glomerular filtration rate in DKD patients with decreased excretion of uric acid.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchangzhong Road, Zhabei District, Shanghai 200072, China.

ABSTRACT

Purpose: To investigate the relationship between uric acid and renal microvascular perfusion in diabetic kidney disease (DKD) using contrast-enhanced ultrasound (CEUS) method.

Materials and methods: 79 DKD patients and 26 healthy volunteers were enrolled. Renal function and urine protein markers were tested. DKD patients were subdivided into two groups including a normal serum uric acid (SUA) group and a high SUA group. Contrast-enhanced ultrasound (CEUS) was performed, and low acoustic power contrast-specific imaging was used for quantitative analysis.

Results: Normal controls (NCs) had the highest levels of AUC, AUC1, and AUC2. Compared to the normal SUA DKD group, high SUA DKD patients had significantly higher IMAX, AUC, and AUC1 (P < 0.05). DKD patients with low urinary uric acid (UUA) excretion had significantly higher AUC2 compared to DKD patients with normal UUA (P < 0.05).

Conclusion: Hyperuricemia in DKD patients was associated with a renal ultrasound image suggestive of microvascular hyperperfusion. The CEUS parameter AUC1 holds promise as an indicator for renal microvascular hyperperfusion, while AUC2 might be a useful indicator of declining glomerular filtration rate in DKD patients with decreased excretion of uric acid.

No MeSH data available.


Related in: MedlinePlus