الفهرس 
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Abstract
Diabetic nephropathy is one of the leading causes of end stage renal disease worldwide.
The diagnosis of DKD depends on different urinary and serum biomarkers. The presence of albuminuria was previously considered the corner stone for diagnosing DKD; but many studies have demonstrated that DKD can be present even in absence of albuminuria, which warranted for the development of other biomarkers as metabolomics and proteomics which are still used only for research purposes.
DKD is a major cause of mortality in diabetic patients due to increased risk of cardiovascular diseases in those patients, thus early screening and interventions for retarding the progression of DKD are required to decrease the risk of progression to end- stage renal disease and for prevention of the major cardiovascular events.
DKD is considered as one of the microvascular complications of diabetes.
Many researches have studied the value of Doppler ultarsonographic examination of the kidney as anon invasive method for early screening of diabetic nephropathy by calculating the RRI.
The aim of the current study is to assess the intrarenal resistive index as a marker for diagnosing the severity of renal disease in diabetic patients in correlation with the stage of diabetic nephropathy, the blood pressure, albuminuria and the other metabolic parameters.
This current prospective case control-study was conducted in the department of internal medicine, Assiut University hospital, Assiut, Egypt in the period from January 2019 to December 2021. A total 103 diabetic patients (47 males(45.6 %) and 56 females (57.4 %)) and 10 healthy controls were included.
The mean age of the patients was 37.36 (± 14.14) years, 42 patients (40.8 %) had type 1 DM, while 61 patients (59.2 %) had type 2 DM.
Forty-four patients (42.7 %) had disease duration less than 5 years, while 59 patients (57.3 %) had disease duration more than 5 years.
The following laboratory investigations were done to all patients:
Serum creatinine, BUN, urine analysis, urinary ACR, 2h-ppBG, HbA1C, lipogram and serum uric acid.The e-GFR was calculated to all patients by the MDRD formula.ECG was done for all patients.
All the participants underwent ultrasonographic examination and colored Doppler examination with calculation of the RRI.
The patients were categorized into 2 groups according to the RRI value, group 1 (76 patients) with normal RRI (≤0.7) and group 2 (27 patients) with raised RRI (>0.7).
Statistical analysis for the correlation between the different patients’ characteristics, laboratory tests and the RRI was done.
The current study showed that the RRI is positively correlating with the patient’s age, duration of diabetes and the diastolic blood pressure, while no correlation was found between the RRI and the presence of diabetic retinopathy or the systolic blood pressure.
It was found that the RRI is positively correlating with the 2h-PPBG, serum creatinine, BUN and the uric acid level and negatively correlating with the 2h-ppBG level and the eGFR, while no correlation with the lipid profile parameters, HbA1C or the urinary ACR.
On multivariate regression analysis it was found that only the age and the BUN are the strong predictors of raised RRI ≥ 0.7
(OR=1.066, 95% CI 1.020 – 1.114, P=0.004, and OR=1.298, 95% CI 1.057 – 1.596, P=0.013) respectively
The best cut off value for the RRI for diagnosis of eGFR <60 ml/min/1.73m2 was 0.675 with sensitivity 91.7% and specificity 73.6%.
Conclusion: baseline estimation of resistive index as a marker of intra renal vascular resistance can be an additional diagnostic tool for assessing the severity and stages of diabetic nephropathy.