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Abstract
Forty-seven patients with type 1 (insulin-dependent) diabetes mellitus and 14 normal subjects had renal volume determined by an ultrasonic technique. Renal volume of 299±49 ml/1.73 m2 (mean±SD) in type 1 diabetic patients with normal urinary albumin excretion exceeded that in the normal subjects (245±53 ml/1.73 m2, p<0.05). Compared with diabetic patients with normal urinary albumin excretion, renal volume was significantly higher in patients with microalbuminuria (372±24 ml/1.73 m2, p<0.05) and patients with clinical nephropathy (352±48 ml/1.73 m2, p<0.05). In a multiple linear regression with HbA1c, urinary albumin excretion, age, diabetes duration and mean blood pressure as independent variables, variations in HbA1c could account for 33% of the variations in kidney volume (n=47, r=0.57, p<0.01). The other variables played no role. When only patients without clinical nephropathy were included, HbA1c and kidney volume remained significantly correlated (n=34, r=0.60, p<0.01). In those patients a strong correlation between kidney volume and function, i.e. the glomerular filtration rate was found (n=34, r=0.70, p<0.01); metabolic control and function were also correlated (n=34, r=0.62, p<0.01). The urinary albumin excretion accounted for only 6% of the variation of the kidney volume (NS). In nine patients with microalbuminuria the kidney volume could be reduced during 2 years of improved metabolic control by means of insulin infusion pumps. Kidney volume was unchanged in a control group of 10 patients with microalbuminuria receiving conventional insulin treatment. The kidneys remained enlarged as the glomerular filtration rate declined along with the development of clinical diabetic nephropathy. At this stage the association between kidney volume and metabolic control could no longer be detected. If hypertrophy of the kidneys, as suggested by others, should turn out to be a predictor of nephropathy, it might be a result of the close association between poor metabolic control and excessive renal enlargement.