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. 2023 Feb;48(2):669-679.
doi: 10.1007/s00261-022-03763-3. Epub 2022 Dec 8.

Diagnostic performance of hypoechoic perinephric fat as a predictor of prediabetes and diabetes

Luyao Shen  1 , Justin R Tse  2 , Lindsey M Negrete  2 , Andy Shon  2 , Luke Yoon  2 , Tie Liang  2 , Aya Kamaya  2
Affiliations

Diagnostic performance of hypoechoic perinephric fat as a predictor of prediabetes and diabetes

Luyao Shen et al. Abdom Radiol (NY). 2023 Feb.

Abstract

Purpose: To evaluate prevalence and predictive value of hypoechoic perinephric fat (HPF) in patients with prediabetes and diabetes compared to non-diabetics.

Methods: Of 240 patients with renal ultrasound and hemoglobin A1c (HbA1c) measurements, 114 patients had either prediabetes (HbA1c 5.7-6.4%) or diabetes (HbA1c ≥ 6.5%), and 126 patients did not. Two radiologists (blinded to diagnosis) reviewed images and discrepancies were resolved by a third. Inter-reader agreement was compared using free-marginal kappa and intraclass correlation coefficient. Fisher's exact test, Mann-Whitney test, multivariable logistic regression, and Spearman's rank correlation test with two-tailed p < 0.05 were used to determine statistical significance.

Results: HPF was exclusively identified in prediabetic and diabetic patients with a prevalence of 23% (vs 0%; p < 0.001). Identification of HPF had almost perfect inter-reader agreement (k = 0.94) and was statistically significant (p = 0.034) while controlling for body mass index (BMI) and estimated glomerular filtration rate in multivariable analysis. HPF had extremely high specificity and positive predictive value (100% for both) in patients with prediabetes and diabetes although it was not a sensitive finding (23% sensitivity). In patients with prediabetes and diabetes, those with HPF were statistically significantly more likely to have chronic kidney disease (CKD) (p = 0.003). There was no statistically significant difference in BMI, stages of CKD, and types of diabetes.

Conclusion: Hypoechoic perirenal fat has almost perfect inter-reader agreement and is highly specific for and predictive of prediabetes and diabetes. Its presence may also help identify those with chronic kidney disease among prediabetic and diabetic patients.

Keywords: Diabetes mellitus; Hypoechoic perirenal fat; Kidney; Metabolic syndrome; Prediabetes.

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