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. 2025 May 27.
doi: 10.1002/jcu.24084. Online ahead of print.

Refining Non-Invasive Diagnosis of Diabetic Nephropathy: The Role of Renal Artery Resistive Index

Juan Guo  1 , Xiaoyu Li  1 , Qinjie Weng  2 , Zhifang Yang  1 , Yunyun Hu  1 , Fuzhou Yi  1 , Yue Song  1 , Ri Ji  1   3
Affiliations

Refining Non-Invasive Diagnosis of Diabetic Nephropathy: The Role of Renal Artery Resistive Index

Juan Guo et al. J Clin Ultrasound. .

Abstract

Rationale and objectives: Accurate differentiation between diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) in type 2 diabetes mellitus (T2DM) patients is crucial for effective management. This study aims to evaluate the diagnostic value of ultrasound, particularly the renal artery resistive index (RRI), in distinguishing DN from NDRD in T2DM patients with early to mid-stage chronic kidney disease (CKD).

Materials and methods: This retrospective study included 164 T2DM patients with renal disease who underwent renal biopsy. Patients were divided into a derivation group (137) and a validation group (27). Each group was further categorized into DN and NDRD subgroups based on biopsy results. Clinical, laboratory, and ultrasound data, including RRI and diabetic retinopathy (DR), were analyzed to differentiate DN from NDRD.

Results: RRI values were significantly higher in DN patients, with optimal cutoffs of ≥ 0.72 for CKD stages 1-2 and ≥ 0.74 for stage 3. Combining RRI with DR achieved a specificity and positive predictive value (PPV) of 100% for diagnosing DN, confirmed in the validation group.

Conclusions: This study emphasizes the need for distinct RRI cutoff values for T2DM patients in early and mid-stage CKD. Stage-specific RRI cutoffs, combined with DR, provide a reliable, non-invasive approach to distinguish DN from NDRD, enhancing clinical decision-making.

Keywords: diabetic nephropathy; diabetic retinopathy; non‐diabetic renal disease; non‐invasive diagnosis; renal artery resistive index.

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