Intrarenal Hemodynamic Alterations and Their Biochemical Correlates in Type 2 Diabetes: A Doppler Ultrasound Study

ORIGINAL ARTICLE
Marwa Mohammed Shareif Farah, Awadia Gareeballah, Moawia Gameraddin, Marzoug Ahmed Ali Hussaun, Mogahid M. A. Zidan, Elrashid AbdElrahim, et al.

 
For citation: Farah MMS, Gareeballah A, Gameraddin M, Hussaun MAA, Zidan MMA, AbdElrahim E, Abouraida RA, Ahmed AM, Hassan N, Elgyoum AMA. Intrarenal Hemodynamic Alterations and Their Biochemical Correlates in Type 2 Diabetes: A Doppler Ultrasound Study. International Journal of Biomedicine. 2026;16(1):71-77. doi:10.21103/Article16(1)_OA9
 
Originally published March 5, 2026

Abstract: 

Background: Diabetic nephropathy (DN) is a major cause of chronic kidney disease (CKD) and end-stage renal disease worldwide. While biochemical markers such as blood urea nitrogen, serum creatinine, estimated glomerular filtration rate (eGFR), and albuminuria are routinely used, early and subclinical renal dysfunction may be missed. Renal Doppler ultrasound, particularly the resistive index (RI) and pulsatility index (PI), provides a noninvasive tool for assessing intrarenal hemodynamics. This study aimed to explore the association between common biochemical markers and renal Doppler ultrasound parameters in diabetic patients and to evaluate how factors such as glycemic control and disease duration influence these measures.
Methods and Results: A cross-sectional study was conducted on type 2 diabetes (T2D). Biochemical markers and Doppler indices were measured. Appropriate statistical tests were performed to examine relationships between biochemical and Doppler ultrasound findings. Of the 150 patients (mean age of 51.2 ± 8.4 years), 41.3% had poor glycemic control (HbA1c > 8%). Both RI and PI exhibited significant negative correlations with eGFR (P<0.001) and significant positive correlations with blood urea and serum creatinine. RI and PI values were noticeably higher in patients with poorer glycemic control and longer duration of diabetes. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) had no significant correlation with biochemical markers (P>0.05).
Conclusion: In patients with T2D, there is a strong correlation between biochemical markers of renal dysfunction and renal Doppler ultrasound parameters, particularly RI and PI. These parameters worsen with poor glycemic control and longer disease duration.

Key Points
• High intrarenal Doppler indices (RI, PI) correlate with worse eGFR stages and higher albuminuria in T2D patients.
• Poor glycemic control and longer duration of diabetes both predict more pronounced renal dysfunction on Doppler.
• Renal Doppler ultrasound holds promise as an adjunct tool for early detection and ongoing assessment of diabetic nephropathy.

Keywords: 
diabetes • Doppler ultrasound • resistive index • pulsatility index • eGFR
References: 
  1. Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine (Abingdon). 2014 Dec;42(12):698-702. doi: 10.1016/j.mpmed.2014.09.007. PMID: 25568613; PMCID: PMC4282306.
  2. Al-Jawaldeh A, Abbass MMS. Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region. Front Nutr. 2022 Mar 16;9:817808. doi: 10.3389/fnut.2022.817808. PMID: 35369054; PMCID: PMC8970016.
  3. IDF diabetes atlas [Internet]. 8th ed. Brussels:  International Diabetes Federation; 2017 [cited 2025 Aug 30]. Available from: https://fmdiabetes.org/wp-content/uploads/2018/03/IDF-2017.pdf
  4. Vedaraju KS, Benegal DS. Correlation of Renal Artery Resistive Index with Albuminuria and Other Risk Factors in Type 2 Diabetes Mellitus Patients. International Journal of Contemporary Medicine, Surgery and Radiology. 2019 Jan;4(1).
  5. Khalifa AGM, Sweed I, Shalaby AI, El Alfy A. Renal Ultrasound and Renal Duplex Ultrasonography for Prediction of Diabetic Nephropathy in Correlation to Biochemical Markers &amp; Glomerular Filtration Rate. The Egyptian Journal of Hospital Medicine. 2025 Apr 1;99(1):1744–50.
  6. K C T, Das SK, Shetty MS. Renal Resistive Index: Revisited. Cureus. 2023 Mar 13;15(3):e36091. doi: 10.7759/cureus.36091. PMID: 37065373; PMCID: PMC10096815.
  7. Sugiura T, Nakamori A, Wada A, Fukuhara Y. Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol. 2004 Feb;61(2):119-26. doi: 10.5414/cnp61119. PMID: 14989631.
  8. Platt JF. Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol. 1992 May;158(5):1035-42. doi: 10.2214/ajr.158.5.1566663. PMID: 1566663.
  9. Veglio F, Frascisco M, Melchio R, Provera E, Rabbia F, Oliva S, Chiandussi L. Assessment of renal resistance index after captopril test by Doppler in essential and renovascular hypertension. Kidney Int. 1995 Nov;48(5):1611-6. doi: 10.1038/ki.1995.455. PMID: 8544422.
  10. Platt JF, Ellis JH, Rubin JM, DiPietro MA, Sedman AB. Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. AJR Am J Roentgenol. 1990 Jun;154(6):1223-7. doi: 10.2214/ajr.154.6.2110732. PMID: 2110732.
  11. Sharma K, Thakur MK, Mahela S, Konwar R, Varma D, Ullah IK, et al. Role of renal doppler ultrasonography in evaluating renal haemodynamics in diabetic patients and its correlation with laboratory parameters (serum HbA1C and serum creatinine). International Journal of Research in Medical Sciences. 2023 May 29;11(6):2174–80.
  12. Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, Maekawa K, Hosoi M, Inaba M, Emoto M, Morii H. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int. 1997 Jun;51(6):1920-7. doi: 10.1038/ki.1997.261. PMID: 9186883.
  13. O'Neill WC. Renal resistive index: a case of mistaken identity. Hypertension. 2014 Nov;64(5):915-7. doi: 10.1161/HYPERTENSIONAHA.114.04183. Epub 2014 Aug 25. Erratum in: Hypertension. 2015 Aug;66(2):e9. doi: 10.1161/HYP.0000000000000032. PMID: 25156171.
  14. Gaurav K, Yalavarthy U, Chamberlain N, Pugh S, Panda M. Correlation between Renal Resistive Index and Estimated Glomerular Filtration Rate in Patients with Hypertension. Journal for Vascular Ultrasound. 2008 Jun;32(2):82–4.
  15. Soyoye DO, Dawha SD, Ayoola OO, Ibitoye BO, Ikem RT, Adedeji TA. Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus. West Afr J Med. 2018 Sep-Dec;35(3):189-194. PMID: 30387092.
  16. Chen Q, He F, Feng X, Luo Z, Zhang J, Zhang L, Wang Y, Tong J. Correlation of Doppler parameters with renal pathology: A study of 992 patients. Exp Ther Med. 2014 Feb;7(2):439-442. doi: 10.3892/etm.2013.1442. Epub 2013 Dec 10. PMID: 24396421; PMCID: PMC3881055.
  17. Baz AA, Abdeen EM, Helmy MY, Al-Bohy AEM. Diagnostic utility of renal shear wave elastography and renal Doppler findings in diabetic nephropathy: a case–control study. Egyptian Journal of Radiology and Nuclear Medicine. 2024 Mar 15;55(1).
  18. Abe M, Akaishi T, Miki T, Miki M, Funamizu Y, Araya K, Ishizawa K, Takayama S, Takase K, Abe T, Ishii T, Ito S. Influence of renal function and demographic data on intrarenal Doppler ultrasonography. PLoS One. 2019 Aug 27;14(8):e0221244. doi: 10.1371/journal.pone.0221244. PMID: 31454365; PMCID: PMC6711528.
  19. Miyoshi K, Okura T, Nagao T, Jotoku M, Enomoto D, Irita J, et al. HbA1c is an Independent Determinant of Renal Vascular Resistance Estimated by Doppler Sonography in Non-Diabetic Hypertensive Patients. Clinical medicine Endocrinology and diabetes. 2008 Jan;1:CMED.S936.
  20. Lotfinejad M, Rashedi A, Amirkhanlou S. The Survey of Relationship Between Resistance Index of Renal Artery and Albuminuria in Diabetic Patients Referring to Shahid Sayyad Shirazi Hospital, 2017 to 2018. Iran J Kidney Dis. 2020 Sep;14(5):358-364. PMID: 32943590.
  21. Khan A, Ahmed A, Bhutta MR, Zafar I, Khan MNN, Ehsan J. Correlation Between Resistive Index and Serum Creatinine in Patients with Diabetic Nephropathy. Pakistan Armed Forces Medical Journal. 2023 Apr 18;73(2):435–8.
  22. Nasir M, Maryam S, Abdul Qadir S, Fatima M. Correlation Between Renal Artery Resistive Index and Renal Function Tests in Type II Diabetic Patients. Avicenna Journal of Health Sciences. 2024 Jul;1(3):62–6.
  23. Youssef DM, Fawzy FM. Value of renal resistive index as an early marker of diabetic nephropathy in children with type-1 diabetes mellitus. Saudi J Kidney Dis Transpl. 2012 Sep;23(5):985-92. doi: 10.4103/1319-2442.100880. PMID: 22982911.
  24. Hamano K, Nitta A, Ohtake T, Kobayashi S. Associations of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients. Diabetes Care. 2008 Sep;31(9):1853-7. doi: 10.2337/dc08-0168. Epub 2008 Jun 19. PMID: 18566339; PMCID: PMC2518358.
  25. Nosadini R, Velussi M, Brocco E, Abaterusso C, Carraro A, Piarulli F, Morgia G, Satta A, Faedda R, Abhyankar A, Luthman H, Tonolo G. Increased renal arterial resistance predicts the course of renal function in type 2 diabetes with microalbuminuria. Diabetes. 2006 Jan;55(1):234-9. PMID: 16380498.

Download Article
Received November 6, 2025.
Accepted December 12, 2025.
©2026 International Medical Research and Development Corporation.