Hindawi Publishing Corporation International Journal of Vascular Medicine Volume 2011, Article ID 656030, 7 pages doi:10.1155/2011/656030 Clinical Study Determinants of Intravascular Resistance in Indian Diabetic Nephropathy Patients: A Hospital-Based Study Anubhav Thukral, 1 Manish Mishra, 1 Vaibhava Srivastava, 1 Hemant Kumar, 1 Amit Nandan Dhar Dwivedi, 2 Ram Chandra Shukla, 2 and Kamlakar Tripathi 1 1 Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India 2 Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India Correspondence should be addressed to Kamlakar Tripathi, kamlakar tripathi@yahoo.co.in Received 31 January 2011; Revised 8 April 2011; Accepted 12 April 2011 Academic Editor: Marc A. Passman Copyright © 2011 Anubhav Thukral et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims and Objectives. Metabolic dysregulation has failed to explain clinical variability of patients with diabetic nephropathy and hence a renewed interest emerged in haemodynamic factors as determinant of progression and development of diabetic nephropathy. We therefore studied for various factors which can correlate with raised renal vascular resistance in diabetic nephropathy. Material and Methods. Renal vascular resistance was measured in patients with established and incipient diabetic nephropathy and compared with controls using noninvasive color Doppler examinations of intrarenal vasculature. Results. Renal vascular resistance correlated with age, duration of disease, GFR, serum creatinine, and stage of retinopathy. Renal vascular resistance was significantly reduced in patients on treatment with RAAS inhibitors and insulin, than those on OHA and antihypertensives other than RAAS inhibitors. Conclusion. The study implies that renal vascular resistance may help identify diabetics at high risk of developing nephropathy, and these set of patients could be candidates for RAAS inhibition and early insulin therapy even in patients without albuminuria. 1. Introduction Diabetes and its complications pose an immense amount of social and economic burden on the health infrastructure and resources throughout the globe. Diabetic nephropathy is the single most common cause of end-stage renal disease (ESRD) throughout the globe accounting for a whooping 25–45% of all patients enrolled in ESRD programmes [1]. Diabetic nephropathy is also a leading cause of chronic kid- ney disease (CKD) in India accounting for about 30% of all CKD patients [2]. Recent estimates suggest that soon India, China, and United States are and will remain the countries with largest number of diabetics [3]. In spite of several decades of research since 1940’s when several studies linked diabetes to renal disease [4, 5], there are still large gaps in the knowledge and understanding of pathophysiology of diabetic nephropathy. One of the intriguing controversies has been that which patients of diabetes (type 1/type 2) are predisposed and are likely to progress to diabetic nephropathy. Several studies have demonstrated that only about 40% of patients of Type 1 and Type 2 diabetes have renal involvement. These set of patients that progress to frank diabetic nephropathy have been labeled as “progressors” and the other set of patients that in spite of similar control of blood sugar and long-term poor glycemic control do not progress have been labeled as “nonprogressors” [6]. There has been a paradigm shift in the understanding of factors held responsible for this discrepancy in the natural history of these two sets of patients with the balance tilting towards hemodynamic factors rather than towards metabolic factors [7]. The other, controversy in diabetic nephropathy surrounds the concept of microalbuminuria. Albuminuria has been linked to diabetic renal disease as early as 1836 by Bright [8]. Several studies have established microalbumin- uria as a hallmark of diabetic nephropathy and microalbu- minuria has been used as a predictive marker for progressive decline in renal function [9–11], however few researchers