The observation of enlarged perivascular spaces and white matter hyperintensities in patients with type 2 diabetic nephropathy based on MRI

Abstract

Background & Objective: Diabetic nephropathy (DN) is one of the common complications of diabetes, and cerebral small vessel disease is associated with cognitive deficits and functional impairment. This study aims to explore the correlation between enlarged perivascular spaces (EPVS) and white matter hyperintensities (WMH) with different stages of type 2 DN, and to evaluate the relationship of diabetes- related parameters with EPVS and WMH.

Methods: A total of 213 type 2 diabetic participants with possible DN underwent 3T MRI and laboratory analysis. The participants were grouped according to the urinary albumin-to-creatinine ratios (UACR) or estimated glomerular filtration rate (eGFR), respectively. EPVS number and grade were rated on MRI in the centrum semiovale (CSO-EPVS) and basal ganglia (BG-EPVS). Periventricular and deep WMH (PWMH and DWMH) were also graded on MRI. The logistic regression analysis was performed to evaluate the association of risk factors with EPVS and WMH.

Results: eGFR was associated with the severity of BG-EPVS (p=0.033), DWMH and PWMH (both p<0.001), and UACR was associated with the severity of BG-EPVS (p=0.010) and DWMH (p<0.001). HbA1c (p=0.013 for DWMH, p=0.024 for PWMH), I2/I0 (p=0.032 for BG-EPVS and DWMH, p=0.014 for PWMH) and CysC (p=0.002 for DWMH, p=0.043 for PWMH) showed associations with the severity of WMH.

Conclusions: Our study indicated the close correlation of kidney function related parameters (eGFR and UACR) and cerebral small vessel diseases (mainly EPVS and WMH) in patients with DN. HbA1c, I2/I0 and CysC may be the risk indicators of WMH in this population.