Evaluation of Proteinuria in Normotensive Diabetics in a Tertiary Care Hospital (original) (raw)
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Panacea Journal of Medical Sciences, 2018
Type 2 diabetes mellitus is the disease which has reached epidemic proportion worldwide. Diabetic kidney disease (DKD) is an important and irreversible microvascular complication of diabetes mellitus which is characterized by persistent proteinuria, hypertension and progressive irreversible decline in renalfunction. The present study was carried out to stratify proportion of diabetic nephropathy as reflected by proteinuria, according to duration of diabetes mellitus as well as to identify the possible demographic, anthropometric and hemodynamic risk factors for the development of proteinuria. This crosssectional study was conducted on 74 patients of type 2 diabetes mellitus. Age, sex, height, weight, systolic and diastolic blood pressure and body mass index was recorded. 4ml of fasting venous blood was collected under aseptic precaution. Proteinuria was assessed semi quantitatively using dipsticks. All data is presented as Mean±SD. Unpaired student t-test was used to compare mean values of continuous variable. Total 37 out of 74 participants showed FPG 126 or more mg/dl out of which 22/37(59.5%) showed no proteinuria but 15/37(40.5%) showed proteinuria. Total 14(18.9%) participants out of 74 were obese out of which 57.1% (8/14) did not have proteinuria while 42.9% (6/14) hadproteinuria. There was clear association seen in frequency of proteinuria with the duration of diabetes. 45% of patients who had diabetes for more than 10 years developed proteinuria as compared to 35.7% and 10% patients who had proteinuria for 5-10 years and less than 5 years respectively. Frequency of proteinuria in type 2 DM patients was 24.32%. Predictors were BMI, FBG and duration of diabetes mellitus. Early measurements should be taken to control obesity, blood pressure and blood glucose to reduce the occurrence of diabetic nephropathy.
Diabetes Research and Clinical Practice, 2000
Aim: To assess the usefulness of an estimated proteinuria (EPE) using the protein to creatinine ratio (P/C ratio) in a random urine sample for follow-up evaluation of kidney function in diabetic patients. Research designs and methods: 410 newly registered Type 2 diabetic patients had annual follow-up for 6 years (M:F 263:147). EPE was calculated by estimation of P/C ratio in random urine sample. Based on the EPE they were divided into those with normal protein excretion (B100 mg/dl), mild proteinuria (100 to B500 mg/dl) and nephropathy (persistent proteinuria \ 500mg/dl) cases. The study subjects were divided into 4 groups based on the proteinuria status at follow-up. Anthropometry, measurement of blood pressure and retinopathy were carried out for all study subjects. Results: at the baseline, 342 (83.4%) had normal protein excretion, 53 (12.9%) had mild proteinuria and 15 (3.7%) had nephropathy. At the follow-up the respective numbers were 276 (67.3%), 64 (15.6%) and 70(17%). During the study period nephropathy developed in 55 (13.4%) and mild proteinuria in 11 (2.7%). Nephropathy developed in 32 (6.7%) subjects in the non-proteinuria group and in 23 (43.4%) of the mild proteinuric subjects. Conversion to nephropathy was greater in the latter group (2 =41.6, PB0.0001). Nephropathy cases had higher duration of diabetes at the baseline (8.8 96.4 years) and at follow-up (7.1 96.0 years) and higher prevalence of hypertension when compared with non-proteinuric group (60 and 43.5% compared with 11.1%, P B0.01). New cases of hypertension were detected in 32.8% of proteinuric and 0.7% of normal protein excretion subjects (2 = 32.24, P =0.0001). During the follow-up 55 of the 70 nephropathy subjects (78.6%) developed retinopathy compared with ten out of the 276 subjects with normal protein excretion (3.6%) (2 =200.6, P =0.0001). Conclusion: EPE is useful in serial evaluation of kidney function. The risk conferred by hypertension, mild proteinuria and duration of diabetes in producing nephropathy are also highlighted. EPE could be used in developing countries to assess the renal function on a follow-up basis.
Prevalence and determinants of proteinuria among type 2 diabetics
Diabetic nephropathy is the leading cause of end stage kidney disease among type 2 diabetics worldwide. Proteinuria has been noted to be the cardinal symptom of progressive loss of renal function. This study examined the impact of duration of diabetes, demography (age, gender) and metabolic factors on the frequency of proteinuria among type 2 diabetics visiting the Komfo Anokye Teaching Hospital (KATH). In this cross-sectional study, 350 type 2 diabetics aged between 28-87 years were randomly selected from January to April 2004, and parameters estimated include fasting blood glucose (FBS), body mass index (BMI), urine protein and blood pressure. Proteinuria among the study cohorts was graded no proteinuria, mild proteinuria to heavy proteinuria. The frequency of proteinuria for the varied grades in type 2 diabetics enrolled in the study ranged from 73.3% (no proteinuria), 15.2% (mild proteinuria) and 15.6% (heavy proteinuria). 1(100%) patient with heavy proteinuria presented with grade 3 hypertension; and 4(33.3%) and 11(20.8%) patients presented with grade 1 and isolated systolic hypertension respectively. Multiple logistic regression analysis showed study participants with duration of diabetes ranging from 11-15 years (OR=2.8; 95% CI=1.1-7.2; p=0.028) and 16-20 years (OR=5.6; 95% CI=1.4-22.5; p=0.016) were at an increased risk of pro-teinuria. The frequency of nephropathy is promoted independently by advanced age, hypertension and duration of diabetes.
Correlation between Proteinuria and Glomerular Filtration Rate in Type 2 Diabetes Mellitus
Majalah Kedokteran Bandung, 2020
Indonesia faces a double burden of communicable and non-communicable diseases, including metabolic and degenerative problems. Delay in the detection of diabetic nephropathy (DN) as one of the chronic microvascular complications is often seen, leading to the need for hemodialysis due to the end-stage renal disease (ESRD). An assessment of diabetes mellitus (DM) control target achievement, based on the guideline from the Indonesian Society of Endocrinology (Perkumpulan Endokrinologi Indonesia, PERKENI), and nephropathy early detection was performed in 54 Type-2 DM patients from 5 private hospitals in Pekanbaru Riau, Indonesia, from November 2018 to September 2019. Results showed poor achievement of DM control with 61.1% had abnormal body mass index (BMI), 57.5% had HbA1c >7%, and 77.7% had LDL serum >100 mg/dL. Nevertheless, most patients achieved good blood pressure control (74%). A high percentage of nephropathy-proteinuria was seen (40.7%) with 40.9% of them revealed renal insufficiency classified as chronic kidney disease (CKD) stage 3 and 4. There was a significant correlation between proteinuria and declined GFR (p= 0.016), onset of DM (p= 0.02), and diastolic blood pressure (p= 0.03). No correlation was found between HbA1c and declined GFR, which may be due to the cross-sectional nature of the study. It will be interesting to perform a prospective study on proteinuria modification as a predictor of nephropathy early detection in DM patients since kidney biopsy and urine albumin creatinine ratio assessment are not available in primary health care services in remote areas.
Diabetic Proteinuria Revisited: Updated Physiologic Perspectives
Cells
Albuminuria, a hallmark of diabetic nephropathy, reflects not only injury and dysfunction of the filtration apparatus, but is also affected by altered glomerular hemodynamics and hyperfiltration, as well as by the inability of renal tubular cells to fully retrieve filtered albumin. Albuminuria further plays a role in the progression of diabetic nephropathy, and the suppression of glomerular albumin leak is a key factor in its prevention. Although microalbuminuria is a classic manifestation of diabetic nephropathy, often progressing to macroalbuminuria or overt proteinuria over time, it does not always precede renal function loss in diabetes. The various components leading to diabetic albuminuria and their associations are herein reviewed, and the physiologic rationale and efficacy of therapeutic interventions that reduce glomerular hyperfiltration and proteinuria are discussed. With these perspectives, we propose that these measures should be initiated early, before microalbuminuria...
Glycemic status, lipid profile and proteinuria in diabetic nephropathy
JNMA; journal of the Nepal Medical Association
Diabetic nephropathy is one of the major complications of Diabetes Mellitus characterized by persistent albuminuria, elevated arterial blood pressure, a relentless decline in glomerular filtration rate (GFR) and a high risk of cardiovascular morbidity and mortality. In this study, urinary micro-albumin estimation was done in 177 diabetic patients. This study aims to ascertain association of glycemic status, lipid profile and proteinuria in Type 2 Diabetes Mellitus with nephropathy. Among 177 patients, 26 had frank proteinuria, 79 had micro-albuminuria and 72 were without proteinuria. Increased frequency of proteinuria was seen in male than female. Micro-albuminuria and frank proteinuria was seen more in older age group. The multiple comparisons showed the significantly increased levels of urea, creatinine, fasting blood glucose in micro-albuminuria and overt proteinuria patients in comparison to without proteinuria. Glycated hemoglobin level was increased with the increasing age gro...
BMC Nephrology, 2019
Background: Although there is a large volume of literature regarding the definition and epidemiology of. Type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m 2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241-57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m 2 per year) (Chawla et al Nat Rev Nephrol 241-57 2017; Andrassy Kidney Int 622-623 2013). Case presentation: We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46-60 mL/min per 1.73m 2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease. Conclusion: We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression.