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The increase in prevalence of diabetes in India is one of the leading causes of blindness due to micro vascular and macro vascular complications. The complications in retina and kidney are due to damage of small vessels. Studies have shown significant association between diabetic retinopathy and diabetic nephropathy. In our study, we are discussing the complications during intra and post-operative period and also both anatomical and functional outcome in these patients after vitrectomy for proliferative diabetic retinopathy. Both eye and kidney share same vascular pattern. One pre-existing condition can be followed by the other condition due to similar microvascular damage. We wanted to evaluate the outcome of vitrectomy in proliferative diabetic retinopathy patients associated with chronic kidney disease.METHODSThis is a retrospective study done at Sarojini Devi Eye Hospital, Telangana State, South India, over a two-year period from June 2017 to June 2019. Data was collected from old medical records of our institute, from patients who presented to Retina Dept. with various complaints. They were examined in detail, documented and treated based on clinical presentation after clearance from physician. Patients presented with different ocular manifestations like non-resolving vitreous haemorrhage, focal tractional retinal detachment, multi focal tractional retinal detachment like broad based, table top, combined retinal detachment and tractional maculopathy. Patients underwent pars plana vitrectomy with or without silicone oil endotamponade.RESULTSPrognosis in these patients was good only in cases of non-resolving vitreous haemorrhage and focal tractional retinal detachment (47.61%) whereas in cases like multifocal retinal detachment cases outcome was favourable (42.82%) but patients with combined retinal detachment (9.52%) had poor anatomical and visual outcome.CONCLUSIONSManagement of these patients is very difficult when there is severe proliferative diabetic retinopathy with multiple broad vitreo retinal adhesions. Outcome is very poor particularly in patients of severe proliferative diabetic retinopathy associated with chronic kidney disease and coronary artery disease due to intra operative complications
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Introduction: Diabetic nephropathy is the leading causeof End Stage Renal Disease in the world, accounting formore than one third of the cases. Micro albuminuria isa marker of wide spread micro vascular damage in Type 2Diabetes Mellitus and an earliest marker for nephropathy.The correlation between presence of overt proteinuria andproliferative diabetic retinopathy have been demonstrated inboth Type 1 and Type 2 diabetic patients. There is an increasingevidence that micro albuminuria could be used as a marker forearly diabetic retinopathy. However, this relationship has notbeen established in our setting. Hence, we planned to evaluatethe prevalence as well as correlation of micro albuminuria andretinopathy in patients of Type 2 Diabetes Mellitus.Material and Methods: 100 Type 2 diabetic patients willingto participate, were enrolled in the study after due approvalfrom the Institutional Ethical committee. Prevalence of microalbuminuria was checked using Micral test. Body Mass Indexand Glycosylated Hemoglobin were also measured. Patientswere evaluated by direct and indirect ophthalmoscopy to lookfor evidence of retinopathy.Results: 56% patients were male with majority of them(70%) were in the age group of 40-60 years. In 39%patients, duration of diabetes was less that 5 years and equalpercentage of patients had micro albuminuria. 45% patientsshowed signs of diabetic retinopathy, whereas, both microalbuminuria and retinopathy were observed in 32% ofpatients (p <0.001). Compared to overall prevalence of microalbuminuria and retinopathy, patients with age more than50 years showed higher prevalence of 51.61% and 56.45%(p=0.001) respectively. Micro albuminuria (52.45%) anddiabetic retinopathy (57.37%) were more likely with durationof diabetes above 6 years (p=0.001). Other factors whichwere statistically significant were Glycosylated Hemoglobin(HbA1c) more than 7% and Body Mass Index (BMI) >25kg/m2.Conclusion: The study showed that there is significantcorrelation between the presence of micro albuminuria anddiabetic retinopathy. Several factors like increase in age,duration of diabetes, HbA1c levels on admission and bodymass index are associated with increased prevalence of microalbuminuria and diabetic retinopathy
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Introducción: Se ha demostrado que la presencia de micro albuminuria puede reflejar el desarrollo de enfermedad cardiovascular en pacientes con diabetes mellitus, este fenómeno también se ha observado en pacientes no diabéticos. Objetivo: Determinar la prevalencia de micro albuminuria en pacientes hipertensos no diabéticos tratados en la Consulta Externa del Hospital General San Juan de Dios. Métodos: Medición de micro albuminuria con tira reactiva urinaria Micral-Test® en 86 pacientes con hipertensión esencial de 1 a 10 años de evolución. Resultados: Se encontró una prevalencia total de micro albuminuria de 81%. Con ICC se encontró diferencia estadísticamente significativa entre el grupo de pacientes que presentó micro albuminuria con 99% de significancia. (p 0.03) IC 95%. No se encontró diferencia estadísticamente significativa entre los grupos de pacientes con y sin micro albuminuria con el resto de variables a estudio.
Introduction: It known that the presence of microalbuminuria can reflect the development of cardiovascular disease in patients with or without diabetes. Objective: To determine the prevalence of microalbuminuria in hypertensive non diabetic patients treated in the outpatient clinic for hypertension in Hospital General San Juan de Dios. Methods: Measure of microalbuminuria using the Micral-Test® reactive urine strip in 86 patients with 1 to 10 years of being diagnosed with essential hypertension. Results: Total prevalence of microalbuminuria was 81%. CHF had statistical difference between the group of patients with and without microalbuminuria with 99% of significance (p 0.03). There was not statistical difference between the group of patients with and without microalbuminuria in the rest of the variables studied.
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Introduction: Hypertension is a major cause of morbidity and mortality. The heart, arterial vessels, brain, kidney and retinal vasculature are major target organs adversely affected by high blood pressure. In adults there is a continuous incremental risk of target organ damage across levels of both systolic and diastolic blood pressure. Cardio vascular disease risk doubles for every 20mmHg systolic and 10mm Hg diastolic rise in blood pressure. Aim of the study: To study different cardiac geometry in newly diagnosed hypertensives and to correlate proteinuria and LV mass in hypertensives. Materials and methods: Fifty newly registered patients at Government Dharmapuri Medical College Hospital from October 2016 - April 2017 were included in the study. In all these patients, history of substance abuse, comprehensive clinical examination and appropriate imaging and bio-chemical evaluation done. Results: Patient distribution between stage I and stage II hypertensives were almost equal. Among the distribution of patients with pulse pressure gradient, 20 patients (40%) had pulse pressure in the range of 41-50, 15 patients (30%) had pulse pressure in the range of 51-60. 7 (14%) and 8 (16%) had pulse pressure below 40 and above 60 respectively. In the study, 18 patients (36%) had urine protein in Mircoproteinuria range as detected by early morning spot urine protein - creatinine ratio. Among 18 patients with Micro- Proteinuria, 15 patients (83%) had abnormal cardiac geometry. Among 26 patients with abnormal cardiac geometry, 15 patients (58%) had micro proteinuria. There is significant association between microproteinuria and abnormal cardiac geometry in patients with essential hypertension. P. Ravikumar. A study on the prevalence of increased left ventricular mass and proteinuria in newly diagnosed hypertensive patients. IAIM, 2017; 4(7): 196-200. Page 197 Conclusion: A significant association was seen between widened pulse pressure and LVH Majority of patients with pulse pressure above 50 had LVH. While most of the patients with pulse pressure < 50 had normal geometry. Majority of patients (70%) with proteinuria and LVH were in stage-II hypertension. Patients were almost equally distributed between stage I and II Hypertension. Majority of patients had normal cardiac geometry in stage I while stage II patients had LVH of whom majority had microproteinuria.
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Objective To explore the role of apelin in the pathogenesis of diabetic nephropathy.Methods A total of one hundred and fourteen patients with type 2 diabetes mellitus in Qingdao Municipal Hospital from July 2015 to June 2016 were divided into normal albuminuria group (56 cases in the NA group) and micro-albuminuria group (58 cases in the MA group),depending on whether the level of urinary micro-albumin in 24 h was higher than 30 mg,with 60 healthy subjects included as the controls group (NC group).Levels of serum apelin and other biochemical indexes were tested.Results (1) WC,BMI,TC,TG,LDL-C,FBG,FINS,HOMA-IR and apelin in the patients of the NA group and MA group were respectively (87.99±10.27) cm,(24.75±3.35) kg/m2,(5.27±1.28) mmol/L,(1.84±1.25) mmol/L,(3.36±0.91) mmol/L,(7.58±0.87) mmol/L,(13.29±3.57) U/L,4.50±1.41,(364.22±85.03) ng/L ,(90.10±8.97) cm,(25.47±2.82) kg/m2,(5.19±1.11) mmol/L,(2.23±1.43) mmol/L,(3.68±0.83) mmol/L,(7.89±1.11) mmol/L,(15.50±5.00) U/L,5.55±2.27,(397.42±91.29) ng/L,which were higher than those of the NC group ((83.20±5.36) cm,(22.59±2.67) kg/m2,(4.68±1.10) mmol/L,(1.37±0.58) mmol/L,(2.56±0.94) mmol/L,(5.11±0.82) mmol/L,(7.17±2.80) U/L,1.65±0.77,(309.34±68.28) ng/L,P<0.05).FINS,HOMA-IR and apelin in the MA group were significantly higher than those in the NA group (P<0.05).(2) After age,sex and BMI were taken into control,partial correlate analysis showed that serum apelin was positively correlated with LDL-C,FPG,FINS and HOMA-IR (r=0.183,0.314,0.374,0.378,P<0.05).(3) Multifactor regression analysis showed that HOMA-IR and BMI were independent related factors to serum apelin (r2=0.288,0.389,P<0.05).Conclusion Apelin levels in the MA group were significantly higher than those in the NA group,and the serum apelin was positively correlated with HOMA-IR.Thus,apelin may contribute to the pathogenesis and progress of diabetic nephropathy.
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Earlier Diabetic nephropathy was thought to be a rare complication in Type II Diabetic patients. The incidence and prevalence of nephropathy in Type II Diabetes have been under estimated in the past probably because most patients with nephropathy succumbed to cardiovascular disease, even before nephropathy could manifest clinically. The current study was done to screen Type II diabetic patients for micro albuminuria and macro albuminuria, to identify the risk factors for development of nephropathy, and to note association of other micro vascular and macro vascular complications, and compare them with diabetics without proteinuria.
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Objective To observe the changes of A20 in mesangial cells of diabetic nephropathy (DN) rat model in?duced by lipopolysaccharide (LPS)-rat, and to explore its possible mechanism. Methods (1)Thirty health male Wistar rats were randomly divided into two group. Model rats were given streptozotocin (STZ) at a dose of 60 mg/kg by intraperitoneal in?jection. Rats in the control group received the same volume of citrate buffer in the same way. Levels of blood glucose and uri?nary microalbumin were detected in two groups at the 6th and the 8th week. Changes of renal pathology were observed by HE staining. Changes of protein A20 were observed by immunohistochemistry. (2) Expression changes of gene and proteins A20, nuclear factor (NF)-κB, IκB, IKKγand MCP-1 in renal cells treated with LPS were determined after treatment with different time points (0, 2, 4, 6, 12, 24, 48 and 72 h) and different concentrations (0.1, 1 and 10μg/L). Results (1) Levels of blood glucose and urinary microalbumin were significantly increased in model group compared with those of control group ( P <0.01). HE stainig showed that hyaline degeneration in tubular epithelial cells was found in model group, especially at the 8th week. Results of immunohistochemistry showed that expression of protein A20 significantly decreased in kidney tubules and nearly disappeared in glomerulus in model group compared with that of control group, which expressed less at the 8th week. (2) There was no significant difference in the expression of IKKγbetween different concentrations and different times. Com?pared with 0 h, the expression of A20 protein was increased at 2 h and 4 h, except that the expression of A20 protein in?creased after 6 h (P<0.05). Meanwhile NF-κB expression increased and IκB expression decreased in different time points (P<0.05). In addition, the expressions of A20 and IκB were decreased concentration-dependently (P<0.05). The expres?sion levels of NF-κB and MCP-1 were increased concentration-dependently (P<0.05). Conclusion A20 may involve in the development of diabetic nephropathy by regulating the NF-κB pathway.