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Objective To study the prevalence of diabetic nephropathy (DN) and the relationship between dietary pattern and risk. Methods From August 2018 to May 2021, 655 T2DM patients in Wuhan Puren Hospital, including 338 males and 317 females, were divided into T2DM group (n=368 cases) and DN group (n=287 cases) according to whether patients had DN. The uniformly trained staff of our hospital used the simplified version of food intake frequency questionnaire designed for diabetes to investigate the reasonable dietary intake of patients in nearly one year. Clinical data of patients in the two groups were collected and the intake of protein, fat, carbohydrate and dietary fiber in the two groups was statistically analyzed. Logistics regression was used to analyze the formula independent risk factors of DN in T2DM, and Pearson correlation analysis was performed on the incidence of diabetic nephropathy and dietary pattern. Results Among of 655 T2DM patients, there were 287 (43.82%) patients with DN, including 149 males and 138 females. The average age, duration of diabetes, smoking in DN group were significantly higher than those in T2DM group (P0.05). Energy, protein intake, carbohydrate and fat intake in DN group were significantly higher than those in T2DM group (P<0.05). Multivariate logistic regression analysis showed that protein, carbohydrate and fat intake were independent risk factors for DEVELOPING DN in T2DM patients (P<0.05). According to Pearson correlation analysis, the risk of developing DN in T2DM patients was positively correlated with protein and fat intake (r=0.449 , 0.517, P<0.05). Conclusion PATIENTS with T2DM have a higher risk of DEVELOPING DN, which is closely related to dietary intake. Reasonable allocation of dietary intake can reduce the risk of developing DN.
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OBJECTIVE: To observe clinical efficacy and safety of febuxostat in the treatment of type 2 diabetic nephropathy complicated with hyperuricemia. METHODS: A total of 137 patients with type 2 diabetic nephropathy complicated with hyperuricemia selected from our hospital during Jan. 2014-Jun. 2016 were divided into group A (46 cases), B (47 cases), C (44 cases) according to random number table. On the basis of routine treatment, group A was given Allopurinol tablets orally with initial dose of 0. 05 g, bid; increasing to 0. 10 g, bid, 2 weeks later. Group B was given Benzbromarone tablets 50 mg orally, qd. Group C was given Febuxostat tablets orally with initial dose of 40 mg, qd; increasing to 80 mg, qd, 2 weeks later. All patients received treatment for consecutive 12 weeks. Clinical efficacies of 2 groups were observed, and the levels of serum uric acid (SUA), Scr and BUN were also observed before and after treatment. The occurrence of ADR was recorded. RESULTS: Four, six, three patients withdrew from the study in group A, B, C, respectively. The total response rates of group B, C (87. 8％, 85. 4％) were significantly higher than that of group A (76. 2％), with statistical significance (P＜0. 05); there was no statistical significance between group B and C (P＞0. 05). Before treatment, there was no statistical significance in the levels of SUA, Scr or BUN among 3 groups (P＞0. 05). Four weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment, with statistical significance (P＜0. 05); there was no statistical significance in other indexes among 3 groups or between before and after treatment (P＞0. 05). Twelve weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment and 4 weeks after treatment, and group B and C were significantly lower than group A; the levels of Scr in group A and C were decreased significantly compared to before treatment, while that of group B was increased significantly compared to before treatment and group B was significantly higher than group A and C, with statistical significance (P＜0. 05). There was no statistical significance in the levels of Scr or BUN among 3 groups compared to 4 weeks after treatment; there was also no statistical significance in the levels of SUA between group B and C, the levels of Scr between group A and C (P＞0. 05). Total incidence of ADR in group C (12. 20％) was significantly lower than group A and B (25. 58％, 24. 39％), with statistical significance (P＜0. 05); there was no statistical significance between group A and B (P＞0. 05). CONCLUSIONS: Febuxostat is better than allopurinol in reducing the level of SUA in type 2 diabetic nephropathy patients with hyperuricemia. It shows small effect on renal function with better safety.
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Objective To perform a meta-analysis on the associations of interleukin (IL)-6-174G ＞ C (rs1800795) and-634C ＞ G (rs1800796) polymorphisms with type 2 diabetic nephropathy (DN).Methods The data on the studies about the associations of IL-6-174G ＞ C and-634C ＞ G polymorphisms with type 2 DN were collected from Pubmed,Embace,CNKI,Wan Fang and VIP database during their inception and April 2017.The statistical analysis was performed with STATA 14.0 and Review manager 5.3 softwares.The heterogeneity in the eligible studies was assessed by Q-statistic and I2 statistic.When the significant heterogeneity was found,the random effect model was used for meta-analysis,otherwise,the fixed effect model was used.The publication bias was evaluated with funnel and Begger graphs.The pooled odds ratios (OR) and corresponding 95％ confidence intervals (95％ CI) were calculated for evaluating the associations of IL-6-174G ＞ C and-634C ＞ G polymorphisms with type 2 DN.In addition,the sub-group analysis was performed according to the regions of subjects.Results A total of 11 studies were enrolled,The studies on the association of IL-6-174G ＞ C polymorphism with type 2 DN included 1 688 subjects,while those on the association of IL-6-634C ＞ G with type 2 DN included 2 180 subjects.In the association analysis of IL-6-174G ＞ C polymorphism with type 2 DN of Asian population,the significant relationship was detected in an allelic genetic model (OR =0.461,95％ CI:0.274-0.777,P ＜ 0.01),a homozygote model (OR =0.126,95％ CI:0.022-0.734,P =0.021),a recessive genetic model (OR =0.146,95％ CI:0.026-0.827,P =0.030) and a dominant genetic model (OR =0.504,95 ％ CI:0.273-0.930,P =0.028),but not in a heterozygote model (OR =0.606,95 ％ CI:0.321-1.143,P =0.122).There was no significant relationship between IL-6-174G ＞ C polymorphism and type 2 DN in European population.In the association analysis of IL-6-634C ＞ G polymorphism with type 2 DN of Asian population,the significant relationship was found in an allelic genetic model (OR =1.467,95％ CI:1.238-1.737,P ＜0.01),a homozygote model (OR =2.793,95％ CI:1.844-4.230,P =0.021),a recessive genetic model (OR =2.296,95 ％ CI:1.586-3.323,P ＜ 0.01) and a dominant genetic model (OR =1.377,95％CI:1.109-1.711,P ＜ 0.01),but not in a heterozygote model (OR =1.733,95％ CI:0.932-1.476,P =0.174).There was no significant relationship between IL-6-634C ＞ G polymorphism and type 2 DN in European population.Conclusion In Asian population,IL-6-174CC genotype may prevent the progression of type 2 DN,however,IL-6-634GG genotype may promote the development of type 2 DN.But in European population,there is no relationship between IL-6-174G ＞ C and-634C ＞ G polymorphisms and type 2 DN.
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Objective To investigate the clinical application value of serum non-esterified fatty acid(NE-FA),albumin(ALB),creatinine(CREA)and β2-microglobulin(BMG)levels in type 2 diabetic nephropathy (T2DN).Methods 140 cases of type 2 diabetes mellitus(T2DM)in this hospital from October 2016 to Febru-ary 2017 were selected and divided into the T2DM non-nephropathy group(47 cases)and T2DN group(93 ca-ses)according to urinary albumin and urinary microalbumin.The T2DN group was further divided into the ALB high value subgroup(ALB>30 g/L,47 cases)and ALB low value subgroup(ALB≤30 g/L,46 cases)ac-cording to serum ALB detection results.Meanwhile 51 persons undergoing healthy physical examination were selected as the healthy control group.The levels of NEFA,ALB,CREA and BMG were measured in each group.Then the correlation among groups was analyzed.Results The levels of serum NEFA and NEFA/ALB in the T2DM non-nephropathy group were significantly higher than those in the healthy control group,the difference was statistically significant(P<0.05).The serum NEFA level in the T2DN group was significantly higher than that in the healthy control group,and the levels of NEFA/ALB,BMG and CREA were higher than those in the healthy control group and T2DM non nephrotic group,while the ALB level was significantly lower than that in the healthy control group and T 2DM non nephropathy group,the difference was statistical-ly significant(P<0.05).The levels of BMG and CREA in the ALB high value subgroup and ALB low value subgroup were significantly higher than those in the T 2DM non-nephropathy group ,the difference was statisticallysignificant( P < 0 .05) ;the levels of NEFA and ALB in the ALB low value subgroup were significantlylower than those in the T2DM non-nephropathy group and ALB high value subgroup ,while the NEFA/ALBlevels were significantly higher than those in the T2DM non-nephropathy group ,the difference was statisticallysignificant(P < 0 .05) .The ALB was positively correlated with NEFA level (r = 0 .252 ,P < 0 .01) ,and wasnegatively correlated with BMG and CREA levels (r = - 0 .424 ,r = - 0 .281 ,P < 0 .01) ;serum BMG level waspositively correlated with serum CREA level (r = 0 .920 ,P < 0 .01 ) .Conclusion Serum BMG ,CREA ,NEFAand ALB play an important role in progress of T2DN ,and can serve as the monitoring indicators of renal injury degree in T2DM .
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Background@#Diabetes mellitus (DM) has become the leading cause of chronic kidney disease (CKD). Nondiabetic renal diseases (NDRDs) have different clinicopathological features and prognosis from those of diabetic nephropathy. Our study sought to analyze the clinical and pathological features of NDRDs, in different age groups through a cross-sectional study.@*Methods@#All patients with type 2 DM at our center who underwent renal biopsy between March 1997 and March 2017 were screened and divided into three groups by age: Group 1 (youth group), 18-44 years old; Group 2 (middle-aged group), 45-59 years old; and Group 3 (elderly group), ≥60 years old. We analyzed the clinicopathological data and risk factors by univariate and multivariate logistic regression for NDRD of the patients to identify the features of NDRD in different age groups.@*Results@#We included 982 patients in the final analysis. Patients with NDRD accounted for 64.4% of all patients. IgA nephropathy (IgAN) was the most common pathological pattern in young patients with NDRD, accounting for 26.3%. In the middle-aged group, the two most common pathological patterns were IgAN and membranous nephropathy. Membranous nephropathy was the most common pathological pattern in elderly patients with NDRD, accounting for 29.3%. Consistent with pathological features, glomerular hematuria is a risk factor for NDRD in Group 1 (odds ratio [OR], 26.514; 95% confidence interval [CI], 2.503-280.910; P = 0.006). On the other hand, rapidly increasing proteinuria or nephrotic syndrome is a risk factor for NDRD in Group 2 (OR, 5.921; 95% CI, 2.061-17.013; P = 0.001) and Group 3 (OR, 90.409; 95% CI, 6.198-1318.826; P = 0.001).@*Conclusions@#This single-center study showed that the proportion and composition of NDRD differ among different age groups. Consistent with pathological features, some clinical indices such as hematuria and proteinuria showed different features among different age groups.
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Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Cross-Sectional Studies , Diabetic Nephropathies , Pathology , Glomerulonephritis, IGA , Pathology , Kidney Diseases , Pathology , Logistic ModelsABSTRACT
Objective: To study the pharmacodynamics effect of Compound Jianshen Granules (CJG) on rats with type 2 diabetic nephopathy induced by high-fat and sugar diet combined low dose streptozotocin (STZ), and to investigate its mechanism. Methods: Type 2 diabetic nephropathy animal model was established by feeding with high fat and sugar diet combined with low dose of STZ. FBS, Scr, BUN, GHb, TC, TG, SOD, MDA, etc were measured to study its effects of reducing blood glucose and protecting kidney, data were dealed with SPSS17.0 software and analyzed in statistics, its pharmacodynamic effects were expounded by kidney and pancreas pathological section. MCP-1, ICAM-1, and IL-6 were tested by ELISA to probe into its mechanism tentatively. Results: Compared with the model group, the weight of each drug administration group of CJG entirely rised, and the difference had statistical significance (P < 0.01); The food, water, urine volume, and urine protein content of each drug administration group of CJG decreased, and the difference had statistical significance (P < 0.05, 0.01); The blood glucose level of each drug administration group of CJG decreased, and the difference had statistical significance (P < 0.05, 0.01); The Scr and BUN of each drug administration group of CJG decreased, and the difference had statistical significance (P < 0.05, 0.01); The GHb of each drug administration group of CJG decreased significantly (P < 0.05, 0.01); TC, TG, and MDA of each drug administration group of CJG decreased significantly (P < 0.01); SOD of each drug administration group of CJG increased significantly (P < 0.01); IL-6, MCP-1, and ICAM-1 of each drug administration group of CJG decreased significantly (P < 0.01). Conclusion: FBG and each biochemical criterion and pathological section results demonstrate that CJG have the certain effects of decreasing blood sugar and protecting kidney, moreover traeatment groups have significant difference compared with model groups. ELISA determination results indicate that the action mechanism of CJG is potentially related to MCP-1, ICAM-1, and IL-6 inflammatory pathway.
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Objective:To explore the protective effect of curcumin on type 2 diabetic nephropathy rats and the possible mechanism.Methods:30 Wistar rats were randomly divided into control group,the DN group and curcumin group,10 cases in each group,rats in DN and curcumin group were fed with high fat,after that they were used the streptozotocin injection to set up DN model.In addition,rats in curcumin group were given 200 mg/kg curcumin once a day,other two group were given sodium carboxymethylcellulose half-and-half.After 12 weeks,the 24 h urine were collected at the last delivery,the blood glucose(BG),total cholesterol(TC),triglyceride(TG),blood urea nitrogen(BUN),serum creatinine(Scr),microalbu minuria(mAlb) were tested,the urinary albumin excretion rate(UAER) was calculated.Furthermore,rats were sacrificed,kidney mass weighed,and the kidney index(KI) was calculated.Renal cortical was fixed with polymers cresol for hematoxylin-eosin(HE) staining,renal cortical was also made renal cortex homogenate and the SOD activity,MDA were detected,the expression of nuclear factor related factor 2(Nrf2) and heme oxygenase 1(HO-1) protein in the kidney tissues was detected with Western blot detection.Results:BG,TC,TG,KI,BUN,Scr,UAER,MDA of DN group and curcumin group were significantly higher than control group,and BM,KM,SOD was significantly lower than the control group,the amplitude raising or reducing in curcumin group were less than DN group,the difference had statistical significance(P<0.05);HE staining results showed that,compared with DN group,renal tubule degeneration in curcumin group was obviously reduced,inflammatory cells infiltration was decreased significantly;Western blot results showed that expression of Nrf2 and HO-1 protein in control group were significantly lower than DN group and curcumin group,and curcumin group was significantly higher than the DN group,the differences were statistically significant(P<0.05).Conclusion:Curcumin may play a role of kidney protection through the activation of Nrf2/ARE signaling pathway to reduce oxidative stress in diabetic nephropathy rats.
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Objective To investigate the levels and clinical significance of serum adiponectin(ADPN),high sensitive C-reactive protein(hs-CRP)and cystatin C(CysC)in type 2 diabetic nephropathy.Methods 75 outpatients and the inpatients with type 2 dia-betes mellitus(T2DM)in our hospital from February 2013 to May 2013 were selected and divided into three groups according to the urinary albumin excretion rate (UAER),normal-albuminuria group(UAER300 mg/d,23 cases).30 subjects of healthy physical examination were selected as the control group.Urine microalbumin was measured by the immune turbidimetric method,UAER was calculated ac-cording to the 24 h urine volume,CysC and hs-CRP were measured by the immune turbidimetric method,and ADPN was measured by the enzyme linked immunosorbent assay(ELISA).The ADPN,hs-CRP and CysC levels were compared among groups.Results The ADPN level in 3 type 2 diabetic nephropathy groups was lower than that in the control group,the difference was statistically significant (P <0.05 ).With increase of UAER,serum ADPN,hs-CRP and CysC levels in 3 type 2 diabetic nephropathy groups were increased,the difference among the groups was statistically significant (P <0.05 ).The levels of serum ADPN,hs-CRP and CysC in type 2 diabetic nephropathy were positively correlated with UAER(r=0.715 6,0.476 3,0.741 3,P <0.05).Conclusion The combined detection of serum ADPN,hs-CRP and CysC has important reference value for the diagnosis and disease course of early renal damage in T2DM.
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Objective To observe the clinical effects of irbesartan combined with ambrette capsule for treatment of mild-to-moderate proteinuria in type 2 diabetic nephropathy. Methods Foutty-six patients with diabetic nephropathy( DN),who meet the diagnostic criteria for diabetes and DN diagnostic criteria which WHO promulgated in 1999 years,were randomly divided into control group(n =23)and treatment group(n =23) . Patients in control group were administrated conventional hypoglycemic drugs,lipid,calcium antagonists step-down and diet control,while in treatment group were administrated irbesartan(75 mg,1 times/d)combined with ambrette capsule(5 pills,3 times/d)on this basis. Both the treatment duration was 8 weeks. Urine protein,blood urea nitrogen( BUN),serum creatinine( SCr)and C reactive protein( CRP)were measured respectively before treatment and 8 weeks after treatment. Results After 8 weeks treatment,the total effective rate in treatment group was 87. 0%(20/23),higher than that of control group(52. 2%(12/23);χ2 =6. 571,P﹤0. 05). The CRP had decreased significantly in treatment group( from( 11. 7 ± 0. 9 ) mg/L to( 5. 8 ± 0. 3 ) mg/L ) which compared with control group(from(10. 1 ± 0. 6)mg/Lto(9. 8 ± 0. 4)mg/L;P﹤0. 05). But BUN and SCr had no significant difference compared with pre-treatment( P ﹥ 0. 05 ). Conclusion Irbesartan combine with ambrette capsule can significantly decrease the urine protein and regulate on the micro-inflammatory state. It is worthy of popularization and application.
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Objective To investigate the clinical effect of shuxuetong injection and its effects on oxidative stress in patients with type 2 diabetic nephropathy (DN).Methods One hundred and twenty cases with type 2 DN meeting the inclusion criteria were divided into two groups equally according to therapeutic scheme.Besides conventional treatments patients in the control group were treated with acarbose,while patients in the observation group were treated with shuxuetong injection and acarbose.The curative efficacy,renal function,superoxide dismutase (SOD),malonaldehyde (MDA) and advanced oxidation protein products (AOPPs) were recorded or detected.Results Therapeutic efficiency ratio (TER) in observation group was 93.3％,significantly higher than that in control group (80.0％;x2 =4.62,P =0.03).The levels of blood urea nitrogen (BUN),serum creatinine (Scr),urine total protein in observation group were (7.9 ± 2.3) mmol/L,(110.7±19.9) μumol/L and (2.2±0.5) g/24,lower than those in control group and the differences were significant ((11.5±2.7) mmol/L,(163.4±20.8) μmol/L and (2.9±0.5) g/24 h;t =7.86,14.48,7.67;P =＞0.000).Regarding of oxidative stress indices,MDA,AOPPs and SOD levels in observation were (3.5±0.4) μmol/L,(50.7±4.8) mmol/L and (56.7±3.8) kU/L,significant different from those in control group((6.7±0.3)μmol/L,(89.5 ± 5.6) mmo]/L and (35.4 ± 4.0) kU/L;t =49.57,40.75,29.90;P =0.00).During the treatment,there was no severe case with adverse reactions and the incidence of adverse reactions in the two groups (10.0％ vs 11.7％;x2 =0.09,P =0.77).Conclusion The method scheme of shuxuetong injection and acarbose on type 2 DN is effective with increasing the therapeutic efficiency ratio,improving renal function and alleviating oxidative stress with minor adverse reactions.
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Aim To observe the effects of tetrahydro-biopterin ( BH4 ) on nitric oxide ( NO ) production in the kidney of type 2 diabetic nephropathy ( DN) mice, and to find a new target for the treatment of type 2 DN. Methods The 12 week-old db/db mice developed in-to DN phase were divided into 2 groups:DAHP group, subjected to intraperitoneal injection of 150 mg·kg-1 DAHP (n=8);DN group, subjected to intraperitone-al injection of same dose of normal saline containing 5% DMSO ( n = 6 ) . The age-matched db/m mice ( NS group) were subjected to intraperitoneal injection of same dose of normal saline containing 5% DMSO ( n =6 ) . Three groups of mice were treated for 7 days. Then the fasting blood-glucose, serum creatinine, u-rine protein and activity of iNOS were determined by chemical colorimetry. And the iNOS protein in renal cortex was determined by immunohistochemisty and western blot, respectively. BH4 was measured by HPLC method. NO level was determined by Griess method. Results The levels of fasting blood-glucose, serum creatinine, 24h urine volume, 24h urine pro-tein, BH4 , iNOS and NO in DN group were signifi-cantly higher than those in NS group;The levels of ser-um creatinine, urine volume, urine protein, BH4 , iN-OS and NO in DAHP group were significantly lower than those in DN group. Conclusion In the kidney of type 2 DN mice, the increased BH4 contributes to over-production of NO by the increased iNOS expression, and resultes in the increase of urine volume and urine protein.
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Objective: To investigate the HbA1c and urinary albumin in early diagnosis of diabetic nephropathy in type 2 diabetes mellitus value. Methods:In 42 patients with diabetes and fasting blood glucose (FBG), glycosylated hemoglobin (HbAlc), microalbuminuria (M-ALB), cholesterol (CHo), glycerin three greases (TG), high density lipoprotein cholesterol with alcohol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood routine determination, and the results compared with healthy controls. According to the determination result of glycosylated hemoglobin for low value group (HbAlc10.1%). Results:The diabetes patient's HbAIc, FBG, CHo, TG, LDL-C concentrations were significantly higher than healthy control group, the serum HDL-C concentration was significantly lower than that of the control group. The difference was statistically significant. With the increase of HbAIc. FBG, m-ALB increased. Conclusion: Diabetic nephropathy is associated with increased HbAlc. Dyslipidemia can increase in microvascular lesions in diabetic nephropathy risk. M-ALB diabetes is early glomerular injury markers. I can be used as the screening index of chronic nephropathy. Combined detection of glycosylated hemoglobin of diabetes and microalbuminuria in favor of diabetic nephropathy early detection, delay the progression of diabetic nephropathy.
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OBJECTIVE:To observe the protection and delaying effects of rosiglitazone on the onset and progression of type2diabetic nephropathy of senile patients.METHODS:23senile patients with type2diabetic nephropathy were random-ized to A and B groups.Group A were treated with rosiglitazone4mg/d and group B were administered orally with dimethyl biguanide1750mg/d(in3times),the course of treatment for both groups were4months.RESULTS:The post-meal blood sugar in both groups showed significant differences after treatment as against pretherapy(P0.05).CONCLUSON:Rosiglitazone has significant curative effect on diabetes,it can also delay the occurrence of albu-minuria and significantly lighten pathological changes of renal glomerulus.