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Objective:To investigate the value of serum monocyte/high-density lipoprotein cholesterol ratio (MHR) and urinary albumin/creatinine ratio (ACR) in the evaluation of osteoporosis in diabetic nephropathy patients.Methods:Diabetic nephropathy patients treated in Hangzhou Ninth People’s Hospital from Jun. 2019 to Jun. 2022 were selected. Gender, age, height and weight of all patients were collected and recorded, and body mass index (BMI) was calculated. Blood calcium (Ca), blood phosphorus (P), parathyroid hormone (PTH), monocyte count (M), high density lipoprotein (HDL-C), urinary microalbumin and creatinine were measured and recorded in all patients. MHR and ACR were calculated, MHR=M/HDL-C, ACR=urinary microalbumin/creatinine. Lumbar spine bone mineral density (L1-L4) was measured by dual-energy X-ray absorptiometry, which was divided into osteoporosis group and non-osteoporosis group.Results:Among the 117 diabetic nephropathy patients, 47 cases were osteoporotic and 70 cases were non-osteoporotic. The proportion of women in osteoporosis group was significantly higher than that in non-osteoporosis group, and BMI, PTH, MHR, ACR and bone mineral density were significantly higher than those in non-osteoporosis group, with statistical significance (all P<0.05). Multivariate binary Logistic regression analysis showed that female, MHR and ACR were independent risk factors for osteoporosis in diabetic nephropathy patients (all P<0.05). Spearman correlation analysis showed that serum MHR and ACR were negatively correlated with lumbar bone density, with statistical significance ( r=0.524 and 0.497, P=0.004 and 0.009, respectively). ROC curve analysis showed that the area under the curve (AUC) of serum MHR and ACR for evaluating osteoporosis in diabetic nephropathy patients was 0.870 (0.809-0.931) and 0.849 (0.792-0.905), respectively. The AUC of serum MHR combined with ACR for osteoporosis in diabetic nephropathy patients was 0.927 (0.891-0.964) . Conclusion:Serum MHR and ACR can be used as the evaluation indexes of osteoporosis in diabetic nephropathy patients, and their combined efficacy is better.
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Objective:To evaluate the effect of urinary albumin creatinine ratio (UACR) on diabetic retinopathy (DR) in patients with type 2 diabetes. Receiver operating characteristic (ROC) curve was applied to find the cut-off value of UACR for diagnosing DR.Methods:A prospective cohort study of 2 490 patients with type 2 diabetes was conducted with a mean follow-up of 7 years ranging from 3 to 10 years. Dilated fundus examination was performed once a year, and patient history and clinical data were collected and analyzed. Patients were divided into three groups according to the UACR: Q1, normal urinary albumin group (UACR<30 mg/g), Q2, microalbuminuria group (30 mg/g≤UACR≤299 mg/g), and Q3, macroalbuminuria group (UACR>300 mg/g), respectively. Cox regression analysis was used to explore the influence of UACR and other factors on DR, and ROC curve was drawn to evaluate the value of UACR in diagnosis of DR.Results:Cox regression analysis showed that UACR was the risk factor of DR( HR=1.108, 95% CI 1.023-1.241, P<0.001). It showed that the patients in Q3 group had the highest risk of proliferative DR ( HR=3.128, 95% CI 2.025-4.831, P<0.001), the patients in Q2 group followed( HR=1.918, 95% CI 1.355-2.714, P<0.001), and the patients in Q1 group were the lowest. ROC curve analysis showed that area under UACR curve was 0.746(95% CI 0.681-0.812, P<0.001), and the cut-off value, sensitivity, and specificity for the diagnosis of PDR were 54.12mg/g, 0.769, and 0.653, respectively. Conclusion:The UACR can predict the progression of PDR in type 2 diabetes patients, therefore it may be used as a preliminary predictor for the progression of DR.
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Objective:To investigate the clinical diagnostic value of joint test of retinol-binding protein (RBP), cystatin C (CYSC) and urinary (albumin/creatinine ratio, ALB/Cr) ALB/Cr in early diabetes nephropathy.Methods:Data of 50 early diabetic nephropathy patients (EDN group) from Jan. 2020 to Jun. 2021 in our hospital, another 50 pure type 2 diabetic patients (T2DM group), and 50 healthy subjects (control group) were compared and analysed. RBP, CYSC and urinary ALB/Cr were tested for the 3 groups. Then the clinical diagnostic value between single index test and joint test for the early diabetes nephropathy were compared.Results:Group EDN had higher RBP, CYSC and urinary ALB/Cr [ (114.66±0.56) mg/L, (2.64±0.33) mg/L, (351.81±15.48) ] mg/g than group T2DM [ (83.58±0.83) mg/L, (1.41±0.29) mg/L, (113.65±12.55) mg/g] and control group[ (38.61±0.66) mg/L, (0.53±0.26) mg/L, (16.36±5.61) mg/g]. The difference was statistically significant ( P<0.05). The specificity and sensitivity of early diabetes nephropathy were 95.38% and 96.21%, both higher than single index test. Conclusion:The combined detection of serum RBP, CYSC and urine ALB/Cr has certain reference value for the clinical diagnosis of early diabetic nephropathy.
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Background: Sepsis following surgery or trauma remains one of the leading causes of morbidity and mortality in hospitalpopulations, especially in populations in intensive care units (ICUs). The key to successful control of sepsis-associated infectionsis early prediction and rapid treatment of the disease. Standard clinical and laboratory parameter testing estimate the levels ofexpression of interleukin-1 β (IL-1 β), IL-6, IL-8, and IL-10, tumor necrosis factor-α, FasL (Fas ligand is a type-II transmembraneprotein), and CCL2 (C-C Motif Chemokines Ligand 2) mRNA and growth differentiation factor-15. These are a few measuredby real- time reverse transcriptase polymerase chain reaction.Aim of the Study: In this study, evaluation of the urinary albumin/creatinine ratio (ACR) was used as a prognostic predictorin critically ill sepsis patients.Materials and Methods: In a prospective observational study, 365 adult critically septic patients were included. After clinicalevaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission Acute Physiologyand Chronic Health Evaluation (APACHE) IV score and the highest recorded Sepsis-related Organ Failure Assessment (SOFA)score of their daily estimation were considered. The need for mechanical ventilation was assessed in addition to inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.Observations and Results: A total of 365 patients who were critically ill with sepsis were initially recruited to this study. Thepatients included in this study were aged between 28 and 87 with a mean age of 62.37 ± 9.15 years. There were 235 (64.38%)males and 130 females (35.61%). The highest SOFA score was 7.4 (4.0–14.0) ranging from 1 to 17 and APACHE IV scorerecorded within the first 24 h of ICU admission was 76.8 (58.8–98.0) ranging from 46 to 118. Of 365 patients, 191 (52.32%)required ventilator support, 201 (55.06%) needed inotropic and/or vasoactive support to maintain hemodynamics, and 71(19.45%) needed RRT. The mean length of hospital stay in the present study was 17.65 ± 8.60 days.Conclusions: Evaluating the urinary ACR values regularly in all critically ill sepsis patients was a simple, rapid, non-invasive,inexpensive, easy to perform, and interpret test for early prognosis and prediction of mortality
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Background: Primary hypothyroidism is a clinical conditiondue to deficiency of thyroid hormones. Thyroid hormones haveprofound effect on renal development, renal hemodynamics,glomerular filtration rate, electrolytes and water homeostasis.The aim of this case control prospective study is to evaluatethe effect of primary hypothyroidism on renal functions.Methods: Serum creatinine, blood urea nitrogen, uric acid,urinary albumin creatinine ratio and eGFR levels wereestimated in 75 newly diagnosed and untreated patients ofprimary hypothyroidism in the age group of 20 to 60 years ofeither sex (Study group) and 75 healthy, age and sex matchedindividuals with normal thyroid profile (Control group). Followup of patients in study group was done after 8 weeks ofthyroxine replacement and serum creatinine, uric acid, urinaryalbumin creatinine ratio and eGFR levels were estimated.Results: The mean eGFR level in study group at baseline waslower and mean serum creatinine, blood urea nitrogen, serumuric acid and urinary albumin creatinine ratio (UACR) levelswere higher than control group. After 8 weeks of thyroxinereplacement; the mean serum creatinine, uric acid, bloodurea nitrogen levels were decreased and eGFR levels wereincreased. Also serum TSH shows positive correlation withserum creatinine, blood urea nitrogen, uric acid and urinaryalbumin creatinine ratio but negative correlation with eGFR.Conclusion: Primary hypothyroidism is associated withsignificant alteration in renal function which is reversible onthyroxine replacement.
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Introduction: Diabetic kidney disease (DKD) representsone of the most frequent microvascular complications ofdiabetes with an overall prevalence of approximately 40% intype 2 diabetes population. Microalbuminuria is one of themost serious problems in type 2 DM. Vildagliptin, DPP-4inhibitors, is a novel oral anti-diabetic drug for the treatmentof type 2 diabetes mellitus (T2DM). The objective of the studywas to evaluate the therapeautic efficacy of vildagliptin onmicroalbuminuria in type 2 diabetes mellitus.Material and methods: We included in our study 103 T2DMpatients with microalbuminuria. Exclusion criteria: NSAIDsinduced nephropathy, Lupus nephropathy, Polycystic KidneyDisease, Medullary Sponge Kidney, All causes of nephriticand nephrotic syndrome, ESRD due to diabetes mellitus andmoderate to severe hepatic failure. We measured UrinaryACR value of parameters at 0,3.6,9,12 months respectively.Vildagliptin was given to those patient and was observed thatafter giving vildagliptin was there any change in albumin tocreatinine i.e microalbuminuria.Result: The mean of ACR baseline (mean±s.d.) of patientswas 125.1436 ± 58.810 with range 50.7000 - 298.0000 and themedian was 100.0000. The mean of ACR of 3, 6, 9, 12months(mean±s.d.) of patients were 110.3184 ± 57.5647, 106.7340 ±48.8492, 103.7252 ± 45.6745, 95.4466 ± 62.342 respectively.Association of ACR in five groups was not statisticallysignificant (p=0.6118).Conclusion: We found that after 12 months of therapy withvildagliptin, a DPP-4 inhibitor, there was some reduction ofACR and it is approximately 30%
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Objective More and more research shows microangiopathy may occur in the early stage of diabetes. The purpose of this study was to observe the relationship between OGTT 1-hour hyperglycemia (1hPG) and 2-hour hyperglycemia (2hPG) levels and urinary albumin creatinine ratio (UACR).Methods We retrospectively analyzed 408 patients with primary hypertension of grade 2 or above who were eligible for 2015 World Health Organization (WHO) outpatient and inpatient visits from September 2015 to April 2018 in our hospital for a course of up to 10 years. All selected participants underwent an OGTT test (1 and 2 hour post-sugar glucose) and records were made on fasting plasma glucose (FPG), OGTT1-hour blood glucose (1 hPG), OGTT 2-hour blood glucose (2 hPG). All the patients were divided into 4 groups according to blood glucose levels: NGT group (n=100), 1 h PG group(n=102), 2h PG group(n=104), 1h PG/2h PG group (n=102). Records were made on the clinical data of 408 patients, including height, weight, BMI, gender, age, history of hypertension, smoking history, blood pressure, blood lipids, creatinine and other general clinical data, and the calculation of glomerular filtration rate (eGFR) values was based on creatinine values and age values to analyze the relationship between 1 hHPG and 2 hHPG levels with ACR.Results No significant difference was found among the four groups in the aspects of hypertension course, age, gender, body mass index (BMI), diastolic blood pressure, lipid metabolism index and fasting blood glucose(P>0.05). There were significant difference in systolic blood pressure, serumcreatinine, eGFR, and ACR among different levels of increased blood glucose(P<0.05). ACR in 1h PG group, 2h PG group and 1h PG/2h PG group were significantly higher than NGT group(P<0.01), ACR in 1h HPG/2hHPG was significantly higher than 1h PG group(P<0.05) and ACR in 1h PG group was significantly higher than 2h HPG group(P<0.05). The logistic regression analysis showed that 1h PG(OR=2.461, 95%CI:1.947-3.112), creatinine (OR=1.071, 95%CI:1.027-1.117) and 2h PG(OR=2.016, 95%CI:1.500-2.710) were risk factors for microalbuminuria(P<0.01).Conclusion The abnormalities of 1h PG and 2h PG are associated with ACR, which may become the key index for predicting early kidney damage.
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Objective There are few researches for the serum betatrophin level and diabetic nephropathy (DN) recently.The aim of this study was to investigate the change of serum betatrophin level and the correlation of serum betatrophin and urinary albumin-to-creatintine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 150 Chinese subjects from Mar 2013 to Jul 2016 were enrolled in the study, including 90 patients with type 2 diabetes and 60 healthy controls.According to the level of UACR, the diabetic patients were divided into two groups:normal UACR group (UACR30 mg/g, n=30).Serum betatrophin was measured by enzyme linked immunosorbent assay (ELISA).UACR was measured by turbidimetric inhibition immune assay.Blood glucose blood lipid were measured simultaneously.Results The serum betatrophin level was significantly higher in abnormal UACR group than that in normal UACR group[677.37±59.02 vs 486.13±41.22 pg/mL, P<0.05];Serum betatrophin level in T2DM patients was positively correlated with age (r=0.246), waist hip ratio (WHR) (r=0.240), fasting blood glucose (FPG) (r=0.234), 2 hour plasma glucose (2hPG) (r=0.363), glycosylated hemoglobin (HbA1c) (r=0.346), fasting insulin (FINS) (r=0.249), insulin resistance index (HOMA-IR) (r=0.309), blood urea nitrogen (BUN) (r=0.223), creatinine (CREA) (r=0.277) and UACR (r=0.244) (P<0.05),and negatively correlated with glomerular filtration rate (GFR) (r=0.308) (P<0.01).Serum betatrophin level in normal UACR group was positively correlated with age, HbA1c and UACR (P<0.05);Serum betatrophin level in abnormal UACR group was positively correlated with WHR (r=0.504), 2hPG (r=0.600), HbA1c (r=0.449), HOMA-IR (r=0.395) (P<0.05).The WHR, HbA1c, HOMA-IR and GFR were the influential factors of the serum betatrophin level.Conclusion The level of serum betatrophin was significantly increased in T2DM patients with albuminuria, which suggests that the betatrophin might play an important role in the pathogenesis of DN.
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Objective To elucidate the effects of eicosapentaenoic acid(EPA)on the metabolic abnormalities and renal pathologic changes during the early stage of diabetic nephropathy in KKAy/Ta mice.Methods Sixteen KKAy/Ta mice(7 weeks of age)were randomly divided into two groups(n=8).Since 12 weeks of age,EPA group were injected with EPA at 1 g?kg-1?d-1 intraperitoneally for 8 weeks,and the control group were injected with 0.9% saline.The levels of serum fatty acids were detected at 20 weeks of age by gas chromatography.The phenotypic characterizations were measured at 12,16 and 20 weeks of age.Renal morphological examinations were performed after 8 weeks of treatment.Results Serum EPA levels in KKAy/Ta mice treated with EPA [(125.8?15.5)?g/mL] were significantly higher than those in control group [(69.2?7.8)?g/mL] at 20 weeks of age(P