RESUMEN
Background: Type 2 diabetes mellitus is the most common single cause of end-stage renal disease [ESRD], where diabetic nephropathy [DN] is considered the cause in almost half of all patients with ESRD. Despite the availability of many modern therapies for glycemic control, there are no specific curative treatments yet for DN and many diabetic patients still progressed to severe renal damage. Currently, albuminuria is the most commonly used marker to predict onset and progression of DN clinically. However, this traditional marker for DN lacks both sensitivity and specificity to detect early stage of DN. Furthermore, there is a lack of a strong association between albuminuria and glomerular filtration rate [GFR]. As such, it is crucial to find earlier and reliable markers for DN diagnosis and intervention providing an opportunity to stop the permanent damage caused by it
Objective: This study focuses on Cyclophilin A [CypA] in urine. CypA is a protein with ubiquitous characteristics, mostly distributed in the cytoplasm and facilitates protein folding and protein trafficking. It has relatively high expression level in normal kidneys. Recently, CypA has been reported to be a reliable novel marker for early diagnosis of DN
Subjects and Methods: Our study was conducted on 90 subjects of comparative age and sex. They were selected from Endocrinology Clinic after written consent at Ain Shams University Hospital and Railway Hospital. Participants were divided into: Group I: 30 healthy control subjects, Group II: 30 T2DM patients without albuminuria [normoalbuminuric], and Group III: 30 T2DM patients with albuminuric DN
Results: Our study showed that regarding the level of urinary CypA there was a highly statistical significant difference between the three groups [F= 221.730, p< 0.01], being higher in GII [normoalbuminuric] [1.69+/-0.87 ng/ml] than in GI [control] [0.55+/-0.14 ng/ml] [t= 7.04, p< 0.01] and higher in GIII [albuminuric DN] [6.01+/-1.61 ng/ml] than GII [t= 12.93, p< 0.001] and GI [t= 18.55, p< 0.0001]. In addition, we found that urinary CypA was significant higher in GIIIb [macroalbuminuria] [7.23+/-0.76 ng/ml] than in GIIIa [microalbuminuria] [4.79+/-1.25 ng/ml] [t= 6.49, p< 0.01]. It worth mentioning that, the level of urinary CypA started to increase significantly in stage 2 DN [2.49+/-0.50 ng/ml] in spite of normal level of albuminuria [no albuminuria] comparing with each of stage 1 DN [1.03+/-0.15 ng/ml], diabetics with no renal affection [0.99+/-0.45 ng/ml] and GI [healthy control] [0.55+/-0.14 ng/ml]. There was significant positive correlation between urinary CypA and each of: sCr in GII [r= +0.39, p< 0.05], GIIIa [r= +0.89, p< 0.001] and GIIIb [r= +0.99, p< 0.001] and ACR in GIIIa [r= +0.93, p< 0.001] and GIIIb [r= +0.98, p< 0.001]
Conclusion: Our study showed that there was a high significant difference in the level of urinary CypA between diabetic patients with any degree of renal affection and healthy subjects being higher in diabetics with renal affection even without the presence of albuminuria
RESUMEN
Diabetes mellitus is the result of absolute or relative hypoinsulinemia, and is currently described as an endocrine disease that causes damage to many organs and systems. The consequences of chronic diabetes mellitus in the central nervous system [CNS] are less known than diabetic peripheral neuropathy and autonomic nervous system neuropathy. Damage to the brain and the spinal cord is less common. is to show the importance of motor and somatosensory evoked potentials [MEP and SEP] for the early diagnosis of unapparent CNS damage related to diabetes mellitus. Thirty diabetic patients [type 1 and type 2] and twenty healthy volunteers who match patient group for age and sex, both groups with no clinical symptoms or signs of central or peripheral nervous system lesion were evaluated. MEPs were recorded from upper and lower extremities bilaterally and central motor conduction time [CMCT] was calculated according to formula: CMCT=MEP-[0.5x [F-M-1] +M]. Similarly, we examined spinal and cortical SEP after median nerve stimulation in diabetics and control group. We measured the peak latencies of individual wave deflections and peripheral and central conduction time of spinal and cortical SEP. The examination of MEPs and SEPs proved and confirmed the prolongation not only of peripheral conduction time, but also of the central conduction time especially in the lower limbs in the diabetic patients compared to the control group. There was no correlation between central conduction time delay and the degree of metabolic control, type of diabetes [type 1 or type 2 diabetes mellitus], patient age, disease duration, presence or absence of retinopathy or nephropathy. In spite of an absence of clinical signs of central nervous system lesion in diabetic patients, a significant prolongation of central conduction time compared to control group was recorded. We assume a presence of diffuse subclinical CNS lesion induced by many factors. Measurement of central conduction time using transcranial magnetic stimulation and somatosensory evoked potentials could be a complementary electrophysiological method for assessment of subclincal cerebral and spinal cord involvement in diabetic patient