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Objective To analyze the influence of medication compliance of chronic type 2 diabetes management patients on disease control in two communities in Kunming.Methods A total of 138 patients with type 2 diabetes who were included in chronic disease management in Guandu and Xiaobanqiao communities of Kunming were selected from December 2021 to September 2022.Basic information collection and HbAlc and other related tests were improved.A questionnaire survey of 8-item Morisliy medication adherence scale(MMAS-8)was conducted to analyze the levels of HbAlc and other indexes of three groups with high(group A),medium(group B),and low(group C)adherence,and to conduct statistical analysis.Results Group A accounted for 22.5%,group B for 44.9%,and group C for 32.6%.There were significance differences in urinary albumin creatinine ratio(UACR),HbA1c and blood creatinine among the three groups(P<0.05).The levels of UACR,HbAlc and serum creatinine in group A were lower than those in group B and group C,and there was a negative correlation between UACR,HbAlc and serum creatinine and medication compliance rate(P<0.05).Conclusion In the Guandu Community and Xiaobanqiao community of Kunming,only 22.5%of patients with chronic type 2 diabetes had high medication compliance.The higher the compliance,the lower the level of UACR,HbAlc and serum creatinine,there is a correlation between the two,suggesting that medication compliance should be regarded as one of the key points in the management of chronic diabetes mellitus in the community,and the intervention of patients'medication compliance should be strengthened.
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Objective:To explore the clinical characteristics and risk factors of abnormal urinary albumin/creatinine ratio(UACR) in obese population.Methods:Baseline data from 2011 to 2012 in Henan Sub-center of"Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) study"were utilized and those of body mass index≥28 kg/m 2 were screened. The patients were divided into UACR normal group and UACR abnormal group(101 pairs) upon being matched on a 1∶1 basis by age and gender. Multivariate logistic regression analysis, receiver operating characteristic(ROC) curve, and restricted cubic spline(RCS)analysis were performed to explore the risk factors for abnormal UACR. Results:Compared with the normal UACR group, the UACR abnormal group had a higher number of alcohol consumers, a higher prevalence of hypertension, elevated systolic blood pressure, and triglyceride(all P<0.05). Multivariate logistic regression analysis showed that alcohol consumption( P=0.008), systolic blood pressure( P<0.001), triglyceride( P=0.049), and homeostasis model assessment for insulin resistance(HOMA-IR, P=0.033) were independent risk factors for abnormal UACR in obese people. The ROC curve analysis indicated that systolic blood pressure had the strongest diagnostic performance as a single factor(ROC curve area=0.801), and there was no significant difference in diagnostic performance compared to multiple factors combination. RCS analysis results showed that the probability of abnormal UACR increased monotonically with the increase of systolic blood pressure when the systolic blood pressure was between 130 and 158 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure was not in the interval, the probability of abnormal UACR did not change significantly. The results of regression analysis of triglyceride subgroup showed that when triglyceride level was greater than or equal to 5.6 mmol/L, the risk of abnormal UACR level was significantly increased( P=0.029). Conclusion:Systolic blood pressure, triglyceride, HOMA-IR, and alcohol drinking history are independent risk factors for abnormal UACR in obese people. When systolic blood pressure is≥130 mmHg or triglyceride is≥5.6 mmol/L, the risk of abnormal UACR is significantly increased.
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Background: Preeclampsia with or without severe symptoms, chronic hypertension with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, or eclampsia all pose a significant risk of morbidity for both the mother and the unborn child. The aim of this study was to investigate if the albumin-to-creatinine ratio in urine spots and the serum beta-hCG level correlate with the hypertensive illness of pregnancy.”Method: “The current inquiry was conducted during the months of October 2020 and August 2022 at the obstetrics and gynaecology department of Subharti medical college in Meerut, Uttar Pradesh. The study was not open to women who were more than 20 weeks pregnant, had gestational diabetes mellitus, had more than one pregnancy, had chronic hypertension, chronic renal disease, chronic liver disease, cardiac disease, systemic lupus erythematosus, or haematological illnesses. We measured the levels of serum beta hCG and the urine albumin-creatinine ratio, and we compared them between the groups.”Results: After ensuring that each participant had given their informed permission, the trial comprised a total of 200 patients. In the hypertensive group of the participants in the study, 31% were between the ages of 21 and 35, and 29% were less than 20 years old. With increased beta hCG and UACR, there was a higher incidence of hypertensive retinopathy, acute renal failure, DIC, and PPH among the patients, as well as the poorest fetal outcomes. (p<0.05)Conclusions: The presence of a substantial relationship between hypertensive diseases and raised levels of beta-hCG during pregnancy, as well as a greater ratio of urine albumin to creatinine. There is a considerable increase in the incidence of fetal growth retardation, preterm, and mortality occurring within the uterus among mothers who have higher levels of beta-hCG and urine ACR.
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Background: Diabetes mellitus (DM) is an expanding global health problem. Type 2 DM (T2DM) patients account about 90% of total DM patients. Magnesium is important for different physiological mechanism. Hypomagnesemia is common in T2DM patient. Magnitude of hypomagnesemia is related with glycemic control and is associated with complications of T2DM. Aims and Objectives: Our aim of the study was to assess the prevalence of hypomagnesemia in patients of T2DM patients and to find their correlation with glycemic control and complications of T2DM patients in rural population of eastern zone of India. Materials and Methods: The hospital-based cross-sectional study includes 99 male and female DM patients between 15 and 60 years age. Fasting blood sugar, postprandial blood sugar, HbA1c, serum total magnesium, and urine albumin creatinine ratio were measured. Data were entered into Microsoft Excel spreadsheet and then analyzed by SPSS (version 25.0; SPSS Inc.) and GraphPad Prism (version 5.0). P < 0.05 was considered statistically significant. Results: From our study, we observed that hypomagnesemia is common in T2DM patients. The magnitude of hypomagnesemia is correlated with glycemic control (P < 0.0001). Moreover, hypomagnesemia is associated with diabetic kidney diseases (P < 0.05). Conclusion: It can be concluded that serum magnesium should be monitored in all T2DM patients and should be managed appropriately because hypomagnesemia may induce complications in T2DM patients.
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Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.
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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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Background: The ever-increasing prevalence of diabetes has led to a higher incidence of progression into complications including nephropathy. Diabetic kidney disease (DKD) is a chronic condition that is managed with renin-angiotensin-aldosterone system blockers which retard its progression. Pentoxifylline as an add-on therapy has been tried for reducing DKD. Aims and Objectives: The aims of this study were to study the safety and efficacy of pentoxifylline added on to an angiotensin II receptor blocker (ARB) to reduce the progression of the disease condition in diabetic nephropathy (DN) patients over 1 year. Materials and Methods: It is a randomized open-label study conducted in the Department of Nephrology, of a tertiary care center for 1 year. Type 2 diabetes patients with DN who satisfied the eligibility criteria were randomized into pentoxifylline added on to ARB or ARB alone and followed up for urine albumin-creatinine ratio (ACR) and serum tumor necrosis factor (TNF)-alpha. Results: Twenty-six patients were recruited and completed the study. Urine ACR was significantly low in the pentoxifylline group compared to the ARB alone group (P = 0.021). Serum TNF-? was decreased in the pentoxifylline group in comparison to the ARB alone group (P = 0.06). Conclusion: Pentoxifylline caused significant lowering of urinary ACR and urine TNF-? for 4 months.
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Background: Urinary tract infection is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. There are wide range of factors identified that can increase susceptibility to UTI, like sexual intercourse, congenital abnormalities, urinary obstruction, prior history of UTI, diabetes, urogenital surgery, estrogen deficiency. Diabetes mellitus has been a significant risk factor for complicated UTI. Presence of microalbumin in urine in patients of urinary tract infection may be a predictor of intrinsic renal pathology and its presence is a predictor of ongoing progressive damage to kidneys. Microalbuminuria is also associated with cardiovascular events and diabetic nephropathy. Early diagnosis of microalbuminuria will decrease the incidence of end stage renal disease and cardiovascular events. The present study was thus conducted to evaluate prevalence of microalbuminuria in patients diagnosed with urinary tract infections.Material & Methods:The present hospital based case control study was conducted on 60 patients visiting the outpatient clinic (OPD) of Department of Urology, Government Medical College and Rajindra Hospital, Patiala and diagnosed with UTI and the control group consisted of 20 age and gender matched individuals. Estimation of urine microalbumin was done by Enyme linked immunoassay(ELISA) kit method in Department of Biochemistry, GMC Patiala.Results:Out of 60 cases of UTI included in the present study, prevalence of microalbuminuria was observed in 43.3% among cases of UTI . A total of 85% of the cases with positive urine culture had microalbuminuria (p<0.01).Conclusions:Microalbuminuria and ACR can be recommended for predicting ESRD at an early stage of kidney disease.
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Objective:To assess the correlation between circulating chemerin and two indicators of renal function, estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR), in individuals with type 2 diabetes and to determine whether chemerin is an independent marker of early renal insufficiency.Methods:A total of 742 patients with type 2 diabetes were recruited into the cross-sectional community study. Basic information, anthropometric parameters, and biochemical parameters of these individuals were determined and collected, and serum chemerin level was measured using enzyme-linked immunosorbent assay.Results:Chemerin levels were significantly higher in the eGFR-impaired group compared with eGFR-normal group, and macroalbuminuria group compared to the normal or microalbuminuria groups. Spearman′ rank correlation analysis showed serum chemerin level was correlated with eGFR ( r=-0.25, P<0.001), UACR ( r=0.23, P<0.001) and some other biochemical indicators such as triglyceride. And univariate and multivariate logistic regression analyses revealed circulating chemerin was an independent risk factor for eGFR impairment or proteinuria after adjusting corresponding covariates. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of circulating chemerin for predicting early impaired eGFR in type 2 diabetes was 0.747, while the AUC of circulating chemerin for predicting macroalbuminuria in type 2 diabetes was 0.748. Conclusion:Circulating chemerin is associated with eGFR or UACR and may be a potential diagnostic marker for early renal insufficiency in type 2 diabetes.
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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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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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Background: Non-alcoholic fatty liver disease (NAFLD) represents a considerable percentage of chronic liver diseases worldwide. The liver is not the only organ affected by NAFLD but also affects other organs such as the cardiovascular system and the kidney. In recent decades, there has been a growing body of evidence linking NAFLD to kidney function. So, the current study aims to assess the percentage of chronic kidney disease (CKD) in NAFLD patients and its link to different stages of hepatic fibrosis. Patients and Methods: A case-control study evaluated 62 non-alcoholic fatty liver disease patients and a control group of 38 volunteers with apparently healthy livers (normal echo pattern by ultrasound). All participants underwent serum creatinine measurement, albumin creatinine ratio in urine, calculation of estimated glomerular filtration rate (eGFR), abdominal ultrasound, and fibroScan examination. Results: The authors showed that the percentage of patients with chronic kidney diseases (patients with GFR less than 60 ml or micro-albuminuria) were significantly higher among NAFLD groups than in healthy controls. There was a significant positive correlation between the albumin creatinine ratio and subcutaneous fat thickness, BMI, and steatosis degrees. The estimated glomerular filtration rate (eGFR) and the age of the patients had a significant negative correlation. In comparison, the eGFR and AST levels had a significant positive correlation. Conclusions: Our results showed that NAFLD substantially raises the risk of getting CKD
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Creatinina , HígadoRESUMEN
ABSTRACT Objective: We assessed plasma adiponectin and its correlation with carotid intima-media-thickness (CIMT), as a marker of atherosclerosis, and urine albumin/creatinine ratio (ACR) in patients with non-alcoholic fatty liver disease (NAFLD). Subjects and methods: The study included 100 Egyptian subjects (50 patients with NAFLD with no history of diabetes or hypertension and 50 age and sex-matched normal healthy control subjects). Urine albumin/creatinine ratio (ACR) was assessed in all participants and fasting plasma adiponectin was measured using ELISA technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using high-resolution Doppler ultrasonography. Results: Mild albuminuria was detected in patients with NAFLD (mean urine ACR = 42 ± 30 mg/g). Plasma adiponectin was significantly lower and urine ACR and CIMT significantly higher in patients with NAFLD as compared with the control group (P < 0.001 for all). A significant negative correlation was found between plasma adiponectin and both urine ACR and CIMT in patients with NAFLD (P < 0.001 and < 0.05 respectively). A significant positive correlation was also found between CIMT and urine ACR in those patients (P < 0.05). Plasma adiponectin and urine ACR were independent determinants of CIMT in patients with NAFLD (P < 0.01 and < 0.05 respectively). Conclusion: Patients with NAFLD, without diabetes, have an increased risk of atherosclerosis and cardiovascular disease. Hypoadiponectinemia and low-grade albuminuria are important markers of that risk.
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Humanos , Enfermedades Cardiovasculares , Enfermedades Cardiovasculares/epidemiología , Adiponectina , Adiponectina/deficiencia , Enfermedad del Hígado Graso no Alcohólico , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Errores Innatos del Metabolismo/epidemiología , Factores de Riesgo , Creatinina , Albúminas , Grosor Intima-Media Carotídeo , Factores de Riesgo de Enfermedad CardiacaRESUMEN
Objective:To explore the relationship between heart rate variability (HRV) and urine albumin/creatinine ratio (ACR) in patients with type 2 diabetes.Methods:A total of 1 543 patients with type 2 diabetes were selected from the Department of Endocrinology of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and all the participants received 24-hour Holter monitoring and ACR measurement. HRV parameters include the standard deviation of all normal to normal intervals (SDNN), root mean square differences of successive RR intervals (rMSSD), the percent of adjacent RR intervals with a difference greater than 50 ms (PNN50), low frequency (LF), high frequency (HF), the ratio of LF to HF (LF/HF). Multivariate linear regression was used to analyze the relationship between HRV and ACR. Logistic regression was performed to further analyze the relationship between HRV and albuminuria while HRV parameter was divided into ≤25% (Q1) and ≥25% (Q2-Q4).Results:Multivariate linear regression results showed that the decrease of HRV parameters [ln(SDNN), ln(PNN50), ln(LF), ln(HF), ln(LF/HF)] was closely related to the increase of ln(ACR) (all P<0.05). Logistic regression analysis results showed that SDNN( OR=1.669, 95% CI 1.290-2.159), PNN50( OR=1.372, 95% CI 1.063-1.770), LF( OR=1.918, 95% CI 1.441-2.551), and LF/HF ( OR=1.623, 95% CI 1.220-2.183) were independent risk factors for albuminuria (all P<0.05); Furthermore, logistic regression analysis stratified by the median duration of diabetes (10 years) and cardiovascular disease found that in patients with diabetes≤10 years or without cardiovascular disease, the risk of albuminuria in the SDNN and LF Q1 group were higher than that in the Q2-Q4 group; while in patients with diabetes>10 years or with cardiovascular disease, the risk of albuminuria in the SDNN, PNN50, LF, and LF/HF Q1 group were higher than that in the Q2-Q4 group. Conclusion:The reduction of HRV parameters in patients with type 2 diabetes is closely related to the increase of ACR. With the progress of diabetes, more HRV parameters demonstrated predictive effect for risk of albuminuria.
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Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients.
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Introduction: Maternally Inherited Diabetes and Deafness(MIDD), a specific clinical syndrome results in sensory neuralhearing defect in diabetes population which may lead toA3243G mutation in tRNALeu (UUR) gene.Materials and methods: A prospective case control study, thenon probability convenient sampling technique was followedin this study. The subjects were divided into non diabetic anddiabetic with maternal inheritance groups. Hundred patientswith the strong maternal history of diabetes is group 1 andhundred non diabetic individuals with no maternal history ofdiabetes is group 2. Blood and urine samples were collectedand analyzed biochemical parameters among the two groups.In addition, audiometric analysis was also carried out for thosegroups.Results: The mean age of onset of diabetes was 41 yearsand deafness was 51 years. The mean plasma glucose,Glycosylated Hemoglobin(HbA1C), Serum Insulin, InsulinResistance, Cholesterol, Triacyl glycerides, Very Low DensityLipoprotein(VLDL), Low Density Lipoprotein, SerumUrea, Serum Uric acid, Serum Creatinine and Albumin toCreatinine Ratio (ACR) levels in patients were significantlyhigher whereas High Density Lipoproteins(HDL) and urinecreatinine levels were significantly low as compared withcontrols. The mean Body Mass Index (BMI) is slightly higherin patients as compared with control group.Conclusion: The study helps us to understand that theMaternally Inherited Diabetes and Deafness syndromeseverely alters the insulin resistance level, ACR ratio and lipidprofile which may lead to multiple organ disorder at early ageof diabetes.
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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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Background: The study was conducted to evaluate and compare the protective effects of spironolactone (alone) and its effects along with ACE inhibitor (ramipril) on diabetics (30-70year) in relation to proteinuria and state of diabetic nephropathy.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70year) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Patients were divided in two groups, group A (n=28, spironolactone 25mg and ramipril 5mg) and group B (n=27, spironolactone 25mg). Subjects were followed over 12weeks and baseline and 12-week urine ACR being compared.Results: Both the group after receiving respective drug were followed for 3month duration and response were assessed by measuring urine ACR value at end of 3months. Mean values of baseline and follow up urine ACR for group A and group B were 471.5±465.62, 244.66±237.54 and 474.88±438.94, 268.42±268.16 respectively, P value found to be >0.05 at 95%C.I. It was observed that percentage reduction of urine ACR were 48% and 43.47% in group A and group B respectively.Conclusions: In the study, it was concluded that spironolactone had significant effect over proteinuria reduction over follow up period in patient with diabetic nephropathy though there was no additional statistically significant advantage of addition of spironolactone and ACE inhibitor over proteinuria reduction. Significant reduction of proteinuria occurred in both group A and group B over 12weeks follow up period, 48 % reduction in group A and 43.47% in group B. This difference proved statistically not significant after applying independent t-test.