Angiogenic imbalance as a contributor to the pathophysiology of preeclampsia among black African women.

OBJECTIVE: The pathogenesis of preeclampsia remains unclear despite extensive research. Altered angiogenic balance has been hypothesized to play a significant role in the clinical manifestations of this syndrome. However this imbalance has not been investigated extensively among black African women. The aim of this study was to investigate the maternal levels of the angiogenic factors soluble vascular endothelial growth factor receptor 1 (sFLT1) and placental growth factor (PlGF) among black African women with preeclampsia. METHODS: A case control study was conducted in the Mthatha hospital complex in South Africa including 51 women with preeclampsia and 82 women with uncomplicated pregnancies. Blood samples were drawn from participants and serum was used to assess sFLT1, and PlGF levels quantified using specific enzyme linked immunosorbent assays. Non- parametric statistics were used for analysis. RESULTS: Black African women with preeclampsia were found to have significantly lower levels of PlGF (90.3 ± 8.9 pg/ml versus 172.8 ± 20.2 pg/ml; p < 0.01), higher sFLT1 (2087.3 ± 200.1 pg/ml versus 1546.5 ± 91.9 pg/ml; p < 0.01) and a higher sFLT1/PIGF ratio (66.8 ± 18.7 versus 22.3 ± 2.9; p < 0.01) compared to black African normotensive controls. CONCLUSION: The results support an altered angiogenic balance may contribute to the pathogenesis/pathophysiology of preeclampsia among black African women as reported in other populations.

Effect of glycaemic control on glomerular filtration rate in diabetes mellitus patients.

BACKGROUND: Glomerular filtration rate (GFR) is a widely accepted parameter in assessing overall renal function. This study sought to assess the effect of glucose lowering on GFR in diabetic patients admitted for short term therapy at Mulago hospital. METHODS: This was a descriptive study where consenting patients were consecutively recruited. Glomerular filtration rate was measured using creatinine clearance in 40 type I and II diabetes mellitus patients admitted on the basis of a glucometer reading of RBS >or= 300 mg/dl both at admission and discharge. Data was analyzed using a paired sample t-test and p-value set at 0.05 (95% CI). RESULTS: A total of 40 patients were assessed. Their mean age was 49.8 years. 82.5% of them had type II DM while only 17.5% had type I DM. The average duration of disease was 7 years. GFR was found to decrease from 157.4 ml/min on admission to 86.4 ml/min at discharge (p=0.001). Random blood sugar levels decreased from 332.2mg/dl on admission to 119.8 mg/dl at discharge (p=0.000). CONCLUSION/RECOMMENDATION: Results imply that glycaemic control lowers the GFR in diabetic patients admitted for short term treatment. A reduction in GFR reflects reduction of hyperfiltration, a process that starts diabetic nephropathy. Good glycaemic control will go along way to delay onset of diabetic nephropathy.