الفهرس | Only 14 pages are availabe for public view |
Abstract DM is a complex metabolic syndrome characterized by chronic hyperglycemia resulting in complications affecting the peripheral nerves, kidneys, eyes, and micro- and macrovascular structures. The prevalence of all types of diagnosed diabetes in most western societies is 3–7%. Preventing vascular complications and monitoring of DM are the need of the hour as the prevalence of DM and its vascular burdens are increasing day by day. Type 2 DM is characterized mainly by impaired insulin secretion and increased tissue insulin resistance. Sustained hyperglycemia leads to a series of interrelated alterations that can cause evident endothelial dysfunction and vascular lesions in diabetic complications. Formation of advanced glycation end products, activation of protein kinase C and disturbances in polyol pathways are the possible mechanisms by which increased glucose induces vascular abnormalities. Diabetic nephropathy (DN) is defined as persistent proteinuria greater than 500mg/ 24 hours or albuminuria greater than 300mg/24 hours and is usually associated with hypertension, and a diminishing glomerular filtration rate (GFR). End stage renal failure may occur many years later and requires dialysis or kidney transplantation . Current treatments include optimization of glycemic and blood pressure control by targeting the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme (ACE) inhibitors and/or angiotensin II receptor blockers. More innovative strategies are needed to prevent and treat this disease. New agents and approaches have recently This page was created using Nitro PDF trial software. To purchase, go to http://www.nitropdf.com/ Summary & Conclusion - 107 - been described that have the potential to delay the progression of diabetic kidney disease and minimize the growing burden of end stage renal disease. Possible targets include the formation of advanced glycation end products (AGEs) and the AGE receptor, increased oxidative stress and inflammation, protein kinase C, endothelin receptors, growth factors and cytokines, the vitamin D receptor, Rho-associated kinases, and the renal sympathetic system. The aim of the current work to assess the existence of early renal involvement identified by microalbuminuria and association of microalbuminuria with potential risk factors as duration of DM ,poor glycemic control (HbA1c) and dyslipidemia. The study was conducted on 110 persons and divided into four groups : Group (1) is included 10 persons is control group of apparently normal individual. Group (2) is included 23 of diabetic patients without evidence of nephropathy. (normoalbuminuric of diabetic patients). Group (3) is included 42 of diabetic patients with microalbuminuria. Group (4) is included 35 of diabetic patients with macroalbuminuria. All participants will be subjected to; (A) Full history taking stress on 1-Duration of diabetes. 2-Family history of diabetes. 3-Age at onset. This page was created using Nitro PDF trial software. To purchase, go to http://www.nitropdf.com/ Summary & Conclusion - 108 - (B) Laboratory investigation including 1-Urine for Albumine / creatinine ratio. 2- Renal functions including ( serum creatinine & blood urea). 3- Fasting blood sugar . 4- 2houres post prandial blood sugar. 5- Hb A1C. 6- eGFR 7- Serum cholesterol & Triglyceride. Result of this study revealed that: As regard of Gender there is no significant difference between the four studied groups . As regard of age there was significant difference between the four studied groups . As regard of family history of diabetes there is no significant difference between the four studied groups . As regard of duration of diabetes there was significant difference between the patients groups as microalbuminuria increased with duration of diabetes . As regard of the age at onset there is no significant difference between the patients groups. There was highly significant positive correlation between FBG,2h PPBG, HbA1c and microalbuminuria . Also there was significant positive correlation between dyslipidemia and microalbuminuria . This page was created using Nitro PDF trial software. To purchase, go to http://www.nitropdf.com/ Summary & Conclusion - 109 - In conclusion : microalbuminuria is the first clinical sign of diabetic nephropathy. The prevalence of microalbuminuria increased with age, duration of diabetes, dyslipedemia and poor glycemic control. Screening and proper treatment of microalbuminuria is a mandatory in diabetic patients to prevent and reduce of diabetic nephropathy. |