Abstract
ABSTRACT. Diabetic nephropathy is the most common complication of microvascular disease due to diabetes and the third leading cause of renal failure to the end stage. One of the causes of diabetic nephrophaty progression is increase oxidants by lipoprotein a. Bilirubin is a lipophilic endogenous antioxidant that can prevent oxidant effect. This study aims to determine the correlation between bilirubin levels and lipoprotein a in patients with diabetic nephropathy. This research is a case control study with consecutive sampling technique. The subjects were divided into two groups, 25 subjects in the diabetic nephropathy group and 25 subjects in the type 2 diabetes mellitus group without nephropathy. Spearman correlation was used to assess the correlation between bilirubin and lipoprotein a and the mann-whitney test to assess the ratio of bilirubin and lipoprotein a levels in both groups. Antioxidant effect of bilirubin significantly negative correlated with lipoprotein a in the diabetic nephropathy group (r = -0.734; p = 0.000) and also significantly negative correlated in the group of type 2 DM without nephropathy (r = -0.476; p = 0.016). Bilirubin levels in diabetic nephropathy were lower when compared with the group of type 2 DM without nephropathy (OR = 1.3, 95%; CI = 0.23-10.3) whereas lipoprotein a in the diabetic nephropathy group was higher when compared to the type 2 DM group without nephropathy ( OR = 2.8; 95%; CI = 1.84-12.07). Lipoprotein a is a more important risk factor for diabetic nephropathy. Low levels of bilirubin can increase oxidant effect of lipoprotein a and lipoprotein a play a role in progressivity of diabetic nephrophaty.
Highlights
Pendahuluan Diabetes mellitus (DM) adalah sekelompok penyakit metabolik yang ditandai dengan hiperglikemia akibat gangguan fungsi insulin, sekresi insulin atau keduanya
This study aims to determine the correlation between bilirubin levels and lipoprotein a in patients with diabetic nephropathy
Pathophysiology of diabetic dyslipidaemia: where are we?
Summary
1,2,3Department of Biomedical Sciences, Faculty of Medicine University of Sumatera Utara. Nefropati diabetik merupakan komplikasi mikrovaskuler terbanyak akibat diabetes dan menjadi penyebab ketiga jatuhnya gagal ginjal ke stadium akhir. Salah satu penyebab progresifitas nefropati diabetik ini adalah peningkatan oksidan oleh lipoprotein a (Lp(a)). Bilirubin adalah antioksidan endogen lipofilik yang dapat mencegah efek oksidan tersebut. Penelitian ini bertujuan untuk mengetahui korelasi antara kadar bilirubin dan lipoprotein a pada pasien dengan nefropati diabetik. Efek antioksidan bilirubin berkorelasi negatif signifikan dengan lipoprotein a pada kelompok nefropati diabetik (r=-0.734 ; p= 0.000) dan juga berkorelasi negatif signifikan pada kelompok DM tipe 2 tanpa nefropati (r=-0.476; p= 0.016). Lipoprotein a merupakan faktor resiko yang lebih berperan terhadap nefropati diabetik. Kata kunci: Bilirubin, Lipoprotein a, Nefropati Diabetik, Diabetes Mellitus tipe 2
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