Diabetic Nephropathy Cases Research Articles

Interactions Between Eleven Sleep-Related Characteristics and Diabetic Nephropathy: A Bidirectional Mendelian Randomization Study in European Population.

Observational studies often report disturbed sleep patterns in individuals with diabetic nephropathy (DN). The possible causal relationship behind these connections remains unknown. This research assessed the possible cause-and-effect relationship between eleven sleep-related characteristics and the risk of developing DN using a two-sample Mendelian randomization (MR) study. This study employed a two-sample bidirectional MR analytical approach. Genetic data for eleven sleep-related characteristics were acquired from the genome-wide association studies (GWAS) database of individuals of European ancestry which involve scanning complete sets of DNA, or genomes. GWAS summary data for DN included 4,111 DN cases and 308,539 controls. Instrumental variables were single nucleotide polymorphisms strongly linked to sleep-related characteristics. The main analysis used the random-effects inverse variance weighted (IVW) approach, with validation through sensitivity testing. MR analysis revealed that a higher genetic predisposition for sleep efficiency reduced the chance of developing DN (odds ratio [OR]: 0.384; 95% confidence interval [CI] 0.205-0.717; p=0.003). Genetic susceptibility to DN was associated with a higher likelihood of experiencing more sleep episodes (OR: 1.015; 95% CI 1.003-1.028; p=0.016). Sensitivity analysis confirmed the robustness of these correlations. No significant connections were found between other genetically predicted sleep characteristics and the likelihood of developing DN. Our research indicates that a genetic predisposition for better sleep efficiency is linked to a lower risk of developing DN. There is also evidence suggesting that genetic predisposition to DN may directly impact sleep episodes. Further research is needed to explore the molecular mechanisms underlying these findings.

Effects of APOE isoforms in diabetic nephropathy patients of South India.

Diabetic nephropathy (DN) is a grave complication and the most common renal dysfunction of diabetes mellitus. Genetic factors, including Apolipoprotein E (APOE) isoforms, have been implicated in the pathogenesis of DN. A total of 577 type 2 Diabetes mellitus subjects were categorized into diabetes non-nephropathic (Controls: n = 321), diabetes nephropathic (DN: n = 256) groups. Demographic, clinical, and biochemical parameters including age, BMI, lipid profiles (TC, LDL-C, HDL-C, TG), glucose metabolism (plasma glucose, HbA1c, serum insulin), renal function (UACR, PCR), and blood pressure (SBP, DBP) were assessed. APOE variant frequencies were determined using restriction fragment length polymorphism (RFLP) analysis, validated against Hardy-Weinberg equilibrium (HWE), and statistically correlated with each clinical and biochemical parameter. The DN group had an increased prevalence of hypertension, fatty liver, and dyslipidemia compared to the Control group. Biochemical analyses revealed elevated levels of TC (213.41mg/dL vs. 189.32mg/dL), LDL-C (134.46mg/dL vs. 107.56mg/dL), and reduced HDL-C (58.13mg/dL vs. 65.32mg/dL) in DN cases compared to Controls (all p < 0.0001). The APOE variants distribution showed a significant increase in E2 allele frequency (69.1% vs. 15.3%) and corresponding homozygous genotype (E2/2: 42.2% vs. 5.6%) in DN cohorts. The study found a higher frequency of E2 allele in the DN group compared to Controls, though no statistically significant risk of DN was linked to this allele. The results suggest a potential association for APOE polymorphisms, requiring broader studies to clarify the role of APOE polymorphisms in DN susceptibility.

Association between body fat variation rate and risk of diabetic nephropathy - a posthoc analysis based on ACCORD database

BackgroundWeight control has consistently been regarded as a significant preventive measure against diabetic nephropathy. however, the potential impact of substantial fluctuations in body fat during this process on the risk of diabetic nephropathy remains uncertain. This study aimed to investigate the association between body fat variation rate and diabetic nephropathy incident in American patients with type 2 diabetes.MethodsThe study used data from the Action to Control Cardiovascular Risk in diabetes (ACCORD) trial to calculate body fat variation rates over two years and divided participants into Low and High groups. The hazard ratio and 95% confidence interval were estimated using a Cox proportional hazards model, and confounding variables were addressed using propensity score matching.ResultsFour thousand six hundred nine participants with type 2 diabetes were studied, with 1,511 cases of diabetic nephropathy observed over 5 years. High body fat variation rate was linked to a higher risk of diabetic nephropathy compared to low body fat variation rate (HR 1.13, 95% CI 1.01–1.26). Statistically significant interaction was observed between body fat variation rate and BMI (P interaction = 0.008), and high level of body fat variation rate was only associated with increased risk of diabetic nephropathy in participants with BMI > 30 (HR 1.34 and 95% CI 1.08–1.66).ConclusionsAmong participants with Type 2 Diabetes Mellitus, body fat variation rate was associated with increased risk of diabetic nephropathy. Furthermore, the association was modified by BMI, and positive association was demonstrated in obese but not non-obese individuals. Consequently, for obese patients with diabetes, a more gradual weight loss strategy is recommended to prevent drastic fluctuations in body fat.Trial registrationClinical Trials. gov, no. NCT000000620 (Registration Date 199909).Graphical

Cohort profile: the PRIMETIME 1 (PRecIsion MEdicine based on kidney TIssue Molecular interrogation in diabetic nEphropathy) cohort – a longitudinal Danish nationwide study of individuals with diabetes and a performed kidney biopsy

PurposeIndividuals with diabetes and chronic kidney disease are at high risk of kidney failure, cardiovascular events and premature mortality and more research is warranted to further improve the prevention and...

Excreted albumin of diabetic microalbuminuria cases exhibits pseudo esterase activity: A new way to explore microalbuminuria, perhaps with more information

BackgroundMicroalbuminuria is associated with several clinical conditions of public health concern. Particularly in diabetic patients, there is routine microalbuminuria screening to understand whether the renal complication has progressed to the microalbuminuria stage or not. Therefore, microalbuminuria detection is a matter of considerable interest. For such detection, the clinical labs rely on immunochemical methods. Nevertheless, the immunochemical methods are believed to be less sensitive for the purpose. So, the need arises for continuous research in the field. We believe that pseudoesterase activity of the excreted albumin in microalbuminuria cases is a potential target. This aspect is investigated here and it is shown that the excreted albumin in diabetic microalbuminuria cases retains its pseudoesterase activity, unlike the overt albuminuria cases. MethodsThe cases of diabetic nephropathy and healthy controls were included in the study. The patients were divided into diabetic controls microalbuminuria, and overt albuminuria group considering the albumin to creatinine ratio (ACR). The urinary proteins of the cases were isolated by centrifugation. The obtained protein pellet was then checked for pseudoesterase activity by electrophoretic and fluorescence-based methods. The CD spectroscopy and LC-MS study was carried out to show the suitability of the substrate for the detection of albumin pseudoesterase activity. To further, understand the structure–function relation, molecular docking studies were carried out. ResultsFrom the CD and LC-MS study the suitability of the used substrate was confirmed. The electrophoretic and fluorescence study showed that the protein of the microalbuminuria group retained the pseudoesterase activity whereas the same is lost in the overt albuminuria group. The molecular docking studies indicated that a change in albumin structure may result in a change in its pseudoesterase activity. ConclusionThe urinary protein of diabetic microalbuminuria cases exhibits pseudoesterase activity. It distinguishes the excreted protein in the diabetic albuminuria group and the overt albuminuria group. This is the first study that showed the retention of pseudoesterase property in excreted albumin. Further, in this study a simple test is developed that distinguishes the excreted albumin in the microalbuminuria group and overt albuminuria group.

Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study.

The paradoxical protective association between overweight/obesity and diabetic microvascular complications (DMC), a phenomenon well-known as the obesity paradox, has been considered a non-causal association based on methodological influences. We aimed to investigate the association of generalized and abdominal obesity, as measured by body mass index (BMI) and waist circumference (WC), respectively, with DMC in patients with type 2 diabetes (T2D), using a causal inference approach. We enrolled 1436 patients with clinically diagnosed T2D but not DMC at baseline in a community-based prospective cohort in China between 2017 and 2019 and followed them annually until 2022 with new-onset DMC recorded. Marginal structural Cox models with inverse probability weighting were constructed to determine the causal association. Subgroup analyses were performed to identify potential effect modifiers. We observed 360 incident DMC cases, including 109 cases of diabetic nephropathy (DN) and 277 cases of diabetic retinopathy (DR) during four follow-up visits. Multivariable-adjusted hazard ratios (95% confidence intervals) for overall DMC, DN and DR were 1.037 (1.005-1.071), 1.117 (1.062-1.175) and 1.018 (0.980-1.059) for 1 kg/m2 increase in BMI, and 1.005 (0.994-1.017), 1.034 (1.018-1.051) and 1.000 (0.987-1.014) for 1 cm increase in WC, respectively. Similar patterns were observed across the BMI and WC categories, while the positive association appeared to be more pronounced in women. Generalized but not abdominal obesity was associated with an increased risk for the overall DMC, whereas both obesities were causally related to DN, albeit not DR, in T2D. Routine weight management should not be neglected in diabetes care, particularly in women.

Neutrophil to lymphocyte ratio as a marker of diabetic nephropathy

Aim of the study is to estimate and analyze neutrophil to lymphocyte ratio (NLR) in diabetes mellitus as a marker of diabetic nephropathy (DN). Forty individuals with DN and forty patients with diabetes mellitus without nephropathy were enrolled. Inclusion criteria included patients with diabetic nephropathy (albuminuria &gt;30 mg/day and/or eGFR &lt;60 mL/min/1.73 m2) in the absence of additional kidney damage symptoms. Complete blood count, glycated haemoglobin (HbA1c), 24-hour urine albumin and serum creatinine were evaluated and compared. The mean NLR of the patients with DN (Cases) was 3.09 ± 0.88 (1.34-4.91) and in patients with diabetes mellitus only (Controls) it was 2.17 ± 0.69 (0.89-3.98). The correlation between urinary albumin excretion (p value =0.0004) and estimated glomerular filtration rate (p value =0.0002) also came out positive and negative respectively. Based on unpaired t-test, the difference between NLR values among the group came out statistically highly significant (p &lt; 0.05). Thus, the NLR in both groups was not comparable. NLR was substantially higher in diabetic nephropathy patients compared to diabetes mellitus patients. Thus, NLR provides us with a simple and low-cost assessment that may be employed as a predictive instrument to diagnose diabetic nephropathy at a preliminary phase.

Study of the Urinary TGF-β1 Profile in Diabetic Nephropathy: A Single-Center Experience From India.

Background Diabetic nephropathy is one of the important causes of end-stage kidney disease (ESKD). Of the various cytokines playing a role in the pathogenesis of diabetic nephropathy, transforming growth factor beta-1 (TGF-β1) is an important one. Its major role is to mediate extracellular matrix deposition. Increased renal expression of TGF-β1 is found in diabetic nephropathy and its urinary excretion can serve as a useful marker of outcomes. Material and methods A prospective observational study was conducted, which included 10 cases of diabetic nephropathy in group A with age ≥ 18 years and a urinary protein creatinine ratio (UPCR) value of > 0.5 mg/mg and 10 healthy controls in group B. Patients with active urinary tract infection, chronic kidney disease (CKD) stage Vd patients on maintenance hemodialysis, and renal transplant recipients were excluded from the study. Urinary TGF-β1 level estimation in a 24-hour urine sample, 24-hour urine protein, and other baseline laboratory investigations were done. Results In diabetic nephropathy cases (group A), the mean value of urinary TGF-β1 levels was 88.33± 12.44 ng/24 hours. In the control group (group B), the mean value of urinary TGF-β1 was 29.03 ± 3.23 ng/24 hours. Urinary TGF-β1 levels were significantly elevated in group A as compared to group B (p<0.001). There was no significant correlation between urinary TGF-β1 levels andestimated glomerular filtration rate (eGFR) (r=0.376, p= 0.285) as well as the urinary TGF-β1 levels and 24-hour urine protein levels (p = 0.334, r = 0.341) in diabetic nephropathy cases. Glycosylated hemoglobin (HbA1c) levels didn't correlate with the urinary TGF-β1 levels (r = -0.265, p = 0.46). Conclusion The urinary TGF-β1 levels were significantly elevated in diabetic nephropathy patients as compared to healthy controls. There was no significant correlation between urinary TGF-β1 levels and proteinuria,eGFR, or HbA1c levels in diabetic nephropathy patients.

Renal biopsy pattern in diabetes mellitus patients and their correlation with clinical parameters

Background. Diabetic nephropathy is a condition marked by persistent proteinuria, hypertension, and a progressive loss of renal function. End-stage kidney disease needing continuous renal replacement treatment is now primarily caused by diabetes. According to Kimmelstiel and Wilson, the hallmark lesion of diabetic nephropathy is nodular glomerulosclerosis. Diabetic nephropathy or Nondiabetic renal disease, or the coexistence of both can be seen in renal histopathology and in differentiating between these diagnostic groups can have an impact on patient care and prognosis.Patients and Methods. Total of 21 cases of Diabetic nephropathy were included in the study. Clinical details and laboratory parameters like diastolic blood pressure, creatinine level, 24 hrs urinary protein level and HbA1C% were recorded in pretested performa in all cases. The biopsy specimens were stained with hematoxylin &amp; eosin and special stains.Results. Among the total DM cases only 21 patients have done renal biopsy, 11 cases (52.3 %) showed KW lesion (Class III) while 06 cases (28.5 %) showed diffuse diabetic glomerulosclerosis (Class IV). The remaining 04 cases (19 %) showed a mild increase in mesangial matrix and slight thickening of glomerular basement membrane (Class II). When compared with clinical parameters, they were more raised in Nodular diabetic glomerulosclerosis type (Class III) lesion as compared to diffuse diabetic glomerulosclerosis.Conclusion. Nodular diabetic glomerulosclerosis was the most common lesion in renal biopsy of type II diabetes mellitus patients. This KW lesion is responsible for more severe clinical and biochemical renal abnormality in most patients with type II diabetes mellitus.

In situ assessment of Mindin as a biomarker of podocyte lesions in diabetic nephropathy.

Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal failure worldwide. Several mechanisms are involved in the pathogenesis of this disease, which culminate in morphological changes such as podocyte injury. Despite the complex diagnosis and pathogenesis, limited attempts have been made to establish new biomarkers for DN. The higher concentration of Mindin protein in the urine of patients with type 2 diabetes mellitus suggests that it plays a role in DN. Therefore, this study investigated whether in situ protein expression of Mindin can be considered a potential DN biomarker. Fifty renal biopsies from patients diagnosed with DN, 57 with nondiabetic glomerular diseases, including 17 with focal segmental glomerulosclerosis (FSGS), 14 with minimal lesion disease (MLD) and 27 with immunoglobulin A nephropathy (IgAN), and 23 adult kidney samples from autopsies (control group) were evaluated for Mindin expression by immunohistochemistry. Podocyte density was inferred by Wilms' tumor 1 (WT1) immunostaining, while foot process effacement was assessed by transmission electron microscopy. Receiver operative characteristic (ROC) analysis was performed to determine the biomarker sensitivity/specificity. Low podocyte density and increased Mindin expression were observed in all cases of DN, regardless of their class. In the DN group, Mindin expression was significantly higher than that in the FSGS, MCD, IgAN and control groups. Higher Mindin expression was significantly positively correlated with foot process effacement only in class III DN cases. Furthermore, Mindin protein presented high specificity in the biopsies of patients with DN (p < 0.0001). Our data suggest that Mindin may play a role in DN pathogenesis and is a promising biomarker of podocyte lesions.

MANAGEMENT OF CHRONIC KIDNEY DISEASE THROUGH AYURVEDA– A CASE REPORT

Chronic kidney disease (CKD) affects over 10% of the population and is a signicant public health problem. CKD can lead to end-stage renal disease (ESRD), cardiovascular disease, and premature death. The most common causes of CKD are diabetic nephropathy and hypertensive nephropathy. Diabetic nephropathy is characterized by slowly progressive albuminuria, worsening hypertension, and renal insufciency. Hypertensive nephropathy is more common in elderly people. Diabetic nephropathy can be correlated to upadrava of vata pradhana sannipathika prameha with increase in the Kleda bhava of medodhatu and kapha, and sthanasamsraya in vasthi. Asingle case of diabetic nephropathy admitted in IPD of Ayurveda College Coimbatore was selected for the study. And the case was managed by adopting deepana pachana, samana and rasayana chikitsa. The changes in blood parameters and RFT was noted and systematically analyzed after each treatment. It was found increase in Hb level, and reduction of values of serum creatinine, blood urea, and urinary excretion of albumin. Marked symptomatic improvement was found in the patient. This management may bring some new hope to the patients of diabetic nephropathy which terminates to chronic renal failure and ultimately to death.

Determining ACE-2 Level and Some Relevant Biochemical Parameters and studying the effect of Gender in Iraqi Diabetic Patients with Glomeruli and Renal Tubules Fibrosis as Early Prediction Marker

Diabetic kidney disease is an illness of the glomerulus that interferes with the glomerular filtration barrier (GFB), which is worked to enable kidney to selective purification of water and solutes in addition to limiting the movement of large macromolecules such as albumin. In the glomerular endothelium, mesangial cells, foot cells, and the brush border of the proximal tubules, ACE-2 is expressed and that the kidneys represent the highest-expressing region of this enzyme. Thus, the current study aimed to evaluate ACE-2 level in this case compared to healthy condition. The study Conducted with 120 male and female ranging in age (30-65) years old. Ninety patients with type 2 diabetes subdivided into three groups on the basis of ACR criteria including normoalbuminuria, microalbuminuria, macroalbuminuria (30 patients for each group) and 30 healthy people served as the control group, all visited Baghdad Teaching Hospital / Medical City and Al-Yarmouk Teaching Hospital, at the period between December 2021 and May 2022. ACE-2 levels were determined using the ELISA technique. Urea results showed significant differences between diabetic nephropathy in patient and control group in female cases but no significant differences in male patients with diabetic nephropathy and control group. Similar results were obtained in K ion. Also the results revealed significant differences in Na ion, ACR, eGFR, Urea, FBS, creatinine between diabetic nephropathy groups and healthy group.ACE-2 represents a good marker for early prediction in diabetic nephropathy case. ROC data analysis support the importance of ACE-2 in diagnosis of the studied disease case.

The role of glomerular lesions in the prognosis of patients with acute kidney injury during hemorrhagic fever with renal syndrome

Objective This study aimed to explore the role of glomerular lesions in patients who suffered from acute kidney injury (AKI) during hemorrhagic fever with renal syndrome (HFRS). Methods The study comprised 66 patients with AKI during HFRS treated at the National Clinical Research Center of Kidney Diseases of China, Jinling Hospital, from January 2014 to December 2018. According to the kidney pathological findings, the 66 patients were divided into two groups: the tubulointerstitial injury group (HFRS-TI group, n = 43) and the tubulointerstitial injury with glomerular lesions group (HFRS-GL group, n = 23). The clinical and pathological characteristics of the 66 patients were analyzed. Results There were 9 cases of IgA nephropathy, 1 case of membranous nephropathy, 2 cases of diabetic nephropathy, and 11 cases of mesangial proliferative glomerulonephritis in the HFRS-GL group. There were more males in the HFRS-GL group than in the HFRS-TI group (92.3% vs. 69.8%, p < .05). A higher proportion of interstitial fibrosis (56.5% vs. 27.9%, p < .05) and more immunoglobulin and complement depositions (p < .001) were observed in the HFRS-GL group than in the HFRS-TI group. Rates of remission of AKI were lower in the HFRS-GL group than in the HFRS-TI group (73.9% vs. 95.3%, p < .05). The presence of glomerular lesions (HR = 5.636, 95% CI = 1.121–28.329, p = .036) and moderate tubulointerstitial injury (HR = 3.598, 95% CI = 1.278–10.125, p = .015) were found to be independent risk factors for kidney prognosis. Conclusions Patients with AKI during HFRS can have glomerular lesions or glomerulonephritis. Patients with AKI during HFRS who have glomerular lesions or moderate renal tubulointerstitial injury proven by kidney biopsy have a relatively poor kidney prognosis. A kidney biopsy can help determine long-term prognosis in patients with AKI during HFRS.

Histopathologic and clinical features of diabetic nephropathy alone and with concomitant nondiabetic renal diseases

Background and objective: Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM) and one of the leading causes of end-stage kidney disease. The aim of the present study was to evaluate the histomorphological and clinical profiles of DN and associated non-diabetic renal dieases (NDRD) in diabetic patients. Materials and methods: The study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka, from July 2019 to December 2020. Renal biopsy samples from known diabetic patients were included in the study. The formalin-fixed tissues were stained with haematoxylene &amp; eosin (H&amp;E), Periodic acid Schiff (PAS), Masson Trichrome (MT) and Jones Methanamine Silver (JMS) stains. Tissues were stained for IgG, IgA, IgM, C3, C1q, kappa and lambda for direct immunofluorescence (DIF) study. DN was histologically classified according to Tervaert classification system. Interstitial fibrosis and tubular atrophy (IFTA) as well as arteriolar hyalinization scoring was also done. Clinical information was retrieved from the patient’s information sheet. Results: Total 46 biopsy samples from DN cases were included in the study. The mean age of the cases was 46.76+10.63 years, including 36 males and 10 females. The most common clinical presentation was nephritic range proteinuria (n=32, 69.56%). Among all, 27 (58.69%) patients had haematuria. The mean serum creatinine level was 4.28+2.61 mg/dl, and 80.43% had serum creatinine levels &gt;1.5 mg/dl. Histopathologic examinatiom revealed type III DN in 26 (56.5%) and type IV DN in 11 (23.9%) cases. IFTA score 1 (&lt;25%) was seen in 20 (43.5%), score 2 (25-50%) in 19 (41.3%) and score 3 (&gt;50%) in 7 (15.2%). Vascular hyalinization score-2 in 25 (54.3%), score-1 in 14 (30.4%) and score-0 in 7 (15.2%). DN class II, III and IV were associated with high urinary total protein (UTP) and serum creatinine levels. Among the histologic changes, percentage of glomerular sclerosis, the mean IFTA score and vascular hyalinization score were found to be highest in class IV DN, and all were significantly associated with histologic glomerular DN classes (p= &lt;0.05). Of the total cases, 21 (45.65%) were found with nondiabetic renal diseases (NDRD), the most common feature was focal segmental glomerulosclerosis (FSGS) (26.57%), followed by IgA nephropathy and post-infectious glomerulonephritis (PIGN). Among 46 cases, one post-transplant biopsy was included, which revealed class II DN along with features of calcineurin inhibitor toxicity. Conclusion: Tervaert’s histologic classification of our cases revealed class III DN lesions as the predominant one, and the classes had a significant association with age of the patient, serum creatinine level, mean IFTA, arteriolar hyalinization and NDRD. Among the NDRD, FSGS was the most common pathology. IMC J Med Sci. 2023; 17(1): 003. DOI: https://doi.org/10.55010/imcjms.17.003 *Correspondence: Sk Md Jaynul Islam, Department of Histopathology, Armed Forces Institute of Pathology, Dhaka Cantonment, Dhaka, Bangladesh. Email: jaynul.islam@gmail.com

Prevalence of nephropathy in Indian children and youth with type 1 diabetes mellitus.

Children with type 1 diabetes (T1D) having diabetic nephropathy (DN) are at increased risk of developing end stage renal disease. The present study aimed to determine the prevalence of DN and its predictors in Indian children and youth with T1D. This cross-sectional study included 319 children and youth (2.6-21 years) with T1D having disease duration of at least 2 years. Demographic data and laboratory findings were obtained using standard questionnaires and protocols. Diagnosis of diabetic nephropathy was based on albuminuria on two occasions within a period of 3months. The prevalence of DN in our study subjects was13.4%. 7.5% subjects were known cases of diabetic nephropathy on treatment with enalapril. Hypertension was found in 14.3% subjects with DN in contrast to 4.1% without DN (p<0.05). Duration of diabetes and estimated glucose disposal rate were the important predictors of DN. Interestingly, of the 43 children with DN, 11.3% (n=8) were under 10 years age. We found a high prevalence of DN in children and youth with T1D including in children under the age of 10 years. Early screening and timely intervention are required to retard the disease progression and avoid end stage renal disease.

POS-106 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS FOR ACUTE KIDNEY INJURY

Continuous ambulatory peritoneal dialysis is a modality used for Renal replacement in patients with End stage renal disease. Herein we report a patient who developed recurrent cardiac arrest with hemodialysis, and hence CAPD was done to treat her Acute Kidney Injury (AKI). A 55 year old woman presented with complaints of pedal edema, progressive dyspnea from last 1 month, with reduced urine output from last 2 days. Known case of diabetic nephropathy since 1 year, with baseline creatinine of 3.2 mg/dl. History of native medication use for one week. She was suspected to have worsening CKD due to native medicines with a serum creatinine of 10.2 mg/dl, and planned for hemodialysis. She was started on hemodialysis and developed cardiac arrest within half hour of initiation, and further developed seizures within half hour of starting second session, and another episode of cardiac arrest within ten minutes of starting third session despite change of dialyzers and heparin. A possibility of dialyzer reaction was considered and she was planned for continuous ambulatory peritoneal dialysis for her AKI. She underwent bedside insertion of Swan neck Tenckhoff catheter and initiated on CAPD, with 3 exchanges per day and discharged home after 4 days. After two weeks, she developed gradual recovery of renal function and became dialysis independent with creatinine of 4.4 mg/dl. CAPD has rarely been used as a modality for treatment of dialysis for AKI. We report a case of successful use of CAPD for AKI in a patient with repeated cardiac arrests. CAPD can therefore be used with good outcomes in resource limited settings.

POS-343 BODY MASS INDEX AND DIABETIC NEPHROPATHY: A MENDELIAN RANDOMIZATION STUDY

The association between obesity and diabetic nephropathy (DN) has been studied but the results of these epidemiological studies are not entirely consistent. The causal effect of body mass index (BMI) on DN and kidney traits in type 2 diabetes was evaluated by a two-sample Mendelian randomization (MR) analysis. A total of 59 independent genetic variants were selected as instrumental variables for BMI in 158,284 participants from Biobank Japan, and their effects on DN risk, eGFR and proteinuria were estimated in 3972 Chinese individuals with type 2 diabetes. Then, subgroup analysis was performed with different BMI levels or sex. In addition, the sensitivity analyses were performed including MR-Egger regression for detecting genetic directional pleiotropic effects, and power calculation for evaluating the reliability of the study. The generalized summary-data-based MR (GSMR) method showed that a one standard deviation increase in BMI was causally associated with a 3-fold increase in the risk of DN (odds ratio [OR], 4.05; 95% confidence interval [95% CI], 2.10 to 7.82; P<0.001), and a 35% decrease of eGFR level (OR, 0.65; 95% CI, 0.54 to 0.78; P<0.001). However, BMI was not associated with the level of proteinuria (OR, 1.26; 95% CI, 0.89 to 1.79; P=0.19). In addition, subgroup analysis showed a positive association between BMI and the risk of DN in individuals with different BMI levels (BMI≥25 vs BMI<25 kg/m2) or sex. Analyses stratified by sex indicated the casual effect of BMI on DN was stronger in women (OR, 9.82; 95% CI, 1.83 to 52.67; P=0.008) than in men (OR, 3.39; 95% CI, 1.23 to 9.34; P=0.02). In sensitivity analyses, the MR-Egger regression intercepts indicated that the results were less likely to be affected by pleiotropy. Based on 1,314 DN cases and 2,658 controls, our study had ≥80% power to detect the causal effect of BMI on DN risk if the genuine OR≥1.69 per standard deviation increase of BMI. Genetic evidence showed that higher BMI levels was causally associated with increased risk of DN and decreased eGFR level, but not with proteinuria. The DN risk for women was more susceptible to BMI levels than men.

POS-330 DIABETIC NEPHROPATHY, CLINICAL AND HISTOLOGIC SPECTRUM, A STUDY IN DHAKA

Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM) and one of the leading causes of end-stage kidney disease. The natural course of DN has traditionally been initial glomerular hyperperfusion followed by microalbuminuria, overt proteinuria, and eventually progressive renal dysfunction. In the present study, we tried to evaluate the histomorphological profiles of DN cases along with associated non-diabetic renal changes and correlation with clinical parameters.

Diabetic nephropathy with crescent: A case report

Abstract Diabetic nephropathy is one of the main complications of diabetes, and is also one of the important causes of end-stage renal disease. It is characterized by pathological changes such as thickening of the glomerular basement membrane, expansion of the mesangial matrix, glomerular sclerosis, and hyalinosis of small arteries. However, diabetic nephropathy is rarely accompanied by the formation of a large number of crescents. At this time, renal puncture is required to search for the cause in diabetic nephropathy with worsening renal function. We report a case of diabetic nephropathy with the formation of a large number of crescents.

A Study to Evaluate the Association Between Thyroid Function and Serum Potassium Level in Diagnosed Cases of Diabetic Nephropathy.

IntroductionCoexistence of diabetes mellitus and thyroid diseases is common. One of the main microvascular complications of diabetes is diabetic nephropathy (DN) and it is found to be the leading cause of chronic kidney disease. The aim of the present study was to assess the association between hypothyroidism and serum potassium levels in diabetic nephropathy patients.Materials and methodsA cross-sectional study was conducted from March 2020 to January 2021. We enrolled 100 patients with DN along with 50 healthy controls belonging to the same localities. Serum potassium, creatinine, thyroid-stimulating hormone (TSH) and total triiodothyronine (T3) levels of all the cases were measured to establish the correlation of serum potassium along with each parameter separately.ResultsSerum potassium, creatinine, TSH levels were increased in all the cases of diabetic nephropathy showing positive correlations of serum potassium with serum TSH and serum creatinine levels with correlation coefficient values 0.71 and 0.7 respectively and serum T3 levels were decreased in all the cases significantly showing negative correlation with serum potassium levels with correlation coefficient value -0.34.ConclusionEstimation of serum TSH and T3 levels along with serum potassium levels is important and helpful in patients with diabetic renal disease. Changes in thyroid parameters like decreased TSH or increased T3 are significantly associated with deterioration in the severity of renal function in diabetic patients.