Incipient Nephropathy Research Articles

Effect of Gandira (Coleus forskohlii Willd Briq) moola churna on Incipient Diabetic Nephropathy-A quasi experimental pilot clinical trial.

Background: Diabetic nephropathy is a leading cause of diabetes mellitus-related to morbidity and mortality. This study explores efficacy of Ayurvedic medicine, Gandira (Coleus forskohlii Willd Briq) moola churna in management of Incipient Diabetic Nephropathy in type 2 diabetes mellitus (T2 DM). Incipient nephropathy is the early stage of nephropathy with low amount of microalbuminuria (30–299 mg/24 hours). Materials and Methods: Study is a quasi experimental pilot study, single group, pre post design, in which placebo intervention (n=14) was followed by test intervention (n=10). Fourteen patients of T2 DM with microalbuminuria on stable anti diabetic medications in the age group of 30-70 years of either sex were enrolled. Intervention was with placebo (starch) 500mg capsules twice a day for 90 days. Micro albuminuria assessed at 90th day showed to be positive in 10 patients and were diagnosed as early onset diabetic nephropathy and were intervened with Gandira (Coleus forskohlii Willd Briq) moola Churna 2.5gms twice a day with warm water before food for next 90 days. The primary assessment parameter was Urine microalbuminuria and Cystatin-c and secondary assessments were with fasting, post prandial blood sugar other subjective assessments like Atisweda (Excess sweating), Fatigue, Asyamadhuryam (Sweet taste in oral cavity), Karadaha (burning sensation in palm), Padadaha (burning sensation in foot), Jiwhopadeham (Excess tongue secretions), Sheetapriyatwam (liking for cold temperatures), Mukha shosham (Mouth dryness), Gauravata (Heaviness of body). Follow up were done on 30th, 60th, 90th, 120th, 150th and 180th days. Results: Intervention with Gandira showed significant improvement in primary criteria of Urine microalbuminuria [p <0.001, p=0.003 (90-180 days), p<0.001 (0-180 days)], and Cystatin-c test (p<0.001) and other secondary parameters like Atisweda (p=0.03), Fatigue (p=0.01), Jiwhopadeham (p=0.01), Sheeta priyatwam (p=0.008), Mukha shosha, (p=0.008), Asyamadhuryam (p=0.03), Karadaha (p=0.03), Padadaha (p=0.01), Guravata (p=0.03). Conclusion: Coleus forskohlli Willd Briq showed beneficial effect in patients of Incipient Diabetic Nephropathy. However limitations of the study are small sample, single group, non randomised design, lack of assessments through GFR and HbA1C

Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics

ABSTRACT The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan–Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.

Engineering DNA tetrahedron as a sensing surface of lateral flow test strips and ratiometric visual detection of exosomal microRNA-150–5p

We here report that DNA tetrahedral probe-based sensing surfaces are capable of efficiently capturing gold nanoparticles (AuNPs) on lateral flow test strips, and we have developed a ratiometric biosensor for exosomal microRNAs by integrating a tetrahedral probe and a catalytic hairpin assembly (CHA). DNA tetrahedrons were devised with barcodes and labeled with biotin as capture probes on the test and control lines of the strip. The CHA system consists of two hairpin substrates that can form stable duplexes via a programmable assembly reaction triggered by exosomal miRNAs. The duplexes hybridized with barcoded tetrahedra via complementary sequences and bound to streptavidin-modified AuNPs (SA-AuNPs) via biotin. Thus, a red line was observed on the test line owing to the immobilized SA-AuNPs. The remaining SA-AuNPs were captured by using a biotinylated tetrahedron on the control line. Because the barcoded and biotinylated tetrahedra consume SA-AuNPs simultaneously, a stronger signal in the test line results in a weaker signal in the control line, thus forming a ratiometric result. Tetrahedral probes avoid movement along with sample flow on sensing zones like single-stranded probes. The strip can have a detection limit of 58.90 fM with high selectivity due to the use of ratiometric color changing response, CHA signal amplification and tetrahedral capture probes. This system is able to rapidly detect exosomal microRNA-150–5p and may have a potential utility in point-of-care diagnosis of incipient diabetic nephropathy.

Urine Zinc-alpha-2-glycoprotein as a Potential Biomarker for Incipient Diabetic Nephropathy: A Pilot Study at a Tertiary Care Hospital

Introduction: Urine albumin-creatinine ratio (UACR) continues to be used as an indicator for detecting diabetic nephropathy (DN); however, damage starts much before that. Currently, no biomarkers are there to indicate incipient damage. As a result, researchers are looking for new biomarkers that could be used to detect DN threats sooner and perhaps hinder the development of end-stage renal disease. The present study intended to know if urine Zinc-alpha-2-glycoprotein (ZAG) levels correlate with glomerular filtration rate (GFR) in the study participants of type 2 diabetes mellitus (T2DM). Materials and Methods: The study included 68 participants with a known history of T2DM. Serum urea and creatinine levels, fasting plasma glucose, serum cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total protein, glycated hemoglobin (HbA1c) and urine ZAG were estimated and UACR along with estimated GFR (eGFR) were calculated for all individuals. The characteristics of the study participants in the microalbuminuric and normoalbuminuric groups were compared. Results: The levels of urine ZAG in the microalbuminuric and normoalbuminuric groups were not observed to be substantially different. The relationship between urine ZAG and diabetes mellitus duration was found to be highly significant in normoalbuminuric patients. Urinary ZAG and correlation with categories of HbA1c % (good &lt;7, 7–9 moderate, &gt;9 poor) among normoalbuminuric individuals were not found to be significant. Conclusion: Despite previous research, we were unable to find a positive relationship between urinary ZAG concentrations and eGFR in this study. Prospective studies with greater sample sizes and follow-up are required to fully comprehend the possible use of ZAG as a biomarker in diabetic nephropathy.

Potential Role and Expression Level of Urinary CXCL8 in Different Stages of Incipient Diabetic Nephropathy with Undiminished Creatinine Clearance: A Pilot Study.

Diabetic nephropathy (DN) is one of the most devastating microvascular complications of diabetes, with a high prevalence and poor prognosis. Early intervention is crucial to improve the outcomes of DN. CXCL8 is related to podocyte damage in incipient DN; however, the role and expression level of CXCL8 have never been elucidated, especially in those with undiminished creatinine clearance. Consecutive inpatients with type 2 diabetes were included in this study. Patients were assigned into four groups based on the Mogensen stage, reflecting pathological features through clinical manifestations: non-DN group, hyperfiltration group, microalbuminuria group and overt DN group. Clinical and laboratory data were retrospectively collected and analyzed. Urinary CXCL8 (uCXCL8) was measured using an enzyme-linked immunosorbent assay (ELISA) method and adjusted for urinary creatinine (Cr) from the same urine sample. In total, 88 eligible consecutive inpatients with type 2 diabetes were included in this study. uCXCL8 was differentially expressed in different stages of incipient DN; it decreased in the hyperfiltration phase of incipient DN (1.40±1.01 pg/μmol Cr) and was highly expressed in patients in the microalbuminuria stage (5.01±4.01 pg/μmol Cr). uCXCL8 was positively correlated with age, diabetes course, cystatin C and urinary albuminuria-to-creatinine ratio, but negatively correlated with estimated glomerular filtration rate (P<0.05). uCXCL8 was a risk factor for classic DN after adjusting for age, diabetes course and cystatin C (OR=1.17, 95% CI 0.98-1.4, P=0.045). CXCL8 played an important role in the progression of incipient DN. The unique expression profile of uCXCL8 may provide a reference for understanding the prognosis and mechanisms of incipient DN progression. uCXCL8 was an independent risk factor for the development of classic DN.

Visualizing increased uptake of [18F]FDG and [18F]FTHA in kidneys from obese high-fat diet fed C57BL/6J mice using PET/CT ex vivo.

It is known that high-fat diet (HFD) and/or diabetes may influence substrate preferences and energy demands in the heart preceding diabetic cardiomyopathy. They may also induce structural glomerular changes causing diabetic nephropathy. PET/CT has been utilized to examine uptake of energy substrates, and to study metabolic changes or shifts before onset of metabolic disorders. However, conventional PET/CT scanning of organs with relatively low uptake, such as the kidney, in small animals in vivo may render technical difficulties. To address this issue, we developed a PET/CT ex vivo protocol with radiolabeled glucose and fatty acid analouges, [18F]FDG and [18F]FTHA,to study substrate uptake in mouse kidneys. We also aimed to detect a possible energy substrate shift before onset of diabetic nephropathy. The ex vivo protocol reduced interfering background as well as interindividual variances. We found increased uptake of [18F]FDG and [18F]FTHA in kidneys after HFD, compared to kidneys from young mice on standard chow. Levels of kidney triglycerides also increased on HFD. Lipoprotein lipase (LPL) activity, the enzyme responsible for release of fatty acids from circulating lipoproteins, is normally increased in postprandial mice kidneys. After long-term HFD, we found that LPL activity was suppressed, and could therefore not explain the increased levels of stored triglycerides. Suppressed LPL activity was associated with increased expression of angiopoietin-like protein4, an inhibitor of LPL. HFD did not alter the transcriptional control of some common glucose and fatty acid transporters that may mediate uptake of [18F]FDG and [18F]FTHA. Performing PET/CT ex vivo reduced interfering background and interindividual variances. Obesity and insulin resistance induced by HFD increased the uptake of [18F]FDG and [18F]FTHA and triglyceride accumulation in mouse kidneys. Increased levels of [18F]FDG and [18F]FTHA in obese insulin resistant mice could be used clinically as an indicator of poor metabolic control, and a complementary test for incipient diabetic nephropathy.

Microalbuminuria as a marker of kidney damage in patients with diabetes mellitus.

Background: diabetes mellitus has increased its incidence and prevalence gradually in recent years throughout the world. Currently, diabetes mellitus and high blood pressure are the main causes of chronic kidney failure in its different stages. Nephropathy is one of the most serious complications affecting diabetics. Its onset is usually insidious, progresses without symptoms, and generally becomes clinically evident after 5 to 10 years of diabetes progression. This complication in early stages (incipient nephropathy) can be diagnosed through microalbuminuria, which is currently the first marker that exists to detect the existence of the condition. This review aims to summarize the importance of the determination of microalbuminuria in diabetic patients with the aim of making an early diagnosis of the disease and the control of risk factors.

Association of Serum Zinc Level with severity of chronic kidney disease in diabetic patients: a cross-sectional study

BackgroundIn recent years, it has been reported that diabetic patients tend to have a lower zinc intake due to unbalanced diet accompanying changes in lifestyle habits. We investigated serum zinc concentration in diabetic patients according to the stage of nephropathy.MethodsWe enrolled 227 diabetic patients (119 men, 108 women, average age 65.7 ± 14.7 [mean ± standard deviation]) who were hospitalized for diabetes treatment due to poor blood glucose control. We investigated the relationship between fasting serum zinc concentration and estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin-to-creatinine ratio, UACR), as well as serum zinc concentration by stage of diabetic kidney disease and chronic kidney disease.ResultsThe mean HbA1c value was 10.5 ± 2.1%. Serum zinc concentration was 75.5 ± 16.0 μg/dL in males and 75.7 ± 12.2 μg/dL in females, showing no gender difference and no significant relationship with diabetes type. The serum zinc concentration was negatively correlated with age (r = − 0.309, P < 0.001) and positively correlated with eGFR (r = 0.144, P = 0.030). A tendency was observed of serum zinc concentration to decrease after overt nephropathy, with values of 76.4 ± 14.1 μg/dL in pre-nephropathy (stage 1, n = 131), 78.5 ± 13.2 μg/dL in incipient nephropathy (stage 2, n = 65), 66.4 ± 14.3 μg/dL in overt nephropathy (stage 3, n = 25), and 65.7 ± 11.9 μg/dL in kidney failure (stage 4, n = 6). Serum zinc showed a negative trend with estimated GFR (P = 0.004) and significant reduction in albuminuria, with stage A3 (n = 29, 65.7 ± 13.9 μg/dL) having lower levels than A1 (n = 131, 76.4 ± 14.1 μg/dL, P = 0.001) and A2 (n = 67, 78.4 ± 13.1 μg/dL, P < 0.001).ConclusionsIn diabetic patients, serum zinc concentration tended to decrease as age increased and also as renal function deteriorated. This study suggests that consideration of zinc deficiency is necessary in patients with overt albuminuria.

Is there a characteristic pattern of ambulatory blood pressure profile in type 1 diabetic children and adolescents?

To examine the characteristics of ambulatory blood pressure (ABP) including blood pressure variability (BPV) and its association with albuminuria in type 1 diabetic (T1D) children and to identify potential predictors of high-normal albuminuria and microalbuminuria. ABP monitoring was performed in 201 T1D children and adolescents (mean age, 14.7±3.8 years) with T1D duration over 1 year. The level of albuminuria was assessed as the albumin/creatinine ratio (ACR) and patients were further classified as low-normal, high-normal or microalbuminuria. Fifteen T1D children (7.5%) were hypertensive using office blood pressure (BP) and 10 (5%) according to ABP. T1D subjects had elevated 24-hour systolic BP (SBP) and diastolic BP (DBP) (+0.2 and + 0.3 standard deviation score [SDS]) and nighttime SBP and DBP (+0.6 and +0.8 SDS) compared to reference values. Patients with microalbuminuria had significantly higher 24-hour, daytime and nighttime DBP compared to normoalbuminuric subjects. There was a high percentage of nondippers (74.1%). Nighttime diastolic BPV was significantly higher in subjects with high-normal compared to low-normal albuminuria (p=0.01). A weak correlation was found between ACR and daytime DBP SDS (r=0.29, p<0.001 and nighttime DBP SDS (r=0.21, p=0.003). Age and nighttime diastolic BPV were predictors of high-normal albuminuria while nighttime DBP was a strong predictor for microalbuminuria. T1D children have impaired BP regulation although most of them do not fulfill the criteria for sustained hypertension. There is an association between diastolic ABP and diastolic BPV with rising levels of albuminuria pointing to a clear connection between BP and incipient diabetic nephropathy.

Microalbuminuria, Serum Creatinine and Other Biomarkers among T2 DM Patients in North India

Background: Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives: To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods: This cross-sectional study involved 213 participants with diabetes mellitus (DM) attending the diabetic clinic of MM Institute of MSR. Aim: We aimed to evaluate the levels of urine microalbumin, urine albumin creatinine ratio, plasma creatinine and glycosylated hemoglobin (HbA1c) among type 2 diabetic patients and assessed the correlation between microalbuminuria and plasma creatinine levels. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Results: Increase in mean level of plasma creatinine (138 μmol/L), urine microalbuminuria (310 mg/L), albumin creatinine ratio (52) and HbA1c (7.9%) was observed among type 2 DM patients. Moderate positive correlation was observed between microalbuminuria and urine albumin creatinine ratio (r = 0.643 P = 0.0008) and between urine albumin creatinine ratio and plasma creatinine (r = 0.645 P = 0.032). Conclusion: We concluded that type 2 DM patients who are at risk of developing renal impairment must be regularly monitored for microalbuminuria, urine albumin creatinine ratio, and HbA1c levels.

Diastolic Pressure and ACR Are Modifiable Risk Factors of Arterial Stiffness in T2DM Without Cardiovascular Disease.

To evaluate early, before the onset of cardiovascular events and of chronic renal insufficiency, the association between chronic kidney disease (CKD)-mineral bone disorder (MBD) biomarkers and vascular stiffness [Cardio Ankle Vascular Index (CAVI)] in the course of type 2 diabetes (T2DM). We evaluated 174 T2DM patients [median age 56 years; male/female (M/F) 100/74] with diabetes duration < 10 years and without decreased estimated glomerular filtration rate (eGFR; ≥60 mL/min/1.73 m2) or macrovascular complications. Thirty-four age-matched healthy subjects [M/F 13/21; age 53.5 (50.0-57.7) years; eGFR 107.5 (97.0-119.7) mL/ min1.73 m2] served as local reference control for CAVI (pathological: ≥8) and the novel CKD-MBD biomarkers. Albumin-to-creatinine ratio (ACR) averaged 8.5 mg/g (5.6-17.2) with 12.6% of the patients showing pathologic values, indicative of incipient diabetic nephropathy. Serum parathyroid hormone, fibroblast growth factor 23, and sclerostin were higher while 1,25-dihydroxyvitamin D and Klotho were lower than a control group. CAVI was normal (<8) in only 54% and correlated positively with age (P < 0.001), hemoglobin 1A1c (P = 0.036), and systolic (P = 0.021) and diastolic blood pressure (DBP) (P = 0.001) and negatively correlated with 25-hydroxyvitamin D (P = 0.046). In multivariate analysis, age, DBP, ACR, and serum Klotho were independent positive predictors of CAVI. In the absence of overt cardiovascular disease and of chronic renal insufficiency, CAVI is frequently pathologic in T2DM. DBP and ACR are modifiable risk factors of vascular stiffness in T2DM, thus warranting optimal assessment.

Muscle Strength in Type-2 Diabetes Mellitus and its Relationship with Biochemical Parameters and Microvascular Complications

Introduction: Sensory symptoms and deficits are frequently observed in diabetic polyneuropathy, but motor deficits are more difficult to recognise or often neglected. As a part of a rehabilitation team, we observed altered muscle strength in Type-2 Diabetes Mellitus (T2DM) in relation to neuropathy. Weakness in muscles in DM has significant effects on patient's daily living activities. Aim: To find the relationship of muscle strength in diabetes subjects characterised by microvascular complications (retinopathy, nephropathy and peripheral neuropathy associated) and biochemical measurements. Materials and Methods: The present observational study was conducted at the Department of Orthopedics, Srinivas Institute of Medical Sciences, Mangaluru, Karnataka, India for a period of nine months from February 2020 to November 2020. Study included 72 T2DM subjects (n=36) and controls (n=36) with age &lt;75 years, with a diabetic history ≥5 years. By using standard laboratory methods, biochemical measurements were taken, which included Fasting Blood Sugar (FBS) level, Glycated Haemoglobin (HbA1c), serum creatine, serum insulin, C-peptide and albumin excretion rate. The retinal status of the diabetic subjects were classified as normal, non proliferative and proliferative retinopathy, renal status classified as incipient and overt nephropathy and neuropathy as asymptomatic and symptomatic by ophthalmologist, nephrologist and neurologist respectively. Muscle strength of the upper extremities and lower extremities were measured by using handheld dynamometer (Baseline® LiTE®). Results: Out of total 72 subjects, the mean age of diabetic and non diabetic group was 55.69±5.50 years and 55.91±5.21 years, respectively. In diabetic subjects, the median value of serum creatine was 1.04 mg/dL , FBS was 171 mg/dL, HbA1c was 9.1%,serum insulin was 24.62 mU/L, C-peptide was 1.13 ng/mL and albumin excretion rate was 57.6 mg/24 hours. Approximately, 10.5% reduction was observed at ankle dorsiflexion and plantar flexion of both sides, 7% reduction of knee extension (both side), and right knee flexion, whereas, the left knee shows a marked 10.81% reduction in muscle strength. Conclusion: Type-2 diabetes subjects have weakness of extensors and flexors of the upper and lower extremity (shoulder and hip strength not assessed in this study) with predominant reduction of muscle strength in the lower limbs.

Microalbuminuria in essential hypertension: A single centre study

To evaluate the prevalence of microalbuminuria in patients with essential hypertension and its relationship to severity of hypertension, to renal function and its association with coronary artery disease and target organ damage, present study was conducted. Total 100 primary hypertensive, non diabetic patients and 25 healthy normotensive, non diabetic patients (controls) admitted in S.S.G.H (Sir Sayajirao General Hospital) from June 2009 to November 2011. Patient's complete history, routine investigation along with microalbuminuria was measured by ACR by immunoturbidimetric method. In present study patient’s mean age was 52.7 years. Total 70% of patients selected for study were males and 30% were females. Total 50% to 75% of patients in the 61 -80 year age group were positive for microalbuminuria. Total 42.85% of males were positive for microalbuminuria as compared to 33.33% of females. Total 75% of patients having hypertension for more than 8 years had microalbuminuria. Total 67.5% of patients positive for microalbuminuria had associated target organ damage. Total 45% of patients positive for microalbuminuria had left ventricular hypertrophy and 40% of patients had hypertensive retinopathy. Microalbuminuria helps to identify incipient nephropathy and vascular changes. Its detection can thus help to prevent the development of complications by aggressive treatment to get down targeting blood pressure.

Characterization of Diabetic Nephropathy and Its Correlates in a Selected Outdoor-Based Diabetic Clinic in Rangpur, Bangladesh

Background:The rising burden of diabetic complication associated with the diabetes mellitus (DM) pandemic. DM is a global public health problem. Diabetic nephropathy (DN) is one of the life-threatening and irreversible microvascular complications of DM. Methods:A cross-sectional study was conducted from November 2017 to April 2018 to characterize and associate of possible DN among people living with diabetes where 40 T1DM, 200 T2DM as cases group and 50 non diabetic as a control groupwere selected conveniently. Data were collected using structured questionnaire and analyzed by SPSS-22. Stages of DN were classified according ‘Revised Classification of DN’ given by the ‘Joint Committee on Diabetic Nephropathy’, Japan, 2014. Results:The mean FBS was 6.81±0.87 mmol/L in T1DM, 7.98±3.25mmol/Lin T2DM and 4.55±0.58 mmol/L in controls. The prevalence of pre-nephropathy (PN), incipient nephropathy (IN) and overt nephropathy (ON) was 10%, 82.5% and 7.5% respectively in T1DM. Similarly, in T2DM the prevalence of PN, IN, ON and chronic kidney failure (CKF) was 5.5% 81%, 10%, and 3.5% respectively. One way ANOVA followed by post hoc-LSD suggested, in T1DM the mean FBS was significantly lower in PN group than IN (p=0.017) and ON (p=0.048) group. Further in T1DM and T2DM, the mean estimated Glomerular Filtration Rate was significantly (p=0.032) lower in IN group than PN and significantly (p=0.026, 0.006) lower in ON than PN and IN respectively. Irrespective of diabetic group, according to multivariate analysis, older age (adjusted OR =1.05, CI: 1.01-1.08; adjusted OR: 2.33, CI: 2.01-2.99), sCreatinine (adjusted OR: 7.73, CI: 2.26-22.47) and female sex (adjusted OR = 0.39, CI: 0.19-0.77) were independently associated with DN adjusting BMI, SBP, DBP and FBS level. Conclusion:This study showed the prevalence rate of DN was high among diabetic and mostly in type 2 diabetics with severe stage.

Clinical and Economic Rationale for the Early use of SGLT2 Inhibitors in Patients with Type 2 Diabetes

Type 2 diabetes (T2D) is a chronic disease associated with a high epidemiological and economic burden. It is associated with a high risk of developing both macrovascular and microvascular complications and cardiovascular diseases represent the main cause of mortality and morbidity in T2D patients. The economic impact of diabetes is primarily due to the cost and duration of treatment and secondary complications of diabetes and associated costs. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are an effective therapy for providing a long-term improvement of glucose control, thus contributing to the long-term prevention of diabetic (particularly microvascular) complications. Furthermore, SGLT-2 inhibitors seem to lead to significant reductions in hospital admissions due to heart failure and progression of renal disease, regardless of baseline atherosclerotic risk category or history of heart failure. Evidence from randomized controlled trials, observational and pharmacoeconomic studies suggest that SGLT2 inhibitors should be considered not only in patients with established cardiovascular disease and incipient nephropathy but also in earlier stages of T2D in order to prevent the first onset of cardiovascular and renal complications and contain the cost of illness.

DIABETES INDUCED MICROALBUMINURIA - A CRITICAL REVIEW

Microalbuminuria is a marker and a risk factor of diabetic renal complications commences its role in path-ogenesis of nephropathy at its third stage, the stage of incipient nephropathy. Microalbuminuria is followed by overt nephropathy and end- stage renal disease of irreversible renal damage. Early detection of microal-buminuria has a decisive role in the healthy survival of diabetics. Urine albumin excretion rate and albumin creatinine ratio on timed urine samples, early morning samples or spot urine are of beneficial use. Ayurve-da describes diabetes mellitus as Prameha roga in which the major pathogenesis takes precedence in Moot-rasaya. Microalbuminuria can be described as Prameha Janya Vrikka Roga. It occurs due to Sanga (ob-struction), Vimarga Gamana (abnormal movement) of albumin; one of the constituents of Raktadhatu (blood) through Rakta and Mootra Vaha Srotas (channels of blood and urine). Medicines which are Pramehaghna (anti-diabetic), Mootra and Raktavaha Srothosodhana (cleanse the channels) may be of good worth to rectify the pathology of microalbuminuria providing an improved life for diabetics.

A study of association of proteinuria with hba1c in diabetes mellitus

Diabetic nephropathy occurs in as many as 30% of insulin dependent diabetes mellitus patients and 25% of noninsulin-dependent diabetes mellitus patients. Diabetic nephropathy is a dreaded disease with progressive and continuous. Deterioration in glomerular function resulting in irreversible renal failure. Diabetic nephropathy is an important cause of morbidity and mortality and is now among the most common cause of end-stage renal disease. However, there is an early phase of diabetic renal disease called incipient diabetic nephropathy. This study is intended to study the association of Proteinuria with HbA1C in Diabetes Mellitus.

Role of duplex doppler ultrasound in evaluation of patients with diabetic nephropathy

Background Color Doppler evaluation of the renal parenchyma may suggest functional or structural changes within the kidneys and could provide useful diagnostic and prognostic information in diabetic nephropathy. Aim The aim was to assess the usefulness of duplex sonography with Doppler waveform analysis in the evaluation and assessment of renal vascular resistance in diabetic patients. Patients and methods This case–control prospective study included a total of 30 patients: 20 diabetic patients and 10 healthy controls. Renal parameters such as renal length, renal parenchymal thickness, parenchymal echogenicity, intrarenal resistive index (RI), and biochemical parameters such as fasting blood sugar, serum creatinine, and urine protein were recorded in all study participants. For the purpose of comparison, the diabetic patients were further subdivided into preclinical nephropathy, incipient nephropathy, overt nephropathy, and renal failure subgroups based on the stage of diabetic renal disease. Results A progressive increase in renal RI values was noted with progression of diabetic nephropathy. RI values showed a positive correlation with albuminuria and serum creatinine, and this correlation was found to be statistically significant. Conclusion Intrarenal RI measured by color Doppler ultrasonography has an important value in identifying diabetic patients who are developing nephropathy and can be used as an additional diagnostic tool in diagnosing diabetic nephropathy as well as to monitor progression of nephropathy.

Microalbuminuria and Traditional Serum Biomarkers of Nephropathy among Diabetic Patients at Mbarara Regional Referral Hospital in South Western Uganda.

Background Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods This cross-sectional study involved 140 participants with diabetes mellitus (DM) attending the diabetic clinic of Mbarara Regional Referral Hospital. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Serum creatinine and uric acid and glucose levels were determined by spectrophotometric methods. Results The overall prevalence of microalbuminuria was 22.9%. Using a simple and multiple linear regression model, serum creatinine (β = 0.010, 95% CI (0.005, 0.014), P = 0.0001) and glucose (β = 0.030, 95% CI (0.011, 0.048), P = 0.0017) levels were significantly associated with microalbuminuria. After adjusting for linearity, family history of DM was the only predictor of microalbuminuria (β = 0.275, 95% CI (0.043, 0.508), P = 0.002). Although microalbuminuria was weakly associated with eGFR (OR = 1.2, 95% CI (0.24, 5.96)), the relationship was not statistically significant (P = 0.824). Conclusion The prevalence of microalbuminuria in patients with diabetes in this study was high. The study suggests the need to screen for microalbuminuria early to reduce the possible burden of ESRD. When serum creatinine is used as a renal function marker among diabetic patients, it should be combined with microalbuminuria for better assessment of incipient nephropathy.

ITRAQ plasma proteomics analysis for candidate biomarkers of type 2 incipient diabetic nephropathy

BackgroundDiabetic nephropathy is the most frequent cause of end-stage renal disease worldwide. Identification of biomarkers for diabetic nephropathy for early diagnosis may be the key to avoiding damage from this condition.MethodsProteomic iTRAQ technology was first used to identify differentially expressed plasma proteins in type 2 incipient diabetic nephropathy (IDN) using a Q-Exactive mass spectrometer.ResultsCompared with controls, 57 proteins (32 upregulated and 25 downregulated proteins) were identified. Furthermore, the gelsolin, collectin-11, PTPRJ, and AKAP-7 proteins were confirmed by Western blots as candidate biomarkers for type 2 IDN through ROC analysis.ConclusionsThese findings offer a theoretical basis for the early treatment of diabetic nephropathy.