Albuminuria In Diabetic Patients Research Articles

Evaluation of Proteinuria in Diabetic Patients Attending Gitwe District Hospital

Background: Proteinuria is a serious condition in which body proteins leak into urine due to kidney dysfunction nearly always caused by elevated serum glucose due to prolonged diabetes. Proteinuria occurs and affects individuals with diabetes, approximately 25% of diabetic patients may have proteinuria. Aim: The aim of this study is to assess the levels of serum glucose and proteins in urine and their association in diabetic patients attending Gitwe District Hospital. Methodology: The study population mainly comprised of diabetic patients, 110 study participants were included. Blood was drawn from finger for testing serum glucose using glucometer and urine samples were collected from diabetic patients and samples were analyzed in parasitology service using urine chemistry strips for proteins in urine testing. Results: During data analysis, SPSS version 22 was used, the majority were female with 66.4% while 33.6% were male. The highest frequency of participants presented in this study were 27(24.6%) found in [43-52] years old. The mean age was 53 years ± 13.882 SD (ranged from 23 to 86 years). 53.7% had normal serum glucose level while 46.3% had high serum glucose level. However, 63.6% had no proteinuria while 20.0% had trace, 11.8% had mild and 4.6% had moderate proteinuria levels. Association between serum glucose and proteinuria was analyzed for statistical significance with Chi-square test and it was statistically significant as their p values were below 0.05(P-value of 0.000). Conclusion: The study found that high serum glucose level leads to the presence of proteins in the urine. This study recommends regular monitoring of serum glucose levels, as well as routine urine tests to detect proteinuria as essential components of diabetes management and other researchers to study the effects of proteinuria in diabetic patients. Keywords: Proteinuria, serum glucose, proteins, diabetic patients

The Pattern of Practice in the Management of Early Diabetic Kidney Disease.

Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.

#1324 The antiproteinuric effect of Gliflozins is associated with the mitochondrial density of endothelial cells in diabetic patients

Abstract Background and Aims The sodium-glucose co-transporter type 2 inhibitors (SGLT2i) such as dapagliflozin and empagliflozin, are a new class of nephro- and cardio-protective drugs in diabetic and non-diabetic patients. SGLT2 is greatly expressed in the proximal tubule cells, and therefore the protective effects of gliflozins are thought to be mediated by a hemodynamic mechanism on glomerular hyperfiltration. However, they could be acting also in other cell types, particularly in diabetic patients, because hyperglycemia induces the expression of SGLT2 in endothelial cells, mesangial cells, cardiomyocytes, etc. Because SGLT2 changes the intracellular concentration of sodium and glucose, gliflozins may indirectly change mitochondrial swelling and activity. In this study, we have tested the hypothesis that gliflozins act on mitochondria in patients suffering from diabetes. Method We have analyzed kidney biopsies from diabetic patients in treatment with a gliflozin (n = 10) or without gliflozin treatment (n = 10) stained with fuchsin red, which gives a color intensity proportional to mitochondrial content. Clinical variables (albumin-creatinine ratio (ACR), blood pressure, eGFR, glycated albumin) have been measured before and after 4 months of treatment. Images have been acquired using a Zeiss Axioscope with 100x objective and analyzed using ImageJ software to quantify staining intensity (expressed as optical density) after background subtraction. Two different cell types have been considered: proximal tubule cells and endothelial cells in glomeruli. Only non-sclerotic glomeruli have been considered. Results The systolic blood pressure was linearly correlated to the intensity of staining of mitochondria in the proximal tubule cells in all patients irrespective of gliflozin treatment. In non-treated diabetic patients, the mitochondrial content of endothelial cells was not related to the extent of ACR reduction over time. In diabetic patients treated with gliflozins, the extent of ACR reduction after treatment was correlated with the intensity of mitochondrial staining in glomerular endothelial cells. This correlation was not present in proximal tubule cells. Gliflozin treatment may induce a change in the mitochondrial content of endothelial cells, particularly in patients responding with a reduction in proteinuria. Conclusion Proteinuria in diabetic patients depends on damage in both the endothelial and podocyte compartments. Gliflozins may improve proteinuria by a hemodynamic mechanism; however, our data suggest an effect of gliflozins specific on mitochondria of the endothelial cells in the glomeruli, which is proportional to their anti-proteinuric effect. Though we do not analyze the mechanism of gliflozins on mitochondria, it is possible to speculate that the changes of intracellular sodium-induced by gliflozins may induce an altered mitochondrial activity.

Potential Renal Effects of Cigarette Smoking in the Diabetic State-A review

Diabetes is an alarming global systemic metabolic disorder that can pose a major threat to patients. The serious consequences of cigarette smoking on the diabetic kidney are not well known among people in different countries. According to different studies, smoking enhances albuminuria in diabetic patients. On the other hand, urinary albumin is a sensitive indicator of glomerular injury. The abnormal trans-glomerular passage of albumin may be seen due to increased permeability of the glomerular capillary wall and their subsequent impaired reabsorption by the epithelial cells of the proximal tubule. Smoking with hyperglycemia increases lipid accumulation and oxidative stress, which mainly up-regulates TGF-β, accumulates AGEs, reduces nitric oxide production, and eventually causes glomerular basement membrane thickening and mesangial expansion that results in the development of glomerulosclerosis and nephropathy. The complex interaction between cigarette smoking and diabetic mellitus poses multiple challenges for researchers, physicians, and patients. Therefore, the present review article aims to find out the feasible consequences for the kidney of a diabetic patient due to the habit of cigarette smoking which may be useful for academicians and researchers in the future.

Upregulation of the protein kinase Lyn is associated with renal injury in type 2 diabetes patients

Background The role of inflammation in the pathogenesis of type 2 diabetes mellitus (T2DM) is well established. Lyn, a member of the nonreceptor protein tyrosine kinase Src family, has been reported to modulate inflammatory signaling pathways. Methods Lyn expression was assessed in kidney biopsies of 11 patients with diabetic kidney disease (DKD) and in kidney tissues of streptozotocin (STZ)-induced DKD mice. 102 recruited T2DM patients were divided into three groups: normoalbuminuria, microalbuminuria and macroalbuminuria. Twenty-one healthy volunteers were recruited as a control group. Clinical data, blood and urine samples of all individuals were collected for analysis. Results Lyn expression was augmented in the kidneys of DKD patients and STZ-induced diabetic mice. Compared with control and normoalbuminuria groups, both mRNA and protein expression of Lyn in peripheral blood mononuclear cells (PBMCs) in the macroalbuminuria group were significantly increased (p < .05). Elevated Lyn levels were independently related to urine albumin/urine creatinine ratio and were positively associated with key inflammatory factors, namely interleukin-1β, monocyte chemoattractant protein-1, and tumor necrosis factor-α. Additionally, Lyn exhibited a noteworthy connection with renal tubular injury indicators, specifically urinary neutrophil gelatinase-associated lipocalin and urinary retinol binding protein. ROC curve analysis showed that Lyn could predict albuminuria in diabetic patients with an area under the curve of 0.844 (95% CI: 0.764–0.924). Conclusion Lyn levels in PBMCs exhibited a positive correlation with the severity of albuminuria, renal tubular damage, and inflammatory responses. Hence, Lyn may be a compelling candidate for predicting albuminuria levels in diabetes.

Urokinase-type plasminogen activator receptor as a predictive marker for cardiac disease among type 2 diabetic patients

Abstract Background: Type 2 diabetes mellitus is a progressive and chronic disease manifested by β-cell dysfunction and improved insulin resistance. Higher levels of urokinase-type plasminogen activator receptors have been found to predict morbidity and mortality among diabetic patients with cardiac disease. Objective: This study aims to explore the role of serum urokinase-type plasminogen activator receptor levels as a prognostic marker among type 2 diabetic Iraqi patients. Materials and Methods: A total of 70 type 2 diabetic patients (40 male and 30 female) (mean age: 46.20 ± 7.56 years) participated in this study; 35 patients were with cardiovascular disease and 35 were without cardiovascular disease; their ages range were 40–55 years. They were collected from Baghdad Teaching Hospital/Medical City, Baghdad, Iraq through the period from October 2022 to February 2023. Moreover, 30 individuals who were apparent healthy were selected as control group. Results: There was significant increase in blood glucose, lipid levels with their ratios, and C-reactive protein in diabetic patients as compared to the control. Also, the present results reveal high levels of urokinase-type plasminogen activator receptor (2500.72 ± 12.36 vs. 2255.32 ± 10.15) ρg/mL with OR = 1.80, 95% CI: 1.2, and P = 0.0001 in type 2 diabetic patients with and without cardiovascular disease, respectively, as compared to healthy control (229.00 ± 14.48) ρg/mL. Moreover, this study reveals that female patients had higher levels of serum urokinase-type plasminogen activator receptor as compared to the male patients. Conclusion: It demonstrated that urokinase-type plasminogen activator receptor levels reliably predict morbidity among type 2 diabetic patients presenting with symptoms suggestive of cardiovascular disease.

Evaluation of Neutrophil/Lymphocyte Ratio, Low-Density Lipoprotein/Albumin Ratio, and Red Cell Distribution Width/Albumin Ratio in the Estimation of Proteinuria in Uncontrolled Diabetic Patients.

Introduction Diabetic nephropathy associated with end-stage renal disease (ESRD) is a significant public health problem due to its high morbidity and mortality. We aimed to improve the estimation of proteinuria in diabetic patients and potentially enhance risk stratification and clinical management strategies with the assessment of the correlation of the neutrophil/lymphocyte ratio (NLR), low-density lipoprotein/albumin ratio (LAR), and red cell distribution width/albumin ratio (RAR) with the proteinuria in the uncontrolled diabetes patient population. Methods This was a retrospective study including 327 patients with uncontrolled diabetes (HbA1c > 10%) seen in an outpatient clinic. The study enrolled patients over 18 years old, excluding those with active infections, malignancies, immunodeficiency, hematological diseases, pregnancy, breastfeeding, or type I diabetes. Patients using specific drugs affecting proteinuria or lipid levels were also excluded. Data from patients were retrospectively obtained, including gender, age, blood parameters, glucose, creatinine, albumin, cholesterol, triglyceride, and HbA1c levels, as well as spot urine protein and creatinine levels. Proteinuria was assessed using a spot urine protein/creatinine ratio (>0.30 indicated proteinuria). Patients were divided into two groups: group 1 (non-proteinuric with uncontrolled diabetes) and group 2 (proteinuric with uncontrolled diabetes). Demographics, laboratory results, and LAR, NLR, and RAR values were compared between the groups with univariate and multivariate analyses. All statistical analyses were performed using IBM SPSS Statistics for Windows software. For the statistical significance level, p<0.05 was accepted as meaningful. Results Among 327 patients with uncontrolled diabetes, 33.03% were proteinuric. Patients with proteinuria were significantly older (median age 65 vs. 61 years) and had higher NLR and RAR values. There were no significant differences observed in terms of LAR values between groups. Serum albumin levels were lower and urea levels were higher in the proteinuric group. A multivariate analysis was done to identify variables for the prediction of proteinuria. NLR and RAR were found to be independent predictors of proteinuria even after adjusting for potential confounders in the multivariate analysis. The model achieved a 71.9% correct classification rate. An NLR cutoff of 1.93 increased the likelihood of proteinuria 1.93-fold, while a RAR cutoff of 3.30 increased the likelihood 1.63-fold. Conclusions We found that the LAR ratio cannot be used to predict proteinuria in patients with HbA1C levels above 10, but the NLR and RAR ratios can guide the clinician regarding proteinuria and potentially enhance risk stratification and clinical management strategies before a detailed workup.

Promising therapeutic mechanism for Chinese herbal medicine in ameliorating renal fibrosis in diabetic nephropathy.

Diabetic nephropathy (DN) is one of the most serious chronic microvascular abnormalities of diabetes mellitus and the major cause of uremia. Accumulating evidence has confirmed that fibrosis is a significant pathological feature that contributes to the development of chronic kidney disease in DN. However, the exact mechanism of renal fibrosis in DN is still unclear, which greatly hinders the treatment of DN. Chinese herbal medicine (CHM) has shown efficacy and safety in ameliorating inflammation and albuminuria in diabetic patients. In this review, we outline the underlying mechanisms of renal fibrosis in DN, including oxidative stress (OS) generation and OS-elicited ASK1-p38/JNK activation. Also, we briefly summarize the current status of CHM treating DN by improving renal fibrosis. The treatment of DN by inhibiting ASK1 activation to alleviate renal fibrosis in DN with CHM will promote the discovery of novel therapeutic targets for DN and provide a beneficial therapeutic method for DN.

The Relationship between Plasma Osteopontin Level and Proteinuria in Diabetic Patients

Background: Elevated serum levels of osteopontin (OPN) have been associated with cardiovascular disease, diabetic nephropathy, and autoimmune disease activity. The aim of this study was to investigate the relationship between OPN serum levels and renal damage in type 2 diabetes patients. Methods: This analytical cross-sectional study was carried out in Yazd, Iran from April to September 2017. Micro-albuminuria and creatinine (Cr) in 750 patients were measured and 180 included patients were divided into the three groups of 60 subjects based on the level of micro-albuminuria; normal (group A), micro proteinuria (group B) and macro proteinuria (group C). Body weight, height, blood pressure, body mass index (BMI), HbA1c and OPN were assessed. Results: Among 179 patients, 60 of them were normal for proteinuria, 59 patients had micro-proteinuria and 60 ones had macro-proteinuria. The mean age of participants was 58.96 (±11.10) years (range 26-80 years), 90 patients (50.8%) were males and 88 ones (49.2%) were females. The mean OPN levels were significantly higher in group C compared to group B, and in group B compared to group A (P=0.0001). Serum OPN was correlated positively with HbA1c (P: 0.012), Cr (P=0.010) and glomerular filtration rate (GFR) (P=0.002). There was a significant difference in the mean of OPN level among the subgroups with the history of ischemic heart disease (IHD) and HbA1C (P=0.035, and 0.047 respectively). Conclusion: These findings suggest that OPN is involved in chronic disease activity, and there is an independent association between plasma levels of OPN, and nephropathy in diabetic patients.

Effects of sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and their combination on albuminuria in diabetic patients.

Diabetes mellitus (DM) is the leading cause of chronic kidney disease. Albuminuria is associated with an increased risk of cardiovascular mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) and mineralocorticoid receptor antagonists (MRAs) protect against albuminuria; however, their combined effects on albuminuria are unclear. We performed a network meta-analysis to investigate the effects of SGLT2-Is, MRAs and their combination on albuminuria in type 2 DM. We systematically searched PubMed, Medline, EMBASE and the Cochrane Library from inception up to 20 November 2022. We selected randomized control and crossover trials that compared MRAs, SGLT2-Is, MRAs + SGLT2-Is, or a placebo in patients with type 2 DM with a urinary albumin-creatinine ratio (UACR) ≥30 mg/g creatinine. The primary outcome was the change in the UACR. This meta-analysis analysed 17 studies with 34 412 patients. The use of combination treatment with SGLT2-Is and MRAs was associated with lower albuminuria compared with the use of SGLT2-Is, MRAs, or the placebo alone [mean difference (95% CI): -34.19 (-27.30; -41.08), -32.25 (-24.53; -39.97) and -65.22 (-57.97; -72.47), respectively]. Treatment with SGLT2-Is or MRAs alone caused a significant reduction in UACR compared with the placebo [mean difference (95% CI): -31.03 (-28.35; -33.72) and -32.97 (-29.68; -36.27), respectively]. The effects of MRAs on the UACR are comparable with those of SGLT2-Is. Sensitivity analyses showed similar results. Combination therapy with SGLT2-Is and MRAs was associated with lower albuminuria in patients with type 2 DM compared with monotherapy with SGLT2-Is or MRAs alone.

LBSUN154 Baseline Albuminuria May Protect Against Severe Covid-19 In Type 2 Diabetes Patients

Abstract Background Diabetes is considered as one of the leading risk factors for severe COVID-19. We aimed to characterize the differences between type 2 diabetic patients after hospitalization in medical departments at our medical center due to COVID-19 or other diseases. Among the patients with COVID-19, we explored clinical parameters that were associated with severe disease. Method: This is a case-control study of diabetic patients after medical department hospitalization between 09/2020-05/2021. Patients with COVID-19 were compared to those without COVID-19. Patients were defined as COVID-19 negative if the SARS-CoV- 2 polymerase chain reaction and serology were negative and COVID-19 positive, according to a positive SARS-CoV- 2 polymerase chain reaction. Baseline albuminuria was defined as urine albumin to creatinine ratio ≥ 30 mg/gr before hospitalization. Patients that had COVID-19 were recruited after their discharge while other diabetic patients were recruited during hospitalization. Multivariable logistic regression was used to determine the risk factors for severe or critical COVID-19, as compared to mild or moderate disease. In the multivariable analysis: the severity of COVID-19 was the dependent variable, while the following variables were independent variables: eGFR, HbA1C and albuminuria before hospitalization, age and polymorphonuclear(PMN) /lymphocytes (NLR max) during hospitalization, and BMI and gender during recruitment. Results 65 diabetic patients after COVID-19 and 144 diabetic patients who were hospitalized in the Medical department due to other reasons were recruited. Patients after hospitalization due to other diagnoses (not COVID-19) were older than patients after COVID-19: (p=0. 005), had longer duration of diabetes (p=0. 03), lower eGFR (p=0. 03) and lower C-reactive protein (CRP) at admission (p&amp;lt;0. 001). In addition, baseline albuminuria was more common in patients without COVID-19 (54.9% versus 30.8%, p= 0. 002). In a multivariate logistic regression analysis that included only patients after COVID-19 infection, a higher body mass index (BMI) was significantly associated with severe COVID-19 pneumonia, OR 1.24 (95% CI 1. 01-1.53, P=0. 04). Similarly, a higher maximal ratio of NLR- Max was significantly associated with severe COVID-19 OR 1.2 (95% CI 1. 06-1.37, P=0. 005). Surprisingly, the presence of albuminuria before hospitalization was associated with a reduced risk for severe COVID-19 OR 0. 09 (95% CI 0. 014-0.62, P=0. 015). Conclusions These findings suggest that the presence of albuminuria in diabetic patients, may serve as a protective factor for severe COVID-19 pneumonia. Further studies are needed to explore this association and the implication to treatment intervention. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Tungsten Disulfide Decorated Screen-Printed Electrodes for Sensing of Glycated Hemoglobin.

Diabetes is a global menace, and its severity results in various disorders including cardiovascular, retinopathy, neuropathy, and nephropathy. Recently, diabetic conditions are diagnosed through the level of glycated hemoglobin. The level of glycated hemoglobin is determined with enzymatic methodology. Although the system is sensitive, it has various restrictions such as long processing times, expensive equipment required for testing, and complex steps involved in sample preparation. These limitations are a hindrance to faster results. The limitations of the developed methods can be eliminated through biosensors. In this work, an electrochemical platform was fabricated that facilitates the identification of glycated hemoglobin protein in diabetic patients. The working electrode on the integrated circuit was modified with molecularly imprinted polymer decorated with tungsten disulfide nanoparticles to enhance its analytical properties. The analytical properties of the biosensor were studied using electrochemical techniques. The obtained detection limit of the nanoelectronic sensor was 0.01 pM. The calculated sensitivity of the biosensor was observed to be 0.27 μA/pM. Also, the sensor promises to operate in a dynamic working concentration range and provide instant results.

MO622: Clinical Value of Kidney Biopsy in Patients with Diabetes Mellitus and Nephrotic-Range Proteinuria: Correlation of Clinical and Laboratory Findings with Histopathological Data

Abstract BACKGROUND AND AIMS Diabetes mellitus (DM) is tightly associated with the increased prevalence and rapid evolution of diabetic nephropathy (DN). Interestingly, deterioration of kidney function in diabetic patients is often nonetheless caused by other factors besides DM and frequently goes undiagnosed. Nondiabetic renal disease (non-DRD) could be suspected in case of rapid progression of renal function impairment and/or severe, nephrotic-range proteinuria. While biopsy of the kidneys is the ‘gold standard’ of the diagnostic approach in such cases, no real consensus exists regarding the profile of diabetic patients with renal disease and proteinuria, who should be submitted to kidney biopsy. Thus, this study intends to correlate the clinical and biochemical profile of diabetic patients with deteriorated kidney function to the histopathological data of a kidney biopsy and allows early differentiation between DN and non-DRD based on the results of kidney biopsy. METHOD A total of 32 patients, who were treated in our outpatient's diabetes clinic from a multidisciplinary team of endocrinologists and nephrologists at Evangelismos General Hospital, were retrospectively studied. All patients suffered from DM2 and presented with nephrotic-range levels of proteinuria. Biochemical data of glycemic control and renal function, clinical findings related to DN and histological findings of kidney biopsy were documented. All patients were submitted to kidney biopsy and depending on the histopathologic findings were categorized into three groups: (i) genuine diabetic nephropathy (GDN), (ii) renal disease due to cause other than diabetes mellitus (ODMRD) and (iii) mixed renal disease (MRD). RESULTS Among the 32 patients, 15 (46.9%) had findings of a GDN, while 17 patients (53.1%) suffered from ODMRD (13 patients) or MRD (4 patients). All patients were hypertensive. The patients with GDN were younger (54.1 versus 68.2 versus 70.5 years, P = 0.016) and had a higher HbA1C value (7.9 versus 6.5 versus 6.8%, P = 0.069) at the time of the kidney biopsy in comparison to the ODMRD and MRD patients. On the contrary, ODMRD patients had significantly smaller disease duration compared with the GDN and MRD groups (8.4 versus 11.6 versus 13.3 years, P = 0.04). Furthermore, the incidence of diabetic retinopathy was greater among patients with GDN and MRD in comparison to the ODMRD patients (60 versus 75 versus 7.6%, P &amp;lt; 0.01). Additionally, interstitial fibrosis was significantly more prevalent among the patients with GDN in comparison to those with ODMRD and MRD, respectively (73.3 versus 38.4 versus 50%, P = 0.02). Finally, the presence of diabetic retinopathy {OR 4.88, [95% confidence interval (CI) 1.06–22.38], P = 0.04}, higher levels (&amp;gt;25%) of interstitial renal fibrosis [OR 5.71 (95% CI 1.16–28.1), P = 0.032] and longer DM2 duration (&amp;gt;10 years) [OR 5.04, (95% CI 1.1–22.96), P = 0.036] were recognized as factors, which were positively associated with GDN. CONCLUSIONS This study highlights emphatically the usefulness of the kidney biopsy and its histopathological findings in case of patients with diabetes mellitus and nephrotic-range levels of proteinuria. The value of a detailed and careful medical history seems to be critical for the early diagnosis of the type of kidney disease in diabetic patients. It is crucial to early differentiate the patients who suffer from nondiabetic nephropathy, from those with diabetic nephropathy and initiate the appropriate therapy, according to the underlying cause. Thus, the detection of nephrotic-range levels of proteinuria in diabetic patients should lead to kidney biopsy especially in case diabetic retinopathy is not present and longer disease duration is observed. Finally, the existing criteria/indications for a kidney biopsy in diabetic patients with nephrotic-range levels of proteinuria should be reconsidered or even revised.

Serum levels of copper and zinc in diabetic retinopathy: Potential new therapeutic targets (Review).

Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes, leading to vision-threatening damage to the retina. The human body has an elaborate system for managing and regulating the number of key trace metals circulating in the blood and stored cells. Inadequate zinc (Zn) and concurrent excess of copper (Cu) levels are associated with an increased level of oxidative stress, which may aggravate the microvascular lesions in diabetes mellitus. Several studies have revealed a significantly lower serum Zn concentration and increased Cu levels in DR when compared with diabetic patients without retinopathy and normal controls. These abnormalities are correlated with the duration of diabetes and higher levels of HbA1C. Multiple pathological mechanisms are proposed to explain these changes including hyperzincuria associated with polyuria, glycosuria, and proteinuria in diabetic patients, as well as impaired absorption of Zn at the gastrointestinal level. Increased levels of free Cu ions may be attributed to glycation and the release of Cu ions from the Cu-binding sites of proteins. Zn supplements and selective Cu chelators may be useful to alleviate oxidative stress and prevent DR progression.

Assessment of Relation of Serum Uric Acid &amp; Micro Albuminuria in the Patients of Diabetes Mellitus Type-2 for Early Detection of Diabetic Nephropathy

Background: Diabetic Nephropathy is one of the serious and life perilous complications of diabetes mellitus. Prolong duration of diabetes, no proper care and management, poor glycemic control in diabetic nephropathy can lead to End Stage Renal Disease (ESRD).&#x0D; Objective: To assess the relation of serum uric acid &amp; micro albuminuria in the patients of diabetes mellitus for early detection of diabetic nephropathy.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Medicine, LUMHS Jamshoro, with a total of 80 diabetic patients as case study subjects and 80 non-diabetic healthy participants as controls. Random glucose was measured using the gluco oxidase technique, and serum uric acid was measured using the uricase enzyme method in a calorimeter. Immunoterbidimetory kit technique was used to calculate microalbuminuria.&#x0D; Results: The mean value of random blood sugar (RBS) in the control group was 135 ± 10.11 mg/dl, but RBS in the case study group was 224 ± 13.52 mg/dl, indicating that RBS in the case study group was extremely significant (P &lt; 0.001). The mean serum uric acid level in the control group was 4.7 ± 0.6 mg/dl, while it was 6.6 ± 1.4 mg/dl in the case study group, which is highly significant (P &lt;0.001) with correlation (r= 0.34). Albumin in urine in the control group was 10 .2 ± 1.78 mg/gm, while it was 54± 10.34mg/gm in the case study group, which is a significant (P&lt; 0.05) increase in the case study group with correlation (r= 0.28). In diabetics, serum uric acid and microalbuminuria show a positive connection.&#x0D; Conclusion: This study concluded that there is strong positive relation of serum uric acid and micro albuminuria in diabetic patients for the early detection of diabetic nephropathy.

Serum chromogranin A correlated with albuminuria in diabetic patients and is associated with early diabetic nephropathy

BackgroundThe kidney is the main site for the removal of chromogranin A (CgA). Previous studies have found that patients with renal impairment displayed elevated concentrations of CgA in plasma and that CgA concentrations reflect a deterioration of renal function. In this study, we aimed to estimate serum CgA levels and to evaluate the role of serum CgA in the early diagnosis of diabetic nephropathy (DN).MethodsA total of 219 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. These patients were classified into normoalbuminuria (n = 121), microalbuminuria (n = 73), or macroalbuminuria (n = 25) groups based on their urine albumin to creatinine ratios (UACRs). The degree of DN is reflected by UACR. A control group consisted of 45 healthy subjects. The serum CgA levels were measured by ELISA, and other key parameters were assayed.ResultsSerum CgA levels were higher in patients with T2DM than in control subjects, and a statistically significant difference among the studied subgroups regarding CgA was found (P < 0.05). The levels of serum CgA increased gradually with the degree of DN (P < 0.001). Serum CgA levels showed a moderate-intensity positive correlation with UACRs (P < 0.001). A cutoff level of 3.46 ng/ml CgA showed 69.86% sensitivity and 66.12% specificity to detect DN in the early stage.ConclusionThe levels of serum CgA increased gradually with the degree of DN and can be used as a biomarker in the early detection of DN.

Albuminuria in diabetic patients: how to measure it?—a narrative review

Albuminuria in diabetic patients: how to measure it?—a narrative review

EFFECT OF SODIUM GLUCOSE CO TRANSPORTER 2 INHIBITOR ON PROTEINURIA IN DIABETIC PATIENTS

Abstract Background Diabetic kidney disease (DKD) is considered a major cause of end stage renal disease (ESRD). It has been established that controlling microalbuminuria can delay progression to ESRD. Sodium glucose co transporter 2 inhibitor (SGLT2 i) is a newer antidiabetic drug that has a renoprotective and antiproteinuric effect. Aim of the Study to study the effect of SGLT2 inhibitor on proteinuria in diabetic patients and compare it with classic antiproteinuric drugs. Patients and Methods we conducted a randomized interventional study, involving 60 adult patients with type 2 DM divided into 2 groups: group I were prescribed the classic antiproteinuric drugs in the form of ACE inhibitors or ARBs, aspirin and statins and group II were prescribed an additional dapagliflozin 10 mg/day. Follow up as regard changes in UACR, HbA1C, Blood pressure, body weight and e GFR was done after 6 months of treatment. Results There was statistically significant decline in UACR after 6 months of treatment with dapagliflozin in group II in comparison to group I (p-value &amp;lt; 0.001). There was also statistically significant decline in SBP in both groups with (p-value &amp;lt; 0.010) in group I and (p-value &amp;lt;0.001) in group II and there was significant decline in DBP in both groups (p-value &amp;lt; 0.001). HbA1c decreased significantly in both groups, (p-value &amp;lt;0.023) in group I and (p-value &amp;lt;0.001) in group II. We also noted a significant reduction of body weight in group II (p-value &amp;lt;0.001). There was a statistically significant negative correlation between the change in UACR and the change in e GFR. Conclusion There was better reduction in albuminuria when adding dapagliflozin to antiproteinuric drugs, so we recommend starting dapagliflozin early in patients with DKD to delay progreesion to ESRD.

Frequency of Albuminuria in Diabetic Patients Presenting with Macrovascular Complications

Objective: The purpose of this research paper is to determine the frequency of albuminuria in diabetic patients presenting with macrovascular complications. Study Design: Descriptive study Place and Duration: The study was conducted at the Medicine department of Fauji Foundation Hospital, Rawalpindi for duration of six months from December 2020 to May 2021. Methods: Total hundred patients of both genders had diabetic mellitus with macrovascular complications were presented in this study. Patients were aged between 18-60 years. Patients’ detailed demographics including age, sex, body mass index and blood pressure were recorded after taking informed written consent. Two tests were performed for albuminuria, one was heating method of albumin detection in a test tube and second was dipstick method. An albumin level more than 30mg was judged significant in a hospital laboratory study using 24-hour urine protein samples. SPSS 25.0 version was used to analyze the complete data. Results: Mean age of the patients was 45.19±9.88 years with mean BMI 29.18±6.71 kg/m2. Majority of the patients 58 (58%) were males and 42 (42%) were females. Mean duration of diabetes was 4.3±4.8 years. 17 (17%) had diabetes type 1 and 83 (83%) cases had diabetes type-2. Mean systolic and diastolic blood pressure of patients were 148.6±29.8 and 95.4±14.52 mmHg. Prevalence of albumin was found among 89 (89%) patients by using heating method of urine in test tube and 45 (45%) was found by using dipstick method. We found that most of the patients had troponin-T positive myocardial infarction 56 (56%), followed by ischaemic cerebrovascular accident (CVA) 27 (27%) and 17 (17%) patients had haemorrhagic cerebrovascular accident (CVA). Conclusion: In this research we concluded that frequency of albumin in diabetic patients with macrovascular complications were significantly high. Diabetes mellitus is one of the key risk factor predicting macrovascular consequences such as myocardial infarction and cardiovascular illnesses. Keywords: Diabetes, Albuminuria, Macrovascular Complications, CVA, Myocardial Infarction

Association of proteinuria and incident atrial fibrillation in patients with diabetes mellitus: a population-based senior cohort study

Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02–1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30–1.69, P < .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26–2.18, P < .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.