Prevalence Of Microalbuminuria as A Marker of Incipient Nephropathy in Type 2 Diabetes Patients at SMIMER Hospital, Surat
Keywords:
Type 2 Diabetes mellitus, Microalbuminuria, Nephropathy, Lipid profileAbstract
Background: Diabetic nephropathy (DN) is one of the most significant long-term complications in diabetes mellitus (DM). The study was primarily aimed to screen type 2 DM patients for renal damage and to find out the prevalence of MAU as marker of nephropathy in the SMIMER hospital, Surat.
Methods: We studied 82 known cases of type 2 DM and 50 healthy subjects as control. Plasma glucose, serum lipid profile, urea, uric acid, creatinine and urine albumin and creatinine were measured in subjects. Based on urine albumin and albumin:creatinine ratio (ACR) stages of nephropathy were diagnosed. Data was expressed as mean ± SD and data was compared by using unpaired student ‘t’ tests for independent sample.
Results: We found significantly higher levels of fasting and post prandial glucose (P<0.05), urea (P<0.01), uric acid (P<0.03), urine albumin and ACR (P<0.05) in DM patients compared to controls. We observed increased level of total cholesterol (P<0.05), triacylgycerol (P<0.05) and non significant decrease in HDL level ((P=0.11) in DM patients compared to controls. In DM patients the prevalence of normoalbuminuria, microalbuminuria and macroalbuminuria were 21.95%, 62.19% and 15.85% respectively.
Conclusion: Our study concludes that MAU is a reliable marker of DN in type 2 DM patients. MAU and dyslipidemia together may be more potent risk factor for complications in type 2 DM. Therefore regular screening for MAU is recommended for all asymptomatic DM patients for reducing cardiovascular risks and slowing the progression to end-stage renal disease to reduce the socioeconomic burden of DM.
References
Sicree R, Shaw J, Zimmet P. The global burden: Diabe-tes and impaired glucose tolerance. In: Gan D, edi-tor. Diabetes atlas. 4th ed. International Diabetes Federation. Belgium: International Diabetes Federa-tion; 2009. pp. 1–105.
Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.
Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 coun-try-years and 2.7 million participants. Lancet, 2011, 378(9785):31–40.
Deepa R, Sandeep S, Mohan V. Abdominal obesity, visceral fat and type 2 diabetes- “Asian Indian Phe-notype. In: Mohan V, Rao GHR (ed). Type 2 diabetes in South Asians: Epidemiology, Risk factors and Pre-vention. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi 2006: 138-152.
Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V. Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian In-dian population. Diabetes Res Clin Pract 1999;44(3):207-13.
Reutens AT, Prentice L, Atkins R. The epidemiology of diabetic kidney disease. In: The epidemiology of diabetes mellitus, 2nd Edition, Ekoé J, et al., Editors. 2008, John Wiley & Sons Ltd: Chichester. p. 499-518.
National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Interna-tional comparisons in 2007 Annual Data Report: At-las of Chronic Kidney Disease and End-Stage Renal Disease in the United States. 2007, National Institutes of Health, National Institute of Diabetes and Diges-tive and Kidney Diseases. : Bethesda. p. 239-54.
R Atkins, P Zimmet. Diabetic kidney disease: Act now or pay later. The Internet Journal of Nephrology. 2009 ; 6(1):1-3.
Molitch ME, DeFronzo, Franz MJ, Keane WF, Mo-gensen CE, Parving HH, Steffes MW, American Dia-betes Association: Nephropathy in diabetes. Diabetes Care 2004; 27(supp 1): S79-S83.
Khosla N, Sarafidis PA, Bakris GL: Microalbuminu-ria. Clin Lab Med 2006; 26; 635-653.
Levey AS, Eckardit KU, Tsukamoto Y, Levin A, Coresh J, et al. Definition and classification of chronic kidney disease: A position stetment from Kidney Dis-ease: Improving Global Outcomes (KIDGO). Kidney Int 2005; 67(6); 2089-2100.
Lembers Heerspink HJ, Brantsma AH, de Zeeuw D, Bakker SJL, de Jong PE, Gansevoort RT; for the PREVEND study Group. Albuminuria assessed from first-morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemol 2008;168(8):897-905.
Levey AS,Coresh J,Balk E, Kausz AT, Levin A, Steffes MW, et al; National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, and stratification. Ann In-tern Med.2003;139(2):137-147.
Keane WF, Eknoyan G, Proteinuria, albuminuria, risk, assessment, detection,elimination (PARADE): a posi-tion paper of the National Kidney Foundation. Am J Kidney Dis.1999;33:1004-10. [PMID: 10213663]
Raabo E, Terkildsen TC. On the enzymatic determina-tion of blood glucose. Scand J Clin Lab Invest 1960; 12: 402-407 [PMID: 13738785 DOI: 10.3109/00365516009065404].
Rifai N, Bachorik PS, Albers JJ. Lipids, lipoproteins and apolipoproteins. In: Burtis CA, Ashwood ER, ed-itors. Tietz fundamentals of clinical chemistry, 5th edn, Philadelphia: Saunders (an imprint of Elsevier); 2001, p. 462- 493.
Newman DJ, Price CP. Nonprotein nitrogen metabo-lites. In: Burtis CA, Ashwood ER, editors. Tietz fun-damentals of clinical chemistry, 5th edn, Philadelphia: Saunders (an imprint of Elsevier); 2001, p. 414- 426.
Fossati P, Prencipe L, Berti G. Use of 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone chromogenic system in direct enzymic assay of uric acid in serum and urine. Clin Chem 1980; 26(2): 227-31.
Bowers LD, Wong ET. Kinetic serum creatinine as-says. II. A critical evaluation and review. Clin Chem 1980; 26(5): 555-61.
Scott MG, Heusel JW, Ligrys VA, Siggaard-Anderson O. Electrolytes and blood gases. In: Burtis CA, Ash-wood ER, editors. Tietz fundamentals of clinical chemistry, 5th edn, Philadelphia: Saunders (an im-print of Elsevier); 2001, p. 495-517.
Gerbaut L. Immunoturbidimetry of albumin in serum, cerebrospinal fluid, and urine with a unique calibration curve. Clin Chem. 1987;33(7):1260-1. [PMID: 3594872].
National Kidney Foundation. Kidney Disease Out-comes Quality Improvement (K/DOQI™) clinical practice guidelines and clinical practice recommenda-tions for diabetes and chronic kidney disease. Am J Kidney Dis 2007;49(Suppl 2):S1-S180.
U.S. Renal Data System, USRDS 2009 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National In-stitutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2009. http://www.usrds.org/atlas09.aspx
Plantinga LC, Crews DC, Coresh J,. Miller ER, Saran R, Yee J et al. for CDC CKD. Surveillance Team. Prev-alence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clin J Am Soc Nephrol. Apr 2010; 5(4): 673–682.
Gross JL , De-Azevedo MJ, Silveiro SP, Canani LH, Caramori M, Zelmanovitz T. Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care 2005; 28:176 –188.
Adler, A., et al., Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003. 63: p. 225-32.
Young BA. Maynard C, Boyko EJ. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabe-tes Care 26:2392–2399, 2003.
28.Kedam DP, Rajaseker P. Study of microalbuminu-ria as a cardiovascular risk factor in type 2 diabetes mellitus. Asian J Pharm Clin Res2012; 5( 2): 42-43 .
Thakkar B, Arora K, Vekariya R, Lulania M, Agnihotri AS. Prevalence of microalbuminuria in newly diag-nosed type 2 diabetes mellitus. NJIRM 2011; 2(4) : 22-25.
Lu B, Wen J, Song XY, Dong XH, Yang YH, Zhang ZY, et al. High prevalence of albuminuria in popula-tion-based patients diagnosed with type 2 diabetes in the Shanghai downtown. Diabetes Res Clin Pract. 2007 Feb;75(2):184-92. Epub 2006 Aug 8.
Al-Maskari F, El-Sadig M, Obineche E. Prevalence and determinants of microalbuminuria among diabetic patients in the United Arab Emirates. BMC Nephrol-ogy 2008; 9:1. doi:10.1186/1471-2369-9-1
Al-Shaikh A. Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetic clinic in king ab-dulaziz university hospital. Pak J Med Sci 2007; 23(2): 223-226.
Kanakamani J, Ammini AC, Gupta N, Dwivedi SN. Prevalence of microalbuminuria among patients with type 2 diabetes mellitus--a hospital-based study from north India. Diabetes Technol Ther. 2010 Feb;12(2):161-6. doi: 10.1089/dia.2009.0133.
Chowta NK, Pant P, Chowta MN. Microalbuminuria in diabetes mellius: Association with age, sex, weight, and creatinine clearance. Ind J Nephrology 2009;19(2):53-57. DOI: 10.4103/0971-4065.53322
Varghese A, Deepa R, Rema M, Mohan V. Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetes centre in southern India. Postgrad Med J 2001;77:399–402
Gupta DK, Verma LK, Khosla PK, Dash SC. The prevalence of microalbuminuria in diabetes: a study from north India. Diabetes Res Clin Pract. 1991 May;12(2):125-8.
Parving, H., et al., Prevalence and risk factors for microalbuminuria in a referred cohort of type II dia-betic patients: a global perspective. Kidney Int, 2006. 69(11): p. 2057-63 ].
Nakhjavani M, Esteghamati AR , Esfahanian F. Heshmat AR. Dyslipidemia in type 2 diabetes melli-tus: more atherogenic lipid profile in women. Acta Medica Iranica 2006; 44(2): 111-118.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.
