Details
Category: Volume 06 Issue 08 August 2018
Hits: 934

Title: Evaluation of Proteinuria in Normotensive Diabetics in a Tertiary Care Hospital

Authors: Mukherjee Brijesh, Mishra Prafulla Kumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.187

Abstract

Background:  Proteinuria has been generally regarded as a marked for the degree of glomerular damage in diabetes. The levels of proteinuria correlate well with the progression for renal functions and interventions that retard the progression of diabetes renal disease also reduce proteinuria. The aim of this study is to collate information on the incidence of proteinuria among normotensive diabetic patients attending Hi-tech Medical College and Hospital, Rourkela, Odisha 

Materials and Methods: The study involved 100 diabetics and 50 healthy controls. Proteinuria was estimated using biuret method, while fasting blood glucose using glucose oxidase method.

Result:  The study shows that an overall 22% of the patients have diabetes related proteinuria with 17% males and 5% females. The duration of the disease < 5 years (42.0%) and > 5 years (58.0%) have 14.5% and 31.1% diabetes related proteinuria respectively. An average age of < 30 years (30%) and > 30 years (70%) have diabetes related proteinuria of (17.1%) and (24.6%) respectively. FBG differed significantly (p<0.05) between patients (11.01±1.03Mmol/L) and controls (4.38±0.07Mmol/L). Urinary protein excretion was significantly higher in diabetics (143.7±5.78) than in controls (90.43±5.78). Increased urinary protein excretion was observed (p<0.05) with duration of diagnosis <5 years (228±5.4mg/24hrs) and >5 years (264±9.1mg/24hrs). Statistically significant increase in proteinuria (p<0.05) was also observed in males (254±10.0mg/24hrs) than in females (194±29mg/24hrs). 

Conclusion:  Given the large number of individual with diabetes is increasing; the number of diabetic nephropathy is undoubtedly enormous. This could produce major constraints on health care budgets in the future. This urgently calls for not only good control of diabetes to prevent nephropathy but also to address the larger issue of primary prevention of diabetes, that is, reduction in the prevalence of diabetes itself by aggressive life style modifications.

Keywords: Proteinuria, diabetes mellitus, normotensive, fasting blood glucose.

References

  1. Remuzzi, G., Bertani, T. Is glomerulos-clerosis consequence of altered glomerular permeability to macromolecules? (Edictorial). Kidney Int. 1990; 38:384-394.
  2. Kimmelstiel, P., Wilson, C. Intracapillary lesions in the glomeruli in the kidney. Am. J. Pathol. 1936; 12:83-97(PMC free article).
  3. Kittell, F. Diabetes Management.” In Thomas LK, Othersen J.B. Nutrition therapy for chronic kidney disease, CRC. 2012; 198. 
  4. Centers for Disease Control and Prevention. National Diabetes Sheet. Atlanta, Ga. US. department of health and human services. 2012. http:www.edu. gov/diabetes /pubs.
  5. Mogensen, CE. Microacy, blood pressure and diabetics renal disease: origin and development of ideas. Diabetologia. 1999; 42: 263-285
  6. Hypertension in Diabetes Study (HDS). 1. prevalence of hypertension in newly presenting type 2 diabetes  and the association with risk factors for cardiovascular and diabetic complication  Hypertens, 1993; 11:309-317.
  7. Hasslacher, C., Stech, w., Wahl, P., Ritz, E. Blood pressure and metabolic control as risk factors for nephropathy in type 1 DM. Diabetologia. 1985; 28:6-11. 
  8. Rossing, P., Hommel, E., Smidt, UM., Parving, HH. Impact of arterial blood pressure and albumin on the progression of DN in type 1 diabetic patients. Diabetes. 1993. 42:715719.
  9. Medical Encyclopedia (Medline plus). Diabetes and kidney disease. 2015. www.nlm.nih.gov.
  10. Stephenson, JM., Kenny, S., Stevens, LK. Proteinuria and mortality in diabetes: the WHO multinational study of vascular disease in diabetes. Diabet Med. 1995; 12:149–155.
  11. Krolewski, AS., Warram, JH., Christlieb, AR. The changing natural history of nephropathy in type 1 diabetes. Am J Med. 1985; 78:785– 794. 
  12. Mogensen, CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med. 1984; 310:356–360. 
  13. Tung, P., Levin, SR. Nephropathy in non insuiln dependent diabetes mellitus. Am. J. Med. 1988; 85:131– 136.
  14. Fabre, J., Balant, LP., Dayer, PG. The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int. 1982; 2:730–738.
  15. Burden, AC., McNally, PG., Feehally, J. Increased incidence of end-stage renal failure secondary to diabetes mellitus in Asian ethnic groups in the United Kingdon. Diabet. Med. 1992; 9:641–645.
  16. John, L., Sunda, PS., Kanagasabapathy, SS. Prevalence of diabetic nephropathy in non-insulin dependent diabetics. Indian J Med Res. 1991; 94:24–29.
  17. Vijay, V., Snehalatha, C., Ramachandran, A. Prevalence of proteinuria in non insulin dependent diabetes. J Assoc Physicians India. 1994; 42:792–794.
  18. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. N Engl J Med. 1993; 329:977–986.
  19. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS). Lancet. 1998; 32:1-18.

Corresponding Author

Dr Brijesh Mukherjee

Associate Professor, Hi-tech medical College and Hospital, Rourkela, Odisha, India

Mobile: 919437115479, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.