الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 131 |  |  |
| | | from | 131 | | |
Abstract
Diabetes is the single most common cause of end-stage renal disease and therefore the most common cause of renal anemia. Anemia is more common in patients with diabetes than without diabetes Diabetic patients with anemia may be at increased risk of adverse outcomes from diabetic retinopathy, nephropathy, neuropathy, and cardiovascular disease The etiology of anemia in diabetes is multifactorial and includes inflammation, nutritional deficiencies, concomitant autoimmune diseases and drugs it has recently become clear that the failure to increase circulating erythropoietin concentrations in response to falling hemoglobin levels is the dominant factor in the genesis of anemia associated with diabetic nephropathy In early diabetic nephropathy, damage to the peritubular fibroblasts can occur and lead to erythropoietin deficiency and anemia prior to the loss of filtration Correction of the anemia not only leads to less fatigue, greater exercise tolerance, and an improved quality of life but also to a reduction in mortality and hospitalizations So diagnosing and treating anemia in patients with diabetes may result in an improved quality of life and decreased morbidity and mortality In the present study the aim of the work is to evaluate the erythropoietin response to anemia in diabetic patients before onset of advanced renal disease This study was conducted on sixty seven patients selected from the inpatient department and outpatient clinics of the Internal Medicine Department in Menoufiya University Hospital from the period of October 2009 to December 2010.They were divided into 5 groups; Group 1: non diabetic subjects with normal renal function and iron deficiency anemia Group 2: included type 2 DM patients with normo-albuminuria
Group3: included type 2 included DM with micro-albuminuria
Group 4: included included type 2 DM with macro-albuminuria Group 5: included non diabetic patients with chronic kidney disease and macro-albuminuria The study included 31 male, 36 female; their age ranged from 48 to 72 years The following patients were excluded from the study; Patients with current or previous history of cytotoxic drugs, Patients with current or recent iron therapy, Patients with recent history of blood transfusion,
Patients on renal replacement therapy, Patients with current history of malignancies and gastrointestinal diseases such as duodenal and gastric ulcer, Chronic inflammatory diseases such as rheumatoid arthritis collagen diseases and chronic infections and Drugs which could affect erythropoiesis. Routine investigations were done including Liver function tests kidney function tests ,Complete blood count , serum iron, serum ferritin and total iron binding capacity , fasting and 2 hours post-prandial plasma glucose, HbA1C,estimated glomerular filtration rate and estimation of micro-albuminuria and macro albuminuria in urine. And specific investigation including serum erythropoietin The present study revealed there were no statistically significant difference between groups as regard age, gender and weight (P>0.05).The duration of diabetes mellitus duration was significantly higher in group 4 than group 2 and group 3((P<0.001). The systolic blood pressure and the diastolic blood pressure were significantly higher in group 5 than other groups (P<0.001).
Fasting blood sugar was significantly higher in group 3 compared to the other groups (P<0.001).
2 hours post prandial was significantly higher in group 4 compared to the other groups (P<0.001).
Glycosylated hemoglobin (HbA1c) was significantly higher in group 4 compared to the other groups (P<0.001).Serum creatinine was significantly higher in group 5 than in other groups (P<0.001). Serum albumin was significantly lower in group 5 than other groups (P<0.001).
Albumin excretion rate mg/24hwas higher in group 5 than in other groups (P<0.001).
Glomerular filtration rate (GFR) was significantly lower in group 5 than other groups (P<0.001).
Hemoglobin concentration was significantly lower in group 1 than in other groups (P<0.001). Serum iron was significantly lower in group 1than other groups P<0.001).
Serum ferritin was significantly lower in group 1 than in other groups (P<0.001)
Total iron binding capacity (TIBC) was significantly higher in group 1 than in other groups (P<0.001). Serum erythropoietin was significantly higher in group 1 than in other groups (P<0.001). Diabetic retinopathy was significantly higher in G3 (61.5%) than in other groups (P<0.01). The present study revealed that there was negative significant correlation between serum erythropoietin and serum creatinine in the studied groups (G3, G4 and G5). The present study revealed that there was no significant correlation between serum erythropoietin and glomerular filtration rate in the studied groups (G3, G4 and G5). The present study revealed that there was positive significant correlation between serum erythropoietin and hemoglobin in the studied groups (G3, G4 and G5).The present study revealed that there was no significant correlation in any of the studied groups between serum erythropoietin and serum iron, serum ferritin, total iron binding capacity and albumin excretion rate.