الفهرس 
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Abstract
Diabetic nephropathy is a clinical syndrome in people with diabetes,
characterized by albuminuria (>300 mg/d or 200 μg/min) on at least two
occasions separated by 3-6 months. Diabetic nephropathy is usually
accompanied by hypertension, progressive rise in albuminuria to reach
frank proteinuria, and decline in renal function (Chiarelli et al., 2009).
Diabetic nephropathy affects about 15 to 25% of type 1 diabetic patients
and 30 to 40% of patients with type 2 diabetes ( Nelson et al., 2008).
Three major pathologic changes occur in the glomeruli of persons
with diabetic nephropathy. First, mesangial expansion is directly induced
by hyperglycemia, perhaps via increased matrix production or
glycosylation of matrix proteins. Second, thickening of the glomerular
basement membrane (GBM) occurs. Third, glomerular sclerosis is
caused by intraglomerular hypertension (induced by dilatation of the
afferent renal artery or from ischemic injury induced by hyaline
narrowing of the vessels supplying the glomeruli). These different
histologic patterns appear to have similar prognostic significance (Mauer
and Fioretto, 2007).
The angiopoietins have been recognised mostly for their
involvement in endothelial activation, angiogenisis and inflammation the
major processes which lie at the core of atherogenisis, and so the
angiopoietins/Tie2 system has been identified as a potential new player in
pathogenesis of CKD associated atherosclerosis (Fiedler and Augustin,
2006).
Summary and Conclusion
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Upregulation of renal Ang-2 levels and decreased Ang-1/Ang-2 ratio
accompanied by glomerular monocytes/macrophage infiltration were
observed in mouse type 1 and type diabetic nephropathy models
(Ichinose et al., 2005).
The aim of the current study is to evaluate the level of plasma
angiopoietin-1 in the patients with diabetic nephropathy. And to study
the relation between serum angiopoietin-1 and the severity of renal
dysfunction in the patients with diabetic nephropathy.
The current study was conducted on 45 diabetic patients and 15
control subjects selected from the internal medicine department and
outpatient clinic of endocrinology of Ain Shams University. These
patients were divided into three groups as regards to the level of
albumminuria and the fourth group was the control group as followed:
Group 1(microalbuminuria group) It includes 15 patients with diabetic
microalbuminuria, Group 2 (macroalbuminuria group) It includes 15
patients with diabetic macroalbuminuria, Group 3 (normoalbuminuria
group) It includes 15 patients with diabetic normoalbuminuria and
Group 4 (control group) It includes 15 healthy control subjects.
All subjects were subjected tho thefollowing: 1- full medical history
taking includind age, sex, diabetes type, medication intake, presence of
any diabetic complications or other diseases that can cause renal injery.
2- throughout clinical examination. 3-Laboratory investigations: complete
urine analysis, albumin\creatinine ratio, serum creatinine, eGFR and
serum angiopoietin-1. 4- ultrasound examination of abdomen and pelvis
Summary and Conclusion
125
to assess kidney shape and size and any abnormalities consistent with
kidney disease and to exclude obstructive uropathy.
The results were statistically analysed and we observed the
following:
There was no significant difference between the four groups as
regardind sex(P = 0.568), age (P = 0.170), body weight (P = 0.331) or
diabetes type (P = 0.659).
Regardindg serum creatinine: Compared to control group, it was
significantly higher in macroalbuminuria group (1.14 ± 0.22 vs 0.89 ±
0.1) mg/dl respectively. Also, it was significantly higher in
macroalbuminuria compared to microalbuminuria (1.14 ± 0.22 vs 0.97 ±
0.13) mg/dl respectively and normoalbuminuria groups (1.14 ± 0.22 vs
0.89 ± 0.09) mg/dl respectively.
Regarding eGFR: Compared to control group, it was significantly
lower in macroalbuminuria group (76.16 ± 11.44 vs 98.81 ± 14.09)
ml/min/1.73mm2 respectively. Also it was significantly lower in
macroalbuminuria compared to microalbuminuria (76.16 ± 11.44 vs
89.58 ± 14.6) ml/min/1.73mm2 respectively and normoalbuminuria
groups (76.16 ± 11.44 vs 96.28 ± 11.63) ml/min/1.73mm2 respectively.
Regarding albumin\creatinine ratio: In comparison to control
group, it was significantly higher in macroalbuminuria group (1409.7 ±
907.0 vs 14.1 ± 6.7) μg/mg respectively. It was significantly higher in
macroalbuminuria group compared to the normoalbuminuria group
(1409.7 ± 907.0 vs 11.1 ± 8.0) μg/mg respectively and microalbuminuria
group (1409.7 ± 907.0 vs 153.2 ± 75.6) μg/mg respectively.
Summary and Conclusion
126
Regarding serum angiopoietin-1: Compared to control group, it
was significantly higher in normoalbuminuria group (1176.3 ± 747.8 vs
3155.0 ± 2446.3) pg/ml respectively and significantly lower in
macroalbuminuria group (3078.3 ± 551.4 vs 3155.0 ± 2446.3) pg/ml
respectively. It was significantly higher in normoalbuminuria group
compared to microalbuminuria group (1176.3 ± 747.8 vs 4776.5 ±
1349.8) pg/ml respectively and macroalbuminuria group (1176.3 ± 747.8
vs 3078.3 ± 551.4) pg/ml respectively. Also, it was significantly higher
in microalbuminuria compared to macroalbuminuria group (4776.5 ±
1349.8 vs 3078.3 ± 551.4) pg/ml respectively.
There was significant inverse correlation between serum
angiopoietin-1 and both serum creatinine (r = -0.341) and urine albumin
creatinine ratio (r = -0.497) , while there was significant direct correlation
between serum angiopoien-1 and eGFR (r = 0.330). There was no
significant correlation between Angiopoietin-1 and age, sex or body
weight (p > 0.05).
Summary and Conclusion
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Conclusion
Decrease of serum Angiopoitin-1 level in patients with diabetic
nephropathy may play a big role in pathogenisis of the disease especially
because serum angiopoietin-1 is decreasing more with the progression of
the proteinuria. Hence this conclusion may implement angiopoietin-1 in
experimental treatment studies to prevent or improve diabetic
nephropathy or to study the cause effect relationship of serum
angiopoietin-1 and diabetic nephropathy to use angiopoietin-1 as a
diagnostic tool for diabetic nephropathy disease.