الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
DM is a complex metabolic syndrome characterized by chronic
hyperglycemia resulting in complications affecting the peripheral nerves,
kidneys, eyes, and micro- and macrovascular structures. The prevalence
of all types of diagnosed diabetes in most western societies is 3–7%.
Preventing vascular complications and monitoring of DM are the
need of the hour as the prevalence of DM and its vascular burdens are
increasing day by day.
Type 2 DM is characterized mainly by impaired insulin secretion
and increased tissue insulin resistance. Sustained hyperglycemia leads to
a series of interrelated alterations that can cause evident endothelial
dysfunction and vascular lesions in diabetic complications.
Formation of advanced glycation end products, activation of
protein kinase C and disturbances in polyol pathways are the possible
mechanisms by which increased glucose induces vascular abnormalities.
Diabetic nephropathy (DN) is defined as persistent proteinuria
greater than 500mg/ 24 hours or albuminuria greater than 300mg/24
hours and is usually associated with hypertension, and a diminishing
glomerular filtration rate (GFR). End stage renal failure may occur many
years later and requires dialysis or kidney transplantation .
Current treatments include optimization of glycemic and blood
pressure control by targeting the renin-angiotensin-aldosterone system
(RAAS) with angiotensin-converting enzyme (ACE) inhibitors and/or
angiotensin II receptor blockers. More innovative strategies are needed to
prevent and treat this disease. New agents and approaches have recently
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Summary & Conclusion
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been described that have the potential to delay the progression of diabetic
kidney disease and minimize the growing burden of end stage renal
disease. Possible targets include the formation of advanced glycation end
products (AGEs) and the AGE receptor, increased oxidative stress and
inflammation, protein kinase C, endothelin receptors, growth factors and
cytokines, the vitamin D receptor, Rho-associated kinases, and the renal
sympathetic system.
The aim of the current work to assess the existence of early renal
involvement identified by microalbuminuria and association of
microalbuminuria with potential risk factors as duration of DM ,poor
glycemic control (HbA1c) and dyslipidemia.
The study was conducted on 110 persons and divided into four
groups :
Group (1) is included 10 persons is control group of apparently
normal individual.
Group (2) is included 23 of diabetic patients without evidence of
nephropathy. (normoalbuminuric of diabetic patients).
Group (3) is included 42 of diabetic patients with
microalbuminuria.
Group (4) is included 35 of diabetic patients with
macroalbuminuria.
All participants will be subjected to;
(A) Full history taking stress on
1-Duration of diabetes.
2-Family history of diabetes.
3-Age at onset.
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Summary & Conclusion
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(B) Laboratory investigation including
1-Urine for Albumine / creatinine ratio.
2- Renal functions including ( serum creatinine & blood urea).
3- Fasting blood sugar .
4- 2houres post prandial blood sugar.
5- Hb A1C.
6- eGFR
7- Serum cholesterol & Triglyceride.
Result of this study revealed that:
As regard of Gender there is no significant difference between the
four studied groups .
As regard of age there was significant difference between the four
studied groups .
As regard of family history of diabetes there is no significant
difference between the four studied groups .
As regard of duration of diabetes there was significant difference
between the patients groups as microalbuminuria increased with
duration of diabetes .
As regard of the age at onset there is no significant difference
between the patients groups.
There was highly significant positive correlation between FBG,2h
PPBG, HbA1c and microalbuminuria .
Also there was significant positive correlation between
dyslipidemia and microalbuminuria .
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Summary & Conclusion
- 109 -
In conclusion : microalbuminuria is the first clinical sign of
diabetic nephropathy. The prevalence of microalbuminuria increased
with age, duration of diabetes, dyslipedemia and poor glycemic control.
Screening and proper treatment of microalbuminuria is a
mandatory in diabetic patients to prevent and reduce of diabetic
nephropathy.