الفهرس 
Chapter 1: Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy is a serious microvascular complication of diabetes mellitus. The decrease in renal function of diabetic nephropathy is characterized by glomerular dysfunction, which is closely related to elevated urinary albumin excretion. Diabetic nephropathy has been categorized according to urinary albumin excretion into three stages, normoalbuminuria (urinary albumin excretion < 30 mg/24h), incipient nephropathy (30< urinary albumin excretion < 300 mg 24h) and overt nephropathy (urinary albumin excretion > 300 mg/24h). Diabetic nephropathy (DN) is the leading cause of end-stage renal failure worldwide. Besides, diabetic nephropathy is associated with cardiovascular disease, and increases mortality of diabetic patients. Several factors are involved in the pathophysiology of DN, including metabolic and hemodynamic alterations, oxidative stress, and activation of the renin-angiotensin system. Chemerin is an adipocyte-secreted protein with autocrine /paracrine roles on adipose development and function as well as endocrine roles in metabolism and immunity. Following prochemerin secretion, protease-mediated generation of chemerin isoforms with a range of biological activities is a key regulatory mechanism controlling local, context-specific chemerin bioactivity. Together, experimental and clinical data indicate that localized and/or circulating chemerin expression and activation are elevated in numerous metabolic and inflammatory diseases including obesity, type2 diabetes and metabolic syndrome. These elevations are positively correlated with deleterious changes in glucose, lipid, and cytokine homeostasis, and may serve as a link between obesity, inflammation and other metabolic disorders. Circulating chemerin, a novel adipokine linked to obesity, glucose tolerance and hyperlipidaemia, was recently reported to be increased in chronic kidney disease (CKD) patients. There are possible links between chemerin and various clinical, nutritional and biochemical markers as well as its association with 5-year all-cause mortality. Serum chemerin levels are strongly associated with diabetic nephropathy, was recently reported to be increased in nephropathy of type 2 diabetic patient’s. There are possible links between serum chemerin concentration and renal dysfunction in type 2 diabetic patients. The aim of the present work was to study serum chemerin levels and determine its association with kidney functions in patients with type 2 diabetes mellitus. The study was conducted on 62 adult patients with type 2 diabetes mellitus, 36 males and 26 females whose mean ages were 48 ± 6 years. The patients were classified according to their micro albumin levels in to group I (UAE < 30 mg / 24 h included 19 patients (13 males and 6 females) whose ages were 46 ± 5 years, group II (30 < UAE < 300) included 22 patients (11 male and 11 females) whose ages were 49 ± 5 years, group III (UAE > 300 mg 24h) included 21 patients (11 male and 10 females) whose ages were 60 ± 5 years, group IV included 15 healthy persons (6 males and 9 females) whose age 50 ± 9 years. Results of this study revealed that:
- There was no significant difference in gender. Significant difference were found in age, duration of DM, BMI, SBP, DBP, HbA1C, HOMA IR, ALT, AST, Urea, Creatinine, TG, TC, HDL, LDL, Urinary albumin and Chemerin. - Age was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy (P < 0.001) and it means was significantly higher in diabetic patients with incipient nephropathy compared to diabetic patients without nephropathy (P < 0.001).
- There was no significant difference between four groups regarding the gender where X2=4.123 and P-value0.248.
- The duration of diabetes was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy (P < 0.001) and its mean was significantly higher in diabetic patients with incipient nephropathy compared to diabetic patients without nephropathy (P < 0.001).
- The body mass index was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy and diabetic patients with incipient nephropathy (P < 0.001).
- The mean blood pressure was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy, diabetic patients with incipient nephropathy and control group (P < 0.001).
- Glycated hemoglobin (HbA1c) was significantly higher in diabetic patients without nephropathy, diabetic patients with incipient 78
nephropathy, and diabetic patients with overt nephropathy compared to control group (P < 0.001).
- Fasting blood sugar was significantly higher in diabetic patients without nephropathy, diabetic patients with incipient nephropathy and diabetic patients with overt nephropathy compared to control group (P < 0.001).
- HOMA.IR was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy, diabetic patients with incipient nephropathy and control group.
- Serum ALT was significantly higher in diabetic patients with overt nephropathy compared to control group (P < 0.001).
- Serum AST was significantly higher in diabetic patients with overt nephropathy compared to control group (P < 0.001).
- Serum urea was significantly higher in diabetic patients with overt nephropathy compared to control group (P < 0.001)
- Serum creatinine was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy and control group (P < 0.001)
- Serum cholesterol was significantly higher in diabetic patients with overt nephropathy compared to diabetic patients without nephropathy, diabetic patients with incipient nephropathy and control group (P < 0.001).
- Serum chemerin was significantly higher in diabetic patients with incipient nephropathy and overt nephropathy compared to diabetic patients without nephropathy and control group (P<0.001).
- Multiple linear regressions showed that age, total cholesterol, urinary albumin and HOMA IR are strong predictors to Chemerin marker.