الفهرس 
Natural historyيوجد فقط 14 صفحة متاحة للعرض العام
 |  | from | 32 |  |  |
| | | from | 32 | | |
المستخلص
Elderly individuals are a fast growing subgroup of the
general population, and diabetes mellitus is now a major
health issue affecting them.
Chronic kidney disease (CKD) complicates diabetes and
also has an increased prevalence in elderly individuals.
Particularly in those older than 60 years, the most common
cause of CKD and end-stage renal disease is diabetic kidney
disease. A third of new ESRD cases in people older than 75
years are caused by diabetic nephropathy (DN).
The time of onset of DM2 (Type II Diabetes Mellitus) is
rarely known accurately, and cardiovascular events in a
patient with DM2 can censor the natural history of DN. A
feature of the natural history of DN that is gaining renewed
investigation is the progression from normoalbuminuria to
proteinuria and then to renal failure. In the classical
paradigm, overt proteinuria precedes the decline in renal
function. Recently, there have been several reports describing
patients with primarily DM2 and presumed DN who have
declining renal function with normoalbuminuria or
microalbuminuria and not the previously well-described
proteinuria.
The objectives of this thesis are to compare the kidney
functions and renal vascular resistance and the associated
cardiovascular risk factors in proteinuric and nonproteinuric
diabetic nephropathic patients.
This study was a two stage study: the first stage was
observational cross-sectional in which 500 elderly diabetic
patients were included from the inpatient wards and
outpatient clinics of geriatric medicine and internal medicine
departments of Ain Shams University hospitals. The second stage was comparative between nonproteinuric nephropathic
patients and their matched proteinuric nephropathic patients.
Twenty more participants were recruited to clarify the
significance of the renal resistance index.
Each patient underwent comprehensive geriatric
assessment including full clinical examination and laboratory
assessment to determine nephropathy and its risk factors,
diabetes complications, cardiovascular disease and
cardiovascular risk factors.
This assessment included:
Framingham 10 Year Risk of General Cardiovascular
Disease
CRP assay, serum Creatinine, Uric acid, Total
bilirubin, lipid profile, protein/creatinine ratio, 24 hrs
urinary protein.
Abdominopelvic ultrasound with Doppler sonographic
examination of the kidneys.
Assessment was carried out on admission.
Any patient with known kidney disease, urinary tract
infections, hepatitis C using drugs affecting kidney functions
as diuretics or abnormal blood urea or high creatinine was
excluded from the study.
Our study revealed that
There is a high prevalence of diabetic nephropathy
with the majority of patients in stage 2-3 and similar
prevalence of nonproteinuric and proteinuric nephropathy in
early stages.Among the risk factors studied only age, gender and
vitamin D use showed significant value, while neither
smoking habits, duration of diabetes, diabetes control, insulin
use, ACEi or ARBs use, statins use nor weight showed any
significant difference.
When studying cardiovascular complications we found
no statistically significant difference in the frequency of
ischemic heart disease events between proteinuric and
nonproteinurics, although most of the participants had a
previous ischemic cardiac event, also for heart failure and
stroke both groups presented no significant difference. But
when we studied peripheral arterial disease, proteinuric
patients suffered from more peripheral arterial disease
significantly specially in the first stage of intermittent
claudication.
When we studied the relation between proteinuria and
risk factors for cardiovascular diseases we found that: There
was no significant difference between proteinurics and
nonproteinurics in the levels of HDL-cholesterol and LDLcholesterol. Also there was no significant difference when we
calculated the Framingham 10 year overall risk score.
Nonproteinuria was associated with increased renal
resistance index indicating nephropathy though this relation
was not statistically significant. It showed significance only
after using a less cutoff point.
Renal resistance index was inversely correlated with
glomerular filtration rate after adjusting ideal body weight.
A scoring system, including age, persistent
microalbuminuria, diabetes duration and control association
with hypertension and rise of RRI, is needed to diagnose
diabetic nephropathy early and accurately to implement
secondary preventive measures.