الفهرس 
Diabetes updates
Diabetic NephropathyOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus represents one of the most important health problems worldwide. The global prevalence of T2DM has reached epidemic proportions over the past few years with global rise in the prevalence of obesity and unhealthy lifestyles. Diabetic Kidney Disease is one of the most common complications of DM. The prevalence of DKD is increasing steeply along with the diabetes epidemic. It is the leading cause of ESKD in many countries. Stage 4 CKD is associated with higher morbidity, mortality and costs compared with patients with earlier stages of CKD and current guidelines recommend greater intensity of care for patients with Stage 4 disease. Early detection of DN, adoption of multifactorial interventions targeting the main risk factors (hyperglycemia, hypertension, dyslipidemia,) and use of agents with reno-protective effect, RAAS blockage do indeed reduce the progression of renal disease and cardiovascular mortality. Our cross sectional study aimed to assess level of care of DN patients in CKD stage 4 in Tanta. We included 257 patients suffered from DN stage 4 including 125 patients from Tanta University Hospital, 59 patients from Medical Insurance Hospital and 73 patients from Elmenshawy Hospital. The study protocol was approved by the institutional ethics committee and informed consents were obtained from the patients Patients in the study underwent full history taking, and investigations including serum creatinine, Hemoglobin level ,serum levels of Ca, Ph, PTH , Summary and conclusion 79 Na, K ,HCO3 , lipid profile, HbA1c and e GFR which had been determined according to abbreviated MDRD equation. Data collected has been compared with KDIGO clinical practice guideline for the Evaluation and Management of CKD. Comparing between the results of the chosen hospitals, Tanta University had the best level for control of HbA1c and Elmenshawy hospital patients were more for using RAAS blockage agents with no significant differences regarding other parameters that may affect care of DN. Of the 257 patients, 136(52.9%) were males and 121 (47.1%) were females.71 (27.6%) were type 1 diabetes and 186(72.4%) were type 2.The mean age was 51.26 years (±14.259).The mean duration of diabetes was 12.43 years (±6.388) and the mean of time of diagnosis of DN was 29.03 months (±19.554). Regarding blood pressure, 77(29.9%) had uncontrolled elevated blood pressure of which 21(27.2%) were on no antihypertensive drugs and regarding usage of RAAS blockage agents, they were used in 134(52.1%) patients and our study proved their effect on level of HbA1c in our patients. As regards control of diabetes, 147(57.2%) had good control (HbA1c≤7), 62(24.1%) had fair control (HbA1c=7.1-7.9) while 41(16%) and 7(2.7%) patients had high (HbA1c=8-10) and extremely high (HbA1Cc˃10) respectively. As regards drugs used for treatment of DM, metformin was used in 59(22%) patients despite against advice of guidelines. Summary and conclusion 80 Our study showed bad control of lipid profile as dyslipidemia was found in 127(49.4%) patients of them 79(62.2%)) patients were on no statin therapy. Regarding assessment of complications of DN, Hypocalcaemia was found in 14(5.4%) patients, elevated phosphate was found in 32(12.4%) patients , 12(4.7%) patients had secondary hyperparathyroidism,205(79.8%) patients had bicarbonate level below normal rang , 25(9.7%) patients had mild elevate potassium level and 55 (20.4%) patients had anemia. With stepwise regression analysis, bad diet quality, high po4 level, low T sat level, anemia, T2DM and treatment taken for DM were considered as predictor factors for high level of HBA1C while male sex, creatinine, aging, high level of PTH, increased diastolic BP and anemia were considered as predictor factors for low level of eGFR in our patients. We concluded that our patients reach stage 4 early after few years of diabetes which may need us to improve our care to these patients to prevent their rapid deterioration. some parameters need more level of care including control of hypertension ,diabetes,treatment used for diabetes,dylsipidemia and acidosis.