الفهرس 
Diabetic NephropathyOnly 14 pages are availabe for public view
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Abstract
D
iabetic nephropathy (DN) is one of the leading causes of end-stage renal disease (ESRD) in developed countries and is becoming more prevalent globally due to the rise in the incidence of obesity and type 2 diabetes.
DN is a progressive kidney disease caused by alterations in the glomerular capillary and tubular structure and function induced by the disturbed glucose homeostasis. Recent studies are conflicting regarding the sensitivity and the specificity of biomarkers currently used in practice for DN diagnosis (e.g., eGFR, albuminuria).
The aim of this work is to evaluate the relation of Growth Differentiation Factor 15 (GDF 15) to early Diabetic Nephropathy. For this purpose we study 90 adult diabetic patients classified into three groups: group (1); 35 patients with micro-albuminuria (UAE 30–299 mg/24h), group (2); 35 patients with macro-albuminuria (UAE ≥ 300 mg/24h), and group (3); 20 patients with norm-albuminuria (UAE <30mg/ 24h). It was found that there is no statistically significant difference between age and sex in the three studied groups, so patients in this study are matched in age and sex.
As regard the type of diabetes in our study there was statistically insignificant difference between microalbuminuric and macroalbuminuric groups in this study as regard type 1 and type 2 diabetes. Our data revealed that there is a statistically insignificant difference between the three studied groups as regard duration of diabetes.
The study also showed that there was statistically insignificant difference between the two studied groups (1 & 2) as regard hypertension, while they were statistically significant compared to controls.
This study showed that GDF-15 was markedly elevated in group 1 & 2 compared to control. There was statistically very highly significant difference between the two studied groups (1 & 2) and control group (3), while there is a statistically significant difference between group 1 and group 2.
The correlation coefficient (r) in our study compared GDF-15 and glomerular filtration rate (GFR) in norm-albuminuria group (3), there is a statistically negative correlation between GDF-15 and GFR. Correlation coefficient (r) compared GDF-15 and HbA1c (%) in micro-albuminuria group (1), there is a statistically positive correlation between HbA1c and GDR-15.
Correlation coefficient (r) of our study compared GDF-15 and serum urea in micro-albuminuria group (1), there is a statistically positive correlation between serum urea and GDF-15. Correlation coefficient (r) also compared GDF-15 and serum urea in norm-albuminuria group (3), there is a statistically highly significant positive correlation between serum urea and GDF-15.
Based on these results, we propose that elevated GDF-15 is significantly associated with early DN even before appearance of mAlb. However, the underlying mechanisms of elevated GDF-15 leading to increased disease progression remain unknown. We suggested that high GDF-15 reflects early renal injury and a mild degree of proteinuria in DN. GDF-15 is independent prediction to proteinuria level as the correlation coefficients of the studied patients (standardized and unstandardized) showed a very highly statistical difference. Further studies are needed to identify the exact mechanisms of GDF-15 in DN.