Abstract
Background: Diabetes Mellitus is the most common endocrine disorder. The pathogenic vision of diabetes mellitus has changed in the last few years, with inflammatory pathways playing pivotal roles in the development and progression of diabetic complications. The present study was devised to find out the correlation between inflammatory markers and diabetic nephropathy.
Aim: To study the correlation between C-reactive protein and 24-hr urinary protein and Glycemic control in diabetic nephropathy patients.
Methods: A prospective observational study was done on 170 diabetic patients who were subjected to urine dipstick test for proteinuria. All those patients having positive dipstick proteinuria test were labeled as Macroalbuminuric diabetics. Dipstick Negative patients were subjected to 24 hours urine for microalbumin. Among these patients having 24 hour urine protein levels between 30-300 mg/24hrs were labelled as Microalbuminuric diabetic patients and less than 30 mg/24hrs were labelled as Normoalbuminuric diabetic patients. CRP levels and HbA1c were measured.
Results: The mean age were 52.26±6.28, 53.5±6.22, 52.9±6.04 in normoalbuminuric, microalbuminuric and macroalbuminuric patients. There were 56 females & 61 males in normoalbuminuric, 15 females & 15 males in microalbuminuric, 10 females & 13 males in macroalbuminuric patients. Mean years since detection of diabetes was 5.36±2.31, 9.10±2.61, 10.17±3.31 in normoalbuminuric, microalbuminuric and macroalbuminuric patients. Glycatedhemoglobin levels were 7.02±0.43, 8.32±0.86, 8.26±0.63 in 3 subsequent groups. Mean Urinary albumin excretion were 7.58±5.8, 188.9±64.9, 617.5±174.0 in 3 groups respectively. Mean levels of C- reactive protein were 1.91±0.975, 11.27±3.66, 12.57±3.58 in these 3 groups respectively. There was positive correlation found between urinary albumin excretion and C- reactive protein levels. Similarly, correlation of glycosylated hemoglobin with C-reactive protein and urinary albumin excretion was significantly positive.
Conclusion: We conclude from our study that there is a significant association between CRP levels and microalbuminuria in type 2 diabetes. Thus activation of inflammatory pathways in progression of kidney disease as represented by CRP can be useful for diagnosis of early stages of diabetic nephropathy.
Keywords-Diabetes Mellitus, C-Reactive Protein, Microalbuminuria, Nephropathy.
References
1. Powers CA. Diabetes Mellitus. Harrison’s Principle of Internal Medicine. 18thedition,Chap 344: Dan LL, Anthony SF, Dennis LK, Stephen LH, Joseph L et al.2012 : 2982-2984.
2. MalinsJM : Clinics Diabetes Mellitus. Eyre and Spottiswoode, London 1968.
3. Pickup J, Crook M. Is type 2 diabetes mellitus a disease of innate immune system.Diabetologia1998 ; 41 : 1241-1248.
4. Crook M, Type 2 diabetes mellitus : A disease of the innate immune system. An update.Diabat Med 2004 ; 21: 203-207.
5. Tietz , N. W, ed, Fundamentals of Clinical Chemistry, 3rd Edition, W.B. Saunders, Philadelphia, PA 1987.
6. M. Saraheimo, C. Forsblom. A.M Teppo. Diabetic nephropathy is associated with low- grade inflammation in diabetic patients. The Finnish Diabetic Nephropathy Study. Diabetologia 2003; 46: 1402-1407.
7. Ridker, PM; et al. Inflammation, Pravastatin and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998; 98: 839-844.
8. Ross R : Atheroscelerosis : An inflammatory disease . N Engl J Med1999; 340: 115-126.
9. Vivek MP, Chaitanyakumar S, Venaktesh P. Diabetic nephropathy and its relation to inflammation.International Journal of Pharmacy and Biological Sciences, Vol 3, Issue 2; April-June: 2013: 117-127.
10. Urooj TB, Ismaa GK, Rauf N. C- reactive protein as a low grade inflammatory marker in type 2 diabetic nephropathy. Ann. Pak .Inst.Med . Sci.2011;7(4):217-221.
11. FestaA , D’ Agonstino R , Howard G , Mykkanen L , Tracy R , and Haffner S . Inflammation and microalbuminuria in nondiabetic and type 2 diabetic subjects , the Insulin Resistence Atherosclerosis study . Kidney Int 2000; 58: 1703-1710.
12. Charumathi Sabanayagam, Jeannette Lee, Anoop S. C- reactive protein and microalbuminuria in a multi-ethnic Asian population. Nephrology Dialysis Transplant 2010; 25(4): 1167-1172.
13. StehouwerC , Gall M, Twisk J, Knudsen E, Emeis J, and Parving H. Increased urinary albumin excretion , endothelial dysfunction , and chronic low grade inflammation in type 2 diabetes : progressive, interrelated , and independently assiociated with risk of death. Diabetes 2002 ; 51 : 1157-1165.
14. Jager A , van Hinsbergh VW, Kostense PJ , Emeis JJ , Yudkin JS ,Nijpels G , Dekker JM ,Heine RJ , Bouter LM , Stehouwer CD : C reactive protein and soluble vascular cell adhesion molecule -1 are associated with elevated urinary albumin excretion but do not explain 22 :593-598.
15. Gomes MB, Nogueria VG. Acute-phase proteins and microalbiminuria among patients with type 2 diabetes . Diabetes Research Clinical Practise .2004 Oct; 66(1) : 31-39.
16. Mojahedi MJ, Bonakdaran S. Elevated serum C – reactive protein level and microalbuminuria in patients with type 2 diabete mellitus. Iran Journal of Kidney Disease, 2009 Jan; 3(1) : 12-16.
17. M. Loredana Marcovecchio MD, Cossimo Giannini MD. C- Reactive protein in relation to the development of Microalbuminuria in diabetes. The Oxford Regional Prospective Study. Diabetes Care May 2008 Vol.31 no.5: 974-976.
18. M. Saraheimo, C. Forsblom. A.M Teppo. Diabetic nephropathy is associated with low- grade inflammation in diabetic patients. The Finnish Diabetic Nephropathy Study. Diabetologia 2003; 46: 1402-1407.
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.36
