Abstract
Background: Diabetes is the leading cause of end stage renal disease, adult-onset blindness, and non-traumatic lower limb amputations. Diabetic nephropathy (DN), is the leading cause of kidney diseases in patients starting renal replacement therapy and affects approximately 40% of type 1 and type 2 diabetic (T2D) patient). The pathogenesis of diabetic nephropathy include glycosylation of circulating and intrarenal proteins and abnormal intrarenalhemo dynamics. Recently various studies shows that level of serum uric acid was shown to be higher in diabetic patients with persistent macroalbumin
Aims & Objectives: To find out the association between serum uric acid and proteinuria level among type 2 diabetic patients attending a tertiary care centre.
Subjects and Methods: A cross sectional study was carried out in the General medicine outpatient department of a tertiary care Centre. Diabetic nephropathy patients of both gender with no significant body weight changes for at least 3 months aged 30-60 years before the study are included in the study and Patients with Family history of gout, with known gout , on chemotherapy and known cancer patients are excluded.
Results: Out of the 50 study participant’s majority are females (60%). Mean ± SE of serum creatinine was 0.88 ± 0.038 mg/dL, mean ± SE of serum uric acid was 4± 0.12 mg/dl, and mean ± SE of proteinuria was 382 ± 24.7 mg/day (median = 300.5 mg/day.
Conclusion: serum uric acid plays a a major pathological role in the development of diabetic nephropathy in type 2 diabetic mellitus patients
Keywords: Serum uric acid, Diabetic nephropathy, Diabetic mellitus.
References
1. Rahimi Z. ACE insertion/deletion (I/D) polymorphism and diabetic nephropathy. J Nephropathology. 2012;1:143–51
2. Mishra R, Emancipator SN, Kern T, Simo-nson MS. High glucose evokes an intrinsic proapoptotic signaling pathway in mesa-ngial cells. Kidney Int. 2005;67:82–93.
3. Hohenstein B, Hausknecht B, Boehmer K, Riess R, Brekken RA, Hugo CP. Local VEGF activity but not VEGF expression is tightly regulated during diabetic nephrop-athy in man. Kidney Int. 2006;69:1654–61
4. Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, preven-tion, and treatment. Diabetes Care. 2005;28(1):164–76.
5. Song KH, Ko SH, Kim HW, Ahn YB, Lee JM, Son HS. et al. Prospective study of lipoprotein(a) as a risk factor for deterio-rating renal function in type 2 diabetic patients with overt proteinuria. Diabetes Care . 2005;28(7):1718–23.
6. Jalal DI, Rivard CJ, Johnson RJ, Maahs DM, McFann K, Rewers M. et al. Serum uric acid levels predict the development of albuminuria over 6 years in patients with type 1 diabetes: findings from the Coronary Artery Calcification in Type 1 Diabetes study. Nephrol Dial Transplant. 2010;25:1865–9.
7. Modan M, Halkin H, Karasik A, Lusky A. Elevated serum uric acid--a facet of hyperinsulinaemia. Diabetologia. 1987;30:713–8.
8. Obermayr RP, Temml C, Gutjahr G, Knechtelsdorfer M, Oberbauer R, Klauser-Braun R. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol. 2008;19:2407–13.
9. Momeni A, Shahidi S, Seirafian S, Taheri S, Kheiri S. Effect of allopurinol in decree-sing proteinuria in type 2 diabetic patie-nts. Iran J Kidney Dis. 2010;4:128–32.
10. Siu YP, Leung KT, Tong MK, Kwan TH. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis. 2006;47:51–9.
11. Kosugi T, Nakayama T, Heinig M, Zhang L, Yuzawa Y, Sanchez-Lozada LG. et al. Effect of lowering uric acid on renal disease in the type 2 diabetic db/db mice. Am J Physiol Renal Physiol. 2009; 297:F 481–8.
12. Behradmanesh, Saeed et al. “Association of Serum Uric Acid with Proteinuria in Type 2 Diabetic Patients.” Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences 18.1 (2013): 44–46.
13. Vinod R, Rehman A. Serum Uric Acid Association with Nephropathy in Diabetic Patients–Study at a Tertiary Care Center. Indian Journal of Applied Research. 2016 May 9;5(12).
14. Doria A, Krolewski AS. Diabetes: Lowering serum uric acid levels to prevent kidney failure. Nat Rev Nephrol. 2011; 7:495–6
15. Hovind P, Rossing P, Johnson RJ, Parving HH. Serum uric acid as a new player in the development of diabetic nephropathy. J RenNutr. 2011;21:124–7
16. Fukui M, Tanaka M, Shiraishi E, Harusato I, Hosoda H, Asano M, et al. Serum uric acid is associated with microalbuminuria and subclinical atherosclerosis in men with type 2 diabetes mellitus. Metabolism. 2008;57:625–9
17. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, Gersch MS, Benner S, Sánchez-Lozada LG. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. The American journal of clinical nutrition. 2007 Oct 1;86(4):899-906.
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.19
