Nowadays it is observed that the chronic kidney disease (CKD) is a growing health problem worldwide and the most com­mon illness associated with this is hypertension (HTN) and diabetes mellitus (DM). This study tries to find out illness associ­ated with CKD and assess the renal parameters according to age and sex group. This is a cross sectional descriptive study. Diagnosed cases of Chronic Kidney Disease patients visiting at KIST Medical College from September to November 2011 are included in this study. SPSS-17 version is used for data analysis and appropriate statistical tests are done. Among 150 patients, 57% are male and 43% are female. Mean age of the study population is 48.62±18.09 years. Level of urine protein for male is higher than female. Mean urea, creatinine, potassium, uric acid, phosphorus and protein creatinine ratio (PCR) are higher in younger age group. The result also depicts hypertension is the leading illness associated with CKD (50%). Only 8% diabetes mellitus cases are associated with CKD followed by both of hypertension and diabetes mellitus (26%) and 16% others. This study provides an overview of routine biochemical parameters with CKD. Hypertension is found as leading ill­ness associated with CKD. Differences in renal parameters are found in gender and different age groups. DOI: http://dx.doi.org/10.3126/jcmc.v3i2.8441 Journal of Chitwan Medical College Vol.3(2) 2013 36-39

BackgroundType II diabetes mellitus is a complex heterogeneous group of metabolic conditions characterized by an increased level of blood glucose, due to impairment in insulin action and/or insulin secretion. Hyperglycemia is a major factor in the pathogenesis of atherosclerosis in diabetes. Oxidative modification of low density lipoprotein (LDL) is recognized as one of the major processes involved in the early stages of atherosclerosis in type II diabetes. LDL contains different antioxidants, which increase LDL resistance against oxidative modification, this is known as its antioxidant potential (AOP).ObjectivesThe present study has been carried out to investigate the sensitivity of LDL to oxidation, AOP of LDL and to assess whether hyperglycemia in diabetes mellitus is associated with increased LDL oxidizability, and whether these relationships are related to diabetic complications.Patients and MethodsThis study was carried out on 100 diabetic subjects, divided into two groups according to their glycosylated hemoglobin (HbA1c) values, either regulated ( < 0.50 M hexose/ M Hb) or unregulated ( > 0.50 M hexose/ M Hb.) A further 50 healthy subjects were included to determine the sensitivity of LDL oxidation and measurement of LDL AOP. LDL from the serum sample was precipitated by the heparin-citrate precipitation method. The LDL fractions were exposed to oxidation with copper sulphate and their sensitivity to oxidation was evaluated. AOP was measured by taking measurements from 30 subjects in each group.ResultsThe sensitivity of LDL oxidation was significantly higher in both diabetic groups compared to the control group. AOP was significantly decreased in all diabetic groups compared to the control group.ConclusionsIn type II diabetes, the increased susceptibility of LDL to oxidation is related to hyperglycemia and low AOP.

The effects of lipid peroxidation products 4‐Hydroxy‐2‐nonenal (4‐HNE) and 4‐oxo‐2‐nonenal (4‐ONE) were evaluated using bovine heart mitochondria. Oxygen consumption rate (OCR), ultrastructure, antioxidant activity, and membrane permeability were examined to compare their effects on isolated mitochondria from beef cardiac muscle. For the mitochondrial morphology, the final concentration of mitochondria and 4‐ONE or 4‐HNE in the reaction tube were 10 mg/ml and 1 mM, respectively. For the OCR experiment, mitochondria (2.5 mg/ml) were incubated with 0.20 mM ONE or in a Clark electrode chamber at 25°C. Mitochondrial membrane permeability was determined by incubating 0.5 mg/ml of mitochondrial protein with either 0.05 mM ONE or HNE or ethanol control at pH 5.6 and 7.4 at 25°C. Transmission electron microscopy (TEM) revealed that the size of 4‐ONE treated mitochondria at pH 7.4 increased (p < .05), as did permeability (p < .05), unlike ethanol controls. However, mitochondria incubated with 4‐ONE at pH 5.6 showed a decrease in volume (p < .05). Incubating mitochondria with 4‐ONE at pH 5.6 and pH increased oxygen consumption rate 7.4 caused less oxygen consumption than either 4‐HNE treatment or ethanol control. The hydrogen peroxide assay (H2O2), ferric reducing antioxidant properties (FRAP), and 2,2’‐azinobis (3‐ethylbenzthiazoline‐6‐sulfonic acid) (ABTS.+) assays revealed that 4‐ONE is a more potent inhibitor of the endogenous antioxidant system of mitochondria than 4‐HNE (p < .05).

Diabetic nephropathy is a major microvascular complication of diabetes, representing the leading cause of end stage renal disease in the world, and a major cause of morbidity and mortality in type 2 diabetic subjects. In the kidney, a number of pathways that generate reactive oxygen species (ROS) such as glycolysis, specific defects in the polyol pathway, uncoupling of nitric oxide synthase, xanthine oxidase, NAD (P) H oxidase, and advanced glycation have been identified as potentially major contributors to the pathogenesis of diabetic kidney disease. Changes in oxidative stress biomarkers, including superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase, glutathione levels, vitamins, lipid peroxidation, nitrite concentration, nonenzymatic glycosylated proteins have been associated with diabetic nephropathy due to oxidative stress induced hyperglycemia. Oxidative stress in diabetes is responsible for endothelial dysfunction releasing inflammatory markers cytokines from the damaged renal tissue. Hyperglycemia induces intracellular reactive oxygen species in mesangial and tubular epithelial cells which induces cytokines, IL-6 and TNF-α production in glomerular mesangial and tubular epithelial cells in diabetic kidney. Antioxidants inhibit high glucose induced transforming growth factors and extra cellular matrix expression in glomerular mesangial and tubular epithelial cells, which ameliorate features of diabetic nephropathy, suggesting that oxidative stress plays an important role in diabetic renal injury causing diabetic nephropathy.

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