No abstract

Altered circulatory asymmetric and symmetric dimethylarginines have been independently reported in patients with end-stage renal failure suggesting their potential role as mediators and early biomarkers of nephropathy. These alterations can also be reflected in urine. Herein, we aimed to evaluate urinary asymmetric to symmetric dimethylarginine ratio (ASR) for early prediction of diabetic nephropathy (DN). In this cross-sectional study, individuals with impaired glucose tolerance (IGT), newly diagnosed diabetes (NDD), diabetic microalbuminuria (MIC), macroalbuminuria (MAC), and normal glucose tolerance (NGT) were recruited from Dr. Mohans' Diabetes Specialties centre, India. Urinary ASR was measured using a validated high-throughput MALDI-MS/MS method. Significantly lower ASR was observed in MIC (0.909) and MAC (0.741) in comparison to the NGT and NDD groups. On regression models, ASR was associated with MIC [OR: 0.256; 95% CI: 0.158-0.491] and MAC [OR 0.146; 95% CI: 0.071-0.292] controlled for all the available confounding factors. ROC analysis revealed ASR cut-point of 0.95 had C-statistic of 0.691 (95% CI: 0.627-0.755) to discriminate MIC from NDD with 72% sensitivity. Whereas, an ASR cut-point of 0.82 had C-statistic of 0.846 (95% CI: 0.800 -0.893) had 91% sensitivity for identifying MAC. Our results suggest ASR as a potential early diagnostic biomarker for DN among the Asian Indians.Diabetic nephropathy (DN) is among the most significant longer-term complications associated with diabetes mellitus. The risk of end-stage renal disease (ESRD), resulting premature morbidity and mortality are estimated to increase with diabetes by 12 fold 1 . A recent epidemiological study reported an increase in mortality rates associated with renal complications in diabetes 2 . Microalbuminuria (MIC) is an early non-invasive marker of renal disease and its progression. However, it takes several years of diabetes for MIC to occur. Interventions are also much less effective in some patients with MIC who manifest advanced pathological changes 3 . Development of sensitive and early stage markers along with alternative diagnostic approaches are thus essential for the detection of DN.Symmetric and asymmetric dimethylarginines (SDMA and ADMA) are structural isomers. They are formed in the protein methylation biosynthetic pathway when methylated protein arginine residues are hydrolyzed and released 4 . These isomers were originally discovered from urine in a relatively high abundance 5,6 . ADMA is predominantly metabolized to citrulline and dimethylamine by dimethylarginine dimethylaminohydrolase (DDAH1) 7 . About 10% of ADMA, however, is eliminated via urinary excretion. The disruption of the DDAH pathway leading to the build up of ADMA has been implicated in its role as an NOS inhibitor 8,9 . Overexpression of renal DDAH and increased urinary elimination of ADMA reduces renal injury in DN 10 . Separately, SDMA could induce arginine deficiency in the endothelial cells thereby reducing the production of nitric oxide (NO) 11 . Increased...

Background: Thyroid hormones play an important role in the homeostasis of calcium and phosphorous levels. A person with thyroid dysfunction may exhibit symptoms that are owing to the alteration in calcium levels. Aim: To find out the calcium alteration in hypothyroidism with different age groups in Kanchipuram district. Methodology: In this study 40 patients with the age group of 20-60 y were taken. The parameters like TSH and Ca 2+ were estimated with commercially available kits. Results: In our study out of 40 patients 18 patients with hypothyroidism had hypocalcemia, which constitute 45% (n=18) of the study had less serum calcium. Remaining 55% patients having normal calcium levels, In future it may develop hypocalcaemia. Discussion and conclusion: Total calcium levels in serum were found to be significantly lower in hypothyroid patients in all age groups. This study concluded that, in Kanchipuram district patients have low levels of serum calcium in hypothyroidism. S.Ca ++ in hypothyroid people demonstrates a constructive connection between the S.Ca ++ and serum TSH. These fluctuations of serum calcium ought to be considered in treating the patients with hypothyroidism by therapeutic experts.