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Introduction/Objective. The aim of the study was to examine the progression of diabetic nephropathy (DN) in a prospective three-year period as well as to establish the risk factors for DN progression. Methods. The study involved 45 patients with type 2 diabetes and DN (26 males, aged 18-62 years) followed for three years. All patients underwent physical examination and laboratory analysis at each visit. Laboratory analyses included complete blood count, serum glucose, urea, creatinine, protein, lipid concentration, glycosylated hemoglobin (HbA1c) and urine protein, albumin and creatinine concentration. Glomerular filtration rate (GFR) was calculated using Modification of Diet in Renal Disease formula. Kidney length and parenchymal thickness were measured by ultrasound. Results. Fasting serum glucose concentration (12.0 ? 2.79 vs. 9.50 ? 2.22, p < 0.001) and HbA1c (7.99 ? 1.43 vs. 7.49 ? 1.29, p < 0.031) were decreased over the three years. Albuminuria increased (43.75 ? 10.83 vs. 144.44 ? 52.70 mg/l, p < 0.001) and GFR (63 vs. 58.3 ml/min/1,73m2) decreased significantly during the study, but serum lipid concentration remained unchanged. Mean kidney length and parenchymal thickness decreased during the three years. Linear regression analysis found systolic blood pressure, fasting glycemia, HbA1c as positive and kidney length and parenchymal thickness as negative predictors of proteinuria increase, but proteinuria as negative and serum iron and albumin concentrations as positive predictors of annual change in GFR. Conclusion. High blood pressure and high HbA1c are selected as significant risk factors for increasing of proteinuria which is a significant predictor of GFR decreasing in patients with DN.

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Introduction. The aim of the study was to examine whether biomarkersof oxidative stress and antioxidant enzyme activities are among other riskfactors for diabetic nephropathy (DN).Methods. The study involved 70 patients with type 2 diabetes (37 males,aged 41 to 81 years) allocated to two groups: one of 32 patients with DNand the other of 38 patients without DN. In the study of oxidative stress 15healthy persons were included. All examined patients were interviewed andunderwent objective examination. Their serum and urine samples were analyzedin order to estimate the quality of glycoregulation and kidney function.Protein thiol groups (P-SH), antioxidant enzyme activities [superoxidedismutase (SOD) and glutathione peroxidase (GPX)] were determined inplasma spectrophotometrically and malondialdehyde-adducts (MDA) byenzyme immunoassay.Results. No significant differences were found between the two groupsfor demographic characteristics, duration and treatment of diabetes, bloodpressure, fasting glucose level and HbA1c. Patients with DN had a higherbody mass index, lower estimated glomerular filtration rate (eGFR) andhigher albuminuria and proteinuria. Plasma activity of GPX and SOD as wellas levels of MDA adducts and P-SH groups were similar in patients with andwithout DN, but GPX and SOD plasma activities were significantly lower andplasma level of MDA significantly higher in all patients than in healthy controls.Patient gender, age, BMI, HbA1c and plasma level of P-SH and MDAwere selected as significant predictors of DN. Patient age, duration of diabetes,serum phosphorus, uric acid levels and plasma SOD activity were negativelyassociated with eGFR. Patient age, serum levels of protein and albuminand plasma GPX activity were negatively, while systolic BP, serum levelsof uric acid and cholesterol were positively associated with proteinuria.Conclusion. Biomarkers of oxidative protein and lipid damage were selectedas risk factors for DN, besides several other well known risk factors.