A study in prevalence of diabetic nephropathy in recently detected cases of type 2 diabetes mellitus as evidenced by altered creatinine clearance, urinary albumin and serum creatinine, with special emphasis on hypertension, hypercholesterolemia and obesity

Abstract

Original Research ArticleA study in prevalence of diabetic nephropathy in recently detected cases of type 2 diabetes mellitus as evidenced by altered creatinine clearance, urinary albumin and serum creatinine, with special emphasis on hypertension, hypercholesterolemia and obesity Vitan Patel, Minal Shastri*, Nisha Gaur, Prutha Jinwala, Abhishek Y. Kadam INTRODUCTIONDiabetes Mellitus (DM) is one of the commonest diseases in the world, especially the industrialized world. But recently, the "Silent epidemic" of diabetes has been spreading like a wild fire through the developing world. India has earned the dubious distinction of being termed the "Diabetes capital of the world" with number of patients expected to cross 79.4 million by year 2030. 1The dangerous fact about diabetes is that it is a "Silent killer". By the time patient is diagnosed to have diabetes, he/she is already affected with complications like diabetic nephropathy, retinopathy and neuropathy. This is especially worse in India, where various factors delay the ABSTRACT Background: Diabetic nephropathy is one of the commonest and most dreaded complications of Diabetes. The Aim was to evaluate the significance of microalbuminuria and creatinine clearance for detecting incipient diabetic nephropathy, and to find out the prevalence of nephropathy among freshly detected Type 2 diabetic patients with vs. those without hypertension, hypercholesterolemia and/or obesity. Methods: In this prospective study, 100 recently diagnosed diabetics were studied. Group A had 50 patients with at least one risk factor are hypertension, hypercholesterolemia and obesity. Group B had 50 patients without any of the aforementioned factors. Patients were investigated for presence of Diabetic nephropathy with abnormal serum Creatinine, creatinine clearance and urinary albumin levels. Results: As many as 43 out of 100 patients were found to have Diabetic nephropathy. The number was significantly higher in group A compared to group B (34/50 vs. 9/50). Incidence of nephropathy was higher with higher number of associated risk factors. Urinary microalbuminuria was the commonest abnormality, Serum creatinine was found in only 30.23% of total positive cases. Conclusions: Incidence of diabetic nephropathy is much larger than imagined in freshly diagnosed/new onset cases of DM type 2. Author also conclude that hypertension, obesity and hypercholesterolemia can contribute to development of nephropathy (68% vs. 18% in those who had the factors vs. those who didn't). Also, urinary microalbuminuria appears to be much more sensitive than serum creatinine as screening tool. While prevalence of nephropathy in diabetes has been extensively studied in past, very few studies have taken to determine how much prevalence is at the time of detection already. This becomes even more important when we take into account how delayed the diagnosis is in Indian patients. And presence of other complicating factors may worsen this. A study is indicated looking for how these factors impact the prevalence of di...

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