Risk factors in diabetic nephropathy

Abstract

Diabetes morbidity and mortality is mainly determined by the late chronic complications of diabetes. Though the macrovascular complications affecting the heart is the leading cause of mortality in diabetes, nephropathy is slowly becoming an important factor in determining the final outcome. This is because of better prevention and treatment of cardiovascular problems with the availability of newer drugs and devices, thereby making diabetic patients live longer. Also it is a well accepted fact, that patients of diabetic nephropathy are more predisposed to cardiovascular and peripheral vascular diseases. Even though the hyperglycemia is closely related to the development of microvascular complications, the evidence of direct relationship between hyperglycemia and nephropathy is less convincing in humans, as only 30% of diabetic patients develop clinical nephropathy [1]. Majority of patients escape renal failure even though some histological evidence of renal damage is present in many. It is unclear why some diabetic patients are more susceptible than others for the development of renal disease. Inherited factors may be providing protection from susceptibility to diabetic nephropathy, but evidence is lacking as to which factors are important. Familial predisposition to raised arterial pressure increases the susceptibility to renal disease in patients with diabetes. Studies have demonstrated that mean blood pressure levels are significantly higher in those who progress to microalbuminuria, than in those who do not, indicating that hypertension is an important risk factor for diabetic nephropathy [2]. There is evidence of familial clustering of diabetic nephropathy in type 2 diabetes and the affected sib-pair linkage analysis have identified loci associated with diabetic nephropathy in type 2 diabetes [3,4]. Interstingly, in Pima Indians blood pressure levels before the onset of diabetes, predicts the future risk of developing nephropathy [5] Factors determining the occurence and progression of diabetic nephropathy include hyperglycemia, hypertension, hyperlipidemia and genetic factors. From a clinical patient management point of view, reversible or treatable factors like hypertension, hyperlipidemia and hyperglycemia are important. At present genetic factors may be important only for theoretical discussion, but with the rapidly advancing field of gene therapy, it may be possible to modify the risk factors for diabetic nephropathy favourably by gene therapy.Genes involved in the genetic predisposition to diabetic nephropathy, are likely to be those involved in reninangiotensin system, nitric oxide pathway, aldose reductase pathway, GLUT-1, and lipoproteins metabolism. These have been investigated, but studies have, by and large, been inconclusive or shown only weak associations [6]. However, a strong association between polymorphism in the 5′ end of aldose reductase gene and the development of diabetic nephropathy in type 1 diabetes has been confirmed by many investigators [7].Renoprotective effects of good glycemic ...

Electrolyte Variations in Diabetic Nephropathy

“…Both age and gender had an impact on diabetic nephropathy as per our study. Similar observations were reported by previous studies [2,11,12,14,15]. The age reported for onset of diabetic nephropathy was comparatively higher in Saudi Arabia than our results [20].…”

“…Inside the cell, glucose phosphate ester formation requires phosphorus, which is also needed as a part of the coenzymes of glucose metabolism. Magnesium is required for the binding activity of the insulin besides activating several enzymes of glucose metabolism [5,10,11]. Alterations in these electrolyte levels are found to be associated with diabetes mellitus [12,13].…”

Determinants of Diabetic Nephropathy among Diabetic Patients in General Public Hospitals of Tigray, Ethiopia, 2018/19

“…Poor glycemic control showed an association with the development of diabetic nephropathy. Similar significant associations were indicated in the findings of other previous studies done in South India, Oman, and westerns countries [ 29 , 30 , 36 , 37 ]. This is because poor glycemic control increases the glomerular filtration rate loss and albuminuria [ 29 , 38 ].…”

Peripheral blood mitochondrial DNA copy number as a novel potential biomarker for diabetic nephropathy in type�2 diabetes patients

“…As demonstrated by multivariate logistic regression analysis, the mtDNA-CN was significantly and independently associated with the occurrence and the development of DN even after adjustment for several variables, including age, mean blood pressure, HbA1c and total cholesterol. As hyperglycemia, hypertension and hyperlipidemia are well-established risk factors for DN progression (52,53), the present results indicate that decreased mtDNA-CN in DN patients is an independent risk factor for DN.…”