Study of Normo albuminuric diabetic nephropathy in type 1 diabetics.

Senthil Kumar, P K (2011) Study of Normo albuminuric diabetic nephropathy in type 1 diabetics. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION : Diabetes is the leading cause of end stage renal disease throughout the world. Diabetic nephropathy occurs in 25-30% of type 1 diabetes. Increased albumin excretion rate has been considered the first clinical sign of diabetic nephropathy both in type1 and type2 diabetes. Though microalbuminuria is considered as the early marker of diabetic nephropathy, in some patients decrease in glomerular filtration rate and hypertension may precede. It has been proved that patients with normoalbuminuria and decreased gfr in type 2 and type 1 diabetic patients had significant glomerular changes in renal histopathology and also has been proved that these patients had rapid progression of diabetic renal disease. As albuminuria is not a predictor but a marker of diabetic nephropathy lot of researches had been undertaken to identify early predictor such as hyperfiltration, estimation of early gfr decline with both creatinine and cystatin c, plasma and urinary markers of inflammatory, oxidative pathways and fibrotic pathways as well as genetic variants that predispose patients to the onset and progression of diabetic nephropathy. Mogensen etal proposed the natural history of diabetic nephropathy in type1 diabetic patients. Accordingly stage1 is characterised by hyperfiltration and hypertrophy of glomeruli, stage 2 – basement membrane thickening and mesangial expansion, stage 3 – microalbuminuria ( incipient nephropathy), stage 4- macroalbuminuria and decline in gfr (overt nephropathy), stage 5- end stage renal disease. This traditional view of the natural history of diabetic kidney disease is now challenged. It is clear that patients spontaneously regress from microalbuminuria and even overt nephropathy levels of proteinuria to normal levels of proteinuria and some patients never develop proteinuria at all prior to progressing on to decreasing gfr and end stage kidney disease. So the true value of albuminuria is questioned. The existence of normoalbuminuric diabetic kidney disease was demonstrated in the united kingdom prospective diabetes study ( UKPDS). A landmark study by perkins and krolewski showed that in 400 patients in joslin diabetes center with type1 diabetes were more likely to regress in their albuminuria than to go on and progress to nephropathy. They followed them for a baseline level of 2 years showing that they had persistent microalbuminuria for those 2 years, and then they followed them for an additional 6 years, and they averaged their albuminuria levels at 2 year intervals. At years 2,4, and 6 about 40% exhibited regression, all spontaneously whereas only 7-15% progressed on to nephropathy. Those who were younger , hemoglobin A1c less than 8%, systolic blood pressure of less than 115 and lower total cholesterol and triglycerides were more likely to regress. AIM OF THE STUDY : 1. To confirm the existence of normoalbuminuric diabetic nephropathy in type1 diabetics. 2. To study the characteristics of these patients. CONCLUSION : 1. There exists an entity – normoalbuminuric diabetic nephropathy in type1 diabetic patients. 2. Incidence of normoalbuminuric diabetic nephropathy increases with duration of diabetes. 3. There is an increase incidence of hypertension(29%) and retinopathy(47%) in this group of patients. 4. Serum magnesium is low in these patients with normoalbuminuric diabetic nephropathy the significance of which is not clearly known yet there are studies to say that low magnesium is associated with poor outcome. 5. So along with screening for albuminuria periodic screening for GFR should also be done so that these normoalbuminuric diabetic nephropathy can be detected early. This patients should be treated as high risk and they should avoid radiocontrast and other nephrotoxic drugs if not mandatory.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Normo albuminuric ; diabetic nephropathy ; type 1 diabetics.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 06:30
Last Modified: 11 Jul 2017 06:30

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