Mohanraj, P (2009) Evaluation of Lipid Profile in patients with Non-diabetic Chronic Kidney Disease stage 3, 4 and 5. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION : The National Kidney Foundation criteria for diagnosis of CKD are : (i) Kidney damage for greater than or equal to 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased glomerular filtration rate, manifest by either: a. pathological abnormalities or b. markers of kidney damage, including abnormalities in the composition of the blood or urine, or abnormalities in imaging tests. (ii) Glomerular filtration rate less than 60 mL/min/1.73 m2 for greater than or equal to 3 months, with or without kidney damage. In accordance with the Kidney Disease Outcomes Quality Initiative (KDOQI) definition, a documented GRF of below 60mL/min/1.73 m2 fulfils the definition of CKD without requiring any additional evidence of underlying kidney damage. This cutoff in GFR was selected because it represents over 50% reduction in kidney function as compared to the level for young healthy adults and it is supported by accumulating evidence demonstrating the presence of complications as the glomerular filtration rate falls below 60 mL/min/1.73 m2. The commonest and most readily available marker of kidney damage resulting in glomerular dysfunction is the presence of proteinuria. Similarly, the presence of abnormal sediment on urine microscopy or the demonstration of multiple cysts on renal imaging in a patient with a family history of polycystic kidney disease would meet the requirement for objective kidney damage. Because the relationship of hypertension to kidney disease is complex and varied, hypertension by itself is not included in the above definition; instead the presence of absence of hypertension is noted separately in conjunction with the presence or absence and the severity of CKD. AIM OF THE STUDY : 1. To estimate various level of lipids in CRF patients. 2. To study whether any correlation exist between the severity of CRF and lipid alterations. 3. To examine which type of hyperlipoproteinemia predominates in these patients. 4. To examine whether the ratio between TC to HDL-C is altered in CRF patients. 5. To examine the association of hypertension in CRF patients. MATERIALS AND METHODS : 1. This study was conducted in 50 patients of CKD in stage 3,4 and 5. They are selected as inpatients of Government Royapettah Hospital during January 2008 to August 2008. This study also included 50 people as control group. 2. Study design: Case control study. Inclusion Criteria : 1. Patients with chronic kidney disease stage 3, 4 and 5 on conservative management or dialysis irrespective of etiology except due to diabetes mellitus. 2. Patients with creatinine clearance less than 60ml/min were included. 3. Patients with bilaterally contracted kidneys on abdomen USG with poor cortico medullary differentiation were included. Exclusion Criteria : Patients with obesity, diabetes mellitus, past history of coronary heart disease , patients with smoking and alcoholism , pregnancy, patients on B-blockers and OCPs were excluded. 50 age and sex matched normal healthy individuals were selected as control. A detailed history and clinical examination were performed in all patients. Height, weight, BP of all patients were recorded. Apart from routine investigations blood urea, creatinine, electrolytes, creatinine clearance by using Cockcroft-Gault equation were measured. RESULTS : One hundred patients took part in this study. Out of hundred patients fifty were known case of CKD and the remaining fifty were control. Of the 50 CKD patients 18 were female and the remaining 32 were male. Their age varied from 28 to 52 yrs. All the 50 patients who took part in the study were found to be hypertensive at the beginning of the study. Their systolic BP varied from 130 to 180 mmHg and diastolic BP varied from 90 to 120 mmHg. Of the 50 patients 34 were known hypertensive on treatment, others were newly detected for the first time on admission. Five patients had previous history of dialysis. Eight patients had arcus senilis and on fundus examination ten patients showed features of hypertensive retinopathy grade 3. Xanthoma was found in two patients. Blood urea levels varied from 47 mg/dl to 160 mg/dl. Creatinine levels varied from 3 mg/dl to 12 mg/dl. 32 patients had bilateral contracted kidneys on ultrasonogram. In 8 patients electro cardiogram showed features of LVH. In 14 patients electro cardiogram showed features of myocardial ischemia. Total cholesterol was above 200 mg/dl in 13(26%) patients. Serum triglycerides were above the upper limit of normal (150 mg/dl) in 39 (78%) patients. HDL was less than 40 mg/dl in 45 (90%) patients. LDL cholesterol was above 130 mg/dl in 14(28%) patients and above 100 mg/dl in 42(84%) patients. Ratio between Total cholesterol and HDL cholesterol was above 6 in 20(40%) patients. Type 4 hyperlipidemia was present in 39 out of 50 patients. CONCLUSION : 1. Most common lipid abnormality in this study is statistically significant reduction of HDL-Cholesterol level in patients with Chronic Kidney Disease stage 3,4 and 5. 2. There is a statistically significant increase in serum triglycerides level in patients with CKD stage 3,4 and 5. 3. There is a statistically significant increase in serum LDL-Cholesterol and Total Cholesterol level in patients with CKD stage 3,4 and 5. 4. There is a negative correlation between serum HDL-Cholesterol and severity of renal failure. 5. There is a positive correlation between the ratio of Total Cholesterol to HDL-Cholesterol and severity of CKD. 6. In Peritoneal Dialysis patients, both Total Cholesterol and LDLCholesterol are within normal limits whereas HDL- Cholesterol is decreased. 7. Systemic hypertension is statistically associated with CKD.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Lipid Profile, Non-diabetic Chronic Kidney Disease, stage 3, 4 and 5. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Thavamani K |
| Date Deposited: | 18 Aug 2017 11:21 |
| Last Modified: | 03 Feb 2018 09:03 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1546 |
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