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Objective:To explore the construction of a Logistic prediction model and countermeasures for type 2 diabetic nephropathy based on clinical data.Methods:The patients with type 2 diabetic nephropathy admitted to Shijiazhuang Second Hospital from September 2019 to September 2021 (study group) were selected and the patients were selected according to a 1∶1 ratio using individual matching (control group), each group with 200 patients. Single and multiple factors analysis were used to analyze the factors influencing type 2 diabetic nephropathy, and Logistic regression equation models were developed to verify their predictive value.Results:Logistic regression equation model showed that the course of type 2 diabetes, glycosylated hemoglobin (HbA 1c), fasting plasma glucose (FPG), homocysteine (Hcy), urinary microalbumin, and serum creatinine (Scr) were high risk factors for type 2 diabetic nephropathy ( P<0.05). The results of Logistic regression model evaluation showed that the model was established with statistical significance, and the coefficients of the regression equations had statistically significant differences. The Hosmer-Lemeshow goodness-of-fit test showed that the model fitting effect was good. Logistic regression model was used to statistically analyzed the data set, and the receiver operating characteristic (ROC) curve of type 2 diabetic nephropathy was drawn, the area under the curve was 0.949(95% CI 0.922 - 0.968), the prediction sensitivity was 81.50%, the specificity was 95.50%, the calibration curve showed that the predicted results was in good agreement with the observed results. Conclusions:The independent predictors of type 2 diabetic nephropathy involve HbA 1c, FPG, Hcy, urinary microalbumin. The Logistic prediction model based on these predictors has reliable predictive value and can help guide clinical diagnosis and treatment.
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Objective:To analyze the law of TCM syndrome differentiation and treatment for type 2 diabetic kidney disease (T2DKD) stage Ⅳ based on literature research.Methods:Literature on type 2 diabetic kidney disease stage Ⅳ was retrieved from CNKI, WanFang data, VIP and SinoMed database. The retrieval time was from the establishment of the databases to December 31, 2020. Data screening was conducted based on the inclusion and exclusion criteria prior to data entry in Microsoft Office Excel 365. Data mining and statistical analysis were performed by SPSS Statistics 23.0 and SPSS Modeler 18.1.Results:A total of 110 articles with 3 969 T2DKD stage Ⅳ cases, 111 prescriptions and 206 kinds of Chinese materia medica were included. Kidney and spleen were the main location of T2DKD stage Ⅳ. T2DKD stage Ⅳ based on TCM deficiency in nature syndrome was mainly based on qi and yin deficiency, and the most common excess in superficiality syndrome was blood stasis. The prescriptions commonly used included Liuwei Dihuang Decoction, Zhenwu Decoction, Buyang Huanwu Decoction, and Shenqi Dihuang Decoction etc. The classification of medication efficacy with the highest frequency was qi-tonifying herb, followed by blood-activating and stasis-resolving herb. Among them, Astragali Radix was the core Chinese materia medica in the prescription. The results of association rule obtained 54 association rules. Conclusions:The disease characteristics of T2DKD stage Ⅳ is simultaneous occurrence of deficiency and excess syndromes. The deficiency in nature is mainly characterized by deficiency of qi and yin, deficiency of spleen and kidney, deficiency of spleen-kidney yang, and excess in superficiality is mainly characterized by blood stasis, dampness and toxin. Tonifying qi and nourishing yin, activating blood circulation and dredging collaterals are the basic treatment methods, while strengthening spleen and kidney, dampness and detoxification should be emphasized. Astragali Radix, Angelicae Sinensis Radix, Salviae Miltiorrhizae Radix et Rhizoma, Poria, Dioscoreae Rhizoma, Corni Fructus, Rhei Radix et Rhizoma and Alismatis Rhizoma were the basic Chinese materia medica in this period, which reflects the idea of "treating qi, blood and water together".
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Objective:To investigate the protective effect and possible mechanism of Tangshenbao on renal damage in diabetic nephropathy (DN) rats.Methods:Totally 36 SPF male SD rats were randomly divided into normal group ( n=6) and model group ( n=30). The DN rat model was prepared by single high-dose intraperitoneal injection of STZ. According to the random number table method, the rats were divided into model group, irbesartan group and Tangshenbao low-, medium- and high-dosage groups, with 6 rats in each group. Drug intervention lasted for 8 weeks. The general condition and body weight of rats in each group were recorded. The blood glucose, kidney index, 24 h urine protein (24 h UTP), SCr and BUN levels were detected. The pathological morphology of renal tissue was observed by PAS staining and transmission electron microscopy. The mRNA and protein expressions of Ets-1, TGF-β1, Smad2 and Smad3 in renal tissue were detected by real-time fluorescence quantitative PCR and Western blot. Results:Compared with model group, the body weight of Tangshenbao low, medium and high dose groups and irbesartan group significantly increased ( P<0.01). The kidney index decreased ( P<0.05 or P<0.01). The contents of 24 hUTP, BUN and SCr significantly decreased ( P<0.05 or P<0.01). Glomerular volume was significantly reduced ( P<0.05 or P<0.01), the mRNA expressions of Ets-1 (1.59 ± 0.06, 1.47 ± 0.04, 1.31 ± 0.03, 1.39 ± 0.03 vs. 1.64 ± 0.04), TGF-β1 (1.65 ± 0.05, 1.59 ± 0.03, 1.38 ± 0.05, 1.49 ± 0.04 vs. 1.77 ± 0.08), Smad2 (1.48 ± 0.05,1.39 ± 0.05, 1.22 ± 0.03, 1.31 ± 0.04 vs. 1.54 ± 0.05), Smad3 (1.57 ± 0.04, 1.48 ± 0.03, 1.28 ± 0.03, 1.39 ± 0.02 vs. 1.64 ± 0.05) in renal tissue of rats significantly decreased ( P<0.05 or P<0.01), the protein expressions of Ets-1 (1.33 ± 0.32, 1.16 ± 0.38, 0.77 ± 0.06, 0.84 ± 0.06 vs. 1.97 ± 0.43), TGF-β1 ( 1.35 ± 0.14, 1.24 ± 0.22, 0.94 ± 0.13, 1.07 ± 0.06 vs. 1.63 ± 0.20), Smad2 (1.24 ± 0.26, 1.14 ± 0.31, 0.77 ± 0.28, 0.85 ± 0.19 vs. 1.72 ± 0.34) and Smad3 (1.29 ± 0.14, 1.19 ± 0.21, 0.85 ± 0.39, 0.90 ± 0.37 vs. 1.76 ± 0.21) decreased ( P<0.05 or P<0.01). Conclusion:Tangshenbao can improve renal damage in DN rats, and its mechanism may be related to the inhibition of Ets-1 expression and TGF-β1/Smads signaling pathway.
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Objective:To explore the changes of disease burden and risk factors of chronic kidney disease (CKD) due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019, and to provide reference data for the prevention and control of diabetic kidney disease (DKD).Methods:The Chinese DKD data were obtained from the 2019 Global Burden of Disease (GBD) database. The morbidity, prevalence, mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life year (DALY) were used to compare the disease burden of CKD due to type 1 and type 2 diabetes mellitus from 1990 to 2019. In addition, the risk factors of DKD were analyzed.Results:The numbers of CKD patients due to type 1 and type 2 diabetes mellitus in China were 574 (95% UI 495-665) and 31 076 (95% UI 28 152-33 909) thousand, and the numbers of new cases were 9 (95% UI 8-11) and 434 (95% UI 390-481) thousand in 2019, respectively. The numbers of death were 13 (95% UI 8-18) and 63 (95% UI 50-77) thousand, respectively. The age groups with the largest number of patients and new cases of CKD due to type 1 diabetes mellitus were 30-34 years old and <5 years old, respectively. The age group with the largest number of patients and new cases of CKD due to type 2 diabetes mellitus were 50-54 years old and 70-74 years old, respectively. From 1990 to 2019, the age-standardized prevalence rate of DKD patients in China was relatively stable, but the age-standardized incidence rate and YLD rate showed an upward trend, while the age-standardized mortality rate, YLL rate, and DALY rate showed a downward trend. The main risk factors associated with DKD death were high fasting plasma glucose, kidney dysfunction, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure. The proportions of DKD death caused by high systolic blood pressure and high body mass index in the Chinese population were still increasing. Conclusions:From 1990 to 2019, the age-standardized incidence and YLD rate of DKD in China shows an upward trend, while the age-standardized prevalence rate is relatively stable, and the age-standardized mortality rate, YLL rate, and DALY rate show a decreasing trend. High fasting glucose, renal failure, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure are risk factors associated with death in DKD patients. With the progress of aging, the disease burden of DKD in China will continuously increase. Future work should be focused on population-specific interventions, taking into consideration the risk factors identified within the study.
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It was a retrospective study. The patients with type 2 diabetes mellitus (T2DM) who underwent renal biopsy in the Department of Nephrology, the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2021 were enrolled to analyze the pathological and clinical manifestations of kidney. There were 483 patients enrolled, including 136 patients who had no history of diabetes mellitus, newly diagnosed as T2DM according to an oral glucose tolerance test. The age was (52.80±13.13) years old. There were 337 males (69.77%). Based on the renal biopsy, the patients were classified as diabetic kidney disease (DKD, 22.15%, 107/483), DKD+non-diabetic kidney disease (NDKD)(6.63%, 32/483), and NDKD (71.22%, 344/483). Membranous nephropathy was the most common pathology in patients with NDKD (40.41%, 139/344) and DKD+NDKD (34.38%, 11/32). In the 136 newly diagnosed T2DM patients, there were 3 patients (2.21%) with DKD, 2 patients (1.47%) with DKD+NDKD, and 131 patients with NDKD (96.32%). The proportions of DKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 10.53% (6/57), 25.00% (16/64), 26.53% (26/98), 41.56% (32/77) and 47.06% (24/51), respectively. The proportions of DKD+NDKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 3.51% (2/57), 3.13% (2/64), 10.20% (10/98), 9.09% (7/77) and 17.65% (9/51), respectively. Multivariate logistic regression analysis results showed that, the duration of diabetes history ( OR=1.130, 95% CI 1.057-1.208, P<0.001), diabetes retinopathy ( OR=12.185, 95% CI 5.331-27.849, P<0.001), urinary red blood cell count ( OR=0.987, 95% CI 0.974-0.999, P=0.039), glycosylated hemoglobin ( OR=1.482, 95% CI 1.119-1.961, P=0.006) as well as hemoglobin ( OR=0.973, 95% CI 0.957-0.990, P=0.001) were independently correlated with DKD. The proportions of DKD and DKD+NDKD increase with the prolongation of diabetes history. Membranous nephropathy is the most common pathology in NDKD and DKD+NDKD patients. Even in patients newly diagnosed with T2DM, it is necessary to screen for DKD. The duration of diabetes history, diabetes retinopathy, urinary red blood cell count, glycosylated hemoglobin and hemoglobin may be used to identify DKD from NDKD.
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A 63-year-old maintenance hemodialysis patient with diabetic nephropathy was reported. The patient was incapacitated, with systemic edema, heart failure, severe anemia, malnutrition, gastrointestinal bleeding, and intractable hypertension. We adopted integrated management methods such as "multidisciplinary collaboration" and "doctor-patient collaboration": by accurately controlling the volume load to protect the residual renal function, taking into account the treatment of underlying diseases and complications, integrating the clinical parameters of dialysis and the interdialysis period, and combining the subjective clinical symptom score with the objective index analysis, the objectives of effectively controlling the dry weight of patients, alleviating complications, improving nutrition and protecting the residual renal function were finally achieved. The quality of life of the patient had been significantly improved.
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Objective:To investigate the correlation between Piwi-interacting RNA (piRNA) and diabetic nephropathy (DN).Methods:The differential expression profiles of piRNAs in renal tissues of patients with DN (experimental group) and renal tissues adjacent to tumors of patients with renal tumors (control group) were detected by high-throughput sequencing. The biological function of differentially expressed piRNAs was described by gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis. Real-time fluorescence quantitative PCR was used to detect the serum expression level of target piRNAs in patients with DN. Spearman correlation analysis was used to analyze the correlation between serum target piRNAs and clinical indexes of patients with DN.Results:The results of high throughput sequencing showed that there were 127 differentially expressed piRNAs between DN group and control group, with screening condition of |log 2(fold changes)|≥2 and P<0.05. Among them, there were 99 up-regulated piRNAs and 28 down-regulated piRNAs. The top 5 up-regulated piRNAs were piRNA-hsa-161686, piRNA-hsa-349255, piRNA-hsa-355720, piRNA-hsa-151229 and piRNA-hsa-154959, respectively. The top 5 down-regulated piRNAs were piRNA-hsa-1929960, piRNA-hsa-174194, piRNA-hsa- 148658, piRNA-hsa-172594 and piRNA-hsa-172421, respectively. The PCR verification results of 3 up-regulated genes and 3 down-regulated genes with low P values and high expression levels showed that serum expression level of piRNA-hsa-77976 was significantly down-regulated in patients with DN ( P=0.028), which was consistent with that of sequencing, while the expression levels of other genes were inconsistent with the sequencing results or had no statistical significance. Bioinformatics analysis results predicted that significantly differentially expressed piRNAs might participate in the regulation of DN through Rap1, Ras, PI3K-Akt and axon guiding pathways. The results of correlation analysis showed that the expression level of piRNA-hsa-77976 was negatively correlated with blood urea nitrogen ( r=-0.584, P=0.028), serum creatinine ( r=-0.637, P=0.014), cystatin C ( r=-0.738, P=0.003) and β2 microglobulin ( r=-0.822, P<0.001), and positively correlated with estimated glomerular filtration rate ( r=0.661, P=0.010). Conclusion:The differential expression of piRNA is closely related to DN, and may be used as a new biomarker for the diagnosis and prognosis of DN.
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Objective:To investigate the risk factors of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients in plain-sand areas and loess hilly areas of Gansu province.Methods:A total of 1 599 T2DM patients who participated in chronic disease and risk factors monitoring and basic public health service management were selected by multi-stage stratified random sampling method in the sandy plain areas and loess hilly areas of Gansu province. Questionnaire survey, physical measurement and laboratory tests were performed. Multivariate binary logistic model was used to analyze the influencing factors.Results:The prevalence of DKD was 22.1% (174/787) among T2DM patients in the sandy plain areas and 19.1%(155/812) in the loess hilly area, respectively. Hypertension ( OR=3.022), hyperuricemia ( OR=2.114) and HbA1c≥7%( OR=2.231) were the risk factors for DKD in the plain-sand areas, and the risk of DKD increased with age. In the loess hilly areas, female sex ( OR=0.379) was the protective factor for DKD; while duration of disease≥10 years ( OR=2.476), hyperuricemia ( OR=1.907), HbA1c≥7% ( OR=1.927) were the risk factors for DKD; and the risk of DKD increased with the increase of age, and decreased with the increase of per capita monthly income. Conclusions:The prevalence of DKD and its influencing factors are different between sandy plain areas and loess hilly areas in Gansu province. The prevention and treatment of hypertension should be given more attention in sandy plain areas. In addition, the screening of DKD should be conducted among T2DM patients, particularly for those with old age, hyperuricemia and HbA1c≥7% in both areas of the province.
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Objective:To investigate the risk factors of diabetic nephropathy (DN) in primary type 2 diabetes mellitus (T2DM) patients and to quantitatively analyze the risk of DN by nomogram modeling.Methods:A total of 1 588 primary T2DM patients from 17 townships and streets in Zhejiang Province were enrolled from June 2018 to August 2018 in this cross-sectional study, with an average age of (56.8±10.1) years (50.06% male) and a mean disease duration of 9 years. The clinical data, biochemical test results, and fundus photographs of all T2DM patients were collected, and logistic regression analysis was used to screen the risk factors of DN. Then, a nomogram model was used to quantitatively analyze the risk of DN.Results:DN occurred in 27.71% (440/1 588 cases) primary type 2 diabetes patients. Hemoglobin A 1c (HbA 1c) ( OR=1.159, 95% CI 1.039-1.292), systolic blood pressure ( OR=1.041, 95% CI 1.031-1.051), serum creatinine (Scr) ( OR=1.011, 95% CI 1.004-1.017), serum globulin (GLOB) ( OR=1.072, 95% CI 1.039-1.105), diabetic retinopathy (DR) ( OR=1.463, 95% CI 1.073-1.996), education level of more than junior high school ( OR=2.018, 95% CI 1.466-2.777), and moderate-intensity exercise ( OR=0.751, 95% CI 0.586-0.961) were influencing factors of DN. Nomogram model analysis showed that the total score of each factor of DN ranged from 64-138 points, and the corresponding risk rate ranged from 0.1-0.9. The nomogram model also predicted a C-index value of 0.753 (95% CI 0.726-0.781) and an area under the receiver operating characteristic curve of DN of 0.753. Internal verification of the C-index reached 0.738. The model displayed medium predictive power and could be applied in clinical practice. Conclusions:HbA 1c, systolic blood pressure, Scr, GLOB, DR, and more than a junior high school education are independent risk factors of DN. Nomogram modeling can more intuitively evaluate the risk of DN in primary T2DM patients.
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Objective:To investigate the correlation between serum remnant cholesterol(RC)and diabetic kidney disease(DKD)in elderly patients with type 2 diabetes mellitus(T2DM).Methods:The elderly patients with T2DM who were hospitalized in the Department of Geriatrics of the Second Xiangya Hospital of Central South University from January 2021 to March 2022 were selected and divided into simple diabetes group(410 cases)and DKD group(433 cases). The general clinical data and laboratory data were collected and the RC level was calculated.Spearman rank correlation was used to analyze the correlation between RC level and metabolic indicators.Logistic regression was used to analyze the correlation between serum RC level and the risk of DKD.Results:Compared with the simple diabetes group, patients in the DKD group had older age, longer duration of diabetes, higher levels of systolic blood pressure(SBP), fasting C-peptide, triglyceride(TG), uric acid(UA), serum creatinine, urinary albumin/creatinine ratio(UACR)and RC, and lower levels of albumin, high-density lipoprotein cholesterol(HDL-C)and estimated glomerular filtration rate(eGFR)( P<0.05 for all). Spearman rank correlation analysis showed that serum RC level was positively correlated with body mass index(BMI)( r=0.069, P=0.046), fasting blood glucose( r=0.099, P=0.004), glycosylated hemoglobin(HbA1c)( r=0.075, P=0.031), fasting C-peptide( r=0.177, P<0.001), TG( r=0.632, P<0.001), total cholesterol(TC)( r=0.306, P<0.001), low density lipoprotein cholesterol(LDL-C)( r=0.243, P<0.001), UA( r=0.128, P<0.001), serum creatinine( r=0.086, P=0.013)and UACR( r=0.147, P<0.001), and was negatively correlated with HDL-C( r=-0.271, P<0.001)and eGFR( r=-0.148, P<0.001). Logistic regression analysis showed that high serum RC level was a risk factor for DKD(Q1 as reference; Q2: OR=2.439, 95% CI: 0.836-7.113, P=0.103; Q3: OR=3.999, 95% CI: 1.187-13.478, P=0.025). Conclusions:High serum RC level is closely related to DKD in elderly patients with T2DM, and is a risk factor for DKD.
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Objective:To investigate and analyze the risk factors of pulmonary infection in hemodialysis patients with diabetes nephropathy (DN), and explore the effect of different antibiotic application methods on the efficacy of DN patients with pulmonary infection.Methods:337 inpatients with DN who were admitted to Lishui Central Hospital from August 2021 to April 2022 were selected as the study subjects, and the proportion of pathogenic bacteria in patients with pulmonary infection caused by hemodialysis was analyzed, and the influencing factors of pulmonary infection were analyzed by single factor and multiple factor logistic regression models. DN patients with pulmonary infection were treated with single or multiple antibiotics, and their curative effects were analyzed and compared.Results:Among 337 hospitalized patients with DN in this study, the rate of pulmonary infection caused by hemodialysis was 24.04%(81/337). 87 strains of pathogenic bacteria were cultivated, and the main pathogens of the infected individuals were Klebsiella pneumoniae (36.78%, 32/87), Staphylococcus aureus (17.24%, 15/87), and Acinetobacter baumannii (16.09%, 14/87). The results of univariate analysis showed that patient age, dialysis time, hospital stay, hemoglobin, postprandial blood glucose, malnutrition (blood albumin level<35 g/L), renal function, and volume load were the influencing factors for pulmonary infection in DN patients undergoing hemodialysis (all P<0.05). Multivariate logistic regression model analysis showed that dialysis time, hemoglobin, postprandial, blood glucose malnutrition, renal function, and volume load were risk factors for pulmonary infection caused by hemodialysis (all P<0.05). After treatment, the levels of white blood cells, neutrophils, and hypersensitive reactive protein in patients with pulmonary infection were significantly reduced compared to before treatment (all P<0.05). The effective rate of multi antibiotic therapy (97.44%, 38/39) was higher than that of single antibiotic therapy (80.95%, 34/42) (χ 2=5.563, P=0.018). Conclusions:There are many independent risk factors for pulmonary infection during hemodialysis in DN patients. The infection rate should be reduced through adequate dialysis, blood glucose control, nutrition supplementation, anemia correction and other measures, and the infected can be treated timely with antibiotics according to the situation.
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Abstract Introduction: Screening patients with diabetes mellitus (DM) for chronic kidney disease (CKD) enables early diagnosis and helps to establish adequate treatment and avoid possible damages to health associated with disease progression. This study aimed to verify whether screening for CKD has been properly conducted in populations with diabetes mellitus seen at primary care clinics. Methods: This descriptive study included 265 individuals with DM seen at Basic Healthcare Clinics in Divinópolis, MG, Brazil. Clinical and laboratory data were collected from the Integrated Health System. Frequency of testing and kidney function evaluations performed within the last 12 months were calculated along with the proportion of patients with increased urinary albumin excretion (UAE) and decreased glomerular filtration rate (GFR) to determine the proportion of patient with kidney involvement. Results: We found that 41.2% of the patients had kidney involvement and that 61.2% of the individuals with kidney involvement were on nephroprotective medication. Of the 21.9% tested for isolated albuminuria, 46.5% had increased UAE. The albumin-to-creatinine ratio (ACR) was measured in 12.1% of the patients, with 43.8% having an increased ACR. We found that 89.0% of the patients had their serum creatinine levels measured, and that 33.1% had a decreased GFR. Conclusion: CKD screening was more frequently performed via the GFR than UAE, a parameter analyzed only in a small proportion of patients. Therefore, CKD screening for patients with diabetes is not being performed properly in primary care.
Resumo Introdução: O rastreio da doença renal crônica (DRC) em pacientes com diabetes (DM) possibilita o diagnóstico precoce e ajuda a estabelecer um tratamento adequado, evitando possíveis danos à saúde pela progressão da doença. O objetivo deste trabalho foi verificar se o rastreio da DRC está sendo feito de maneira adequada entre diabéticos acompanhados na atenção primária à saúde. Métodos: Estudo descritivo com 265 pacientes com DM atendidos nas Unidades Básicas de Saúde de Divinópolis, MG. A coleta de dados clínicos e laboratoriais foi realizada por meio de consulta ao Sistema Integrado de Saúde. Foram calculadas a frequência de realização dos exames de avaliação da função renal nos últimos 12 meses e a frequência de pacientes com excreção urinária de albumina (EUA) aumentada e a taxa de filtração glomerular (TFG) reduzida, e assim determinada a frequência de pacientes com comprometimento renal. Resultados: Foi observado que 41,2% dos pacientes têm comprometimento renal; dentre esses, 61,2% utilizam algum medicamento nefroprotetor. Apenas 21,9% realizaram o exame de albuminúria isolada, dos quais 46,5% apresentaram albuminúria aumentada. O exame de relação albumina/creatinina (RAC) foi realizado por 12,1% dos pacientes, dos quais 43,8% apresentaram RAC aumentada. Foi observado que 89,0% dos pacientes realizaram o exame de creatinina sérica, dos quais 33,1% apresentaram TFG reduzida. Conclusão: Foi observado maior índice de rastreio da DRC por meio da TFG em relação ao rastreio por meio da EUA, o qual foi realizado por pequeno número de pacientes. Portanto, o rastreio da DRC não está sendo realizado adequadamente na atenção básica ao diabético.
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Abstract Objective: to describe the clinical and histopathological characteristics of diabetic patients with nephrotic-range proteinuria. Materials and methods: the kidney biopsies of diabetic patients with nephrotic proteinuria were reviewed. Descriptive analyses were performed along with a comparison of three groups according to the histopathological findings. Results: the medical charts of 19 patients from 2018 through 2020 were collected, most of whom (94.7%) were diagnosed with type 2 diabetes mellitus (DM), with an average age of 58 years, and an average duration of DM of 9.9 years (SD: ±7.3). The findings from biopsies performed throughout the years prior to data collection showed that 26.3% had diabetic nephropathy as the only finding, 31.6% had a nephropathy other than diabetic nephropathy, and 42.1% had findings of both diabetic and nondiabetic nephropathy. A comparison of the groups showed a significant difference in the duration of DM, which was greater in patients with diabetic nephropathy (16.4 vs. 5 vs. 9.5 years, respectively, p: 0.024). Conclusions: we present a case series of diabetic patients with nephrotic-range proteinuria in Colombia, showing that kidney biopsy lesions other than diabetic nephropathy may be a cause of proteinuria. We found that patients with a report of DN alone had a much longer duration of diabetes. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2231).
Resumen Objetivo: describir las características clínicas e histopatológicas de pacientes diabéticos con proteinuria en rango nefrótico. Material y métodos: se revisaron biopsias renales de pacientes diabéticos con proteinuria ne frótica, se realizaron análisis descriptivos y comparación entre tres grupos de acuerdo con hallazgos histopatológicos. Resultados: se recolectaron historias de 19 pacientes, entre los años 2018 y 2020, la mayoría (94.7%) con diagnóstico de diabetes mellitus (DM) tipo 2, edad promedio de 58 años, con un tiempo de evolución de la DM en promedio de 9.9 años (DE: ±7.3). En los hallazgos de la biopsia, practica das a lo largo de años anteriores a la recolección, se encontró que 26.3% tenían nefropatía diabética como único hallazgo, el 31.6% otra nefropatía diferente a la diabética y 42.1% hallazgos tanto de nefropatía diabética como no diabética. Al comparar los grupos se encontró diferencia significativa en el tiempo de evolución de la DM, siendo mayor en pacientes con nefropatía diabética (16.4 vs 5 vs 9.5 años respectivamente, p: 0.024). Conclusiones: se presenta una serie de casos de pacientes diabéticos con proteinuria en rango nefrótico en Colombia, mostrando que existen lesiones diferentes a la nefropatía diabética en la biopsia renal como posible causa de la proteinuria. Se encontró que los pacientes en quienes se reportó ND únicamente, tenían un tiempo de evolución de la diabetes mucho mayor. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2231).
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RESUMEN Introducción: la diabetes mellitus es considerada un grave problema en Salud Pública porque genera un gran impacto en la demanda de servicios médicos. Además, es incapacitante, causal de ausentismo laboral, disminuye la calidad de vida y, finalmente, causa una alta tasa de mortalidad por sus complicaciones. Objetivos: determinar la frecuencia de complicaciones crónicas en pacientes con diabetes mellitus tipo 2. Métodos: diseño de tipo observacional, descriptivo, de corte trasversal, en pacientes adultos de ambos sexos con diabetes mellitus tipo 2, internados en el Hospital Nacional de Itauguá en periodo 2020-2021. El estudio se basa en la recopilación de datos de las fichas clínicas. Resultados: se evaluaron 106 pacientes, con una edad promedio de 59 ± 13 años, el 60% corresponde al sexo masculino, 80% procede de la zona urbana y solo el 3% tiene nivel educativo universitario. El 82% se conocía portador de diabetes mellitus, de los cuales solo el 87% recibía algún tratamiento, siendo irregular el mismo en el 58% de ellos. El 75% de los casos está asociado a otras comorbilidades como hipertensión arterial y obesidad. En cuanto al control laboratorial, la mayoría tenía mal control glicémico al ingreso, solo el 19% tenía hemoglobina glicada menor a 7%, 15% tenía hipercolesterolemia y 50% hipertrigliceridemia. En cuanto a las complicaciones crónicas, se encontraron presentes en el 96% de los pacientes. Conclusión: existe una alta frecuencia de complicaciones crónicas en los diabéticos tipo 2, predominando la retinopatía, seguida de la nefropatía y las cardiopatías estructurales.
ABSTRACT Introduction: diabetes mellitus is considered a serious problem in public health because it generates a great impact on the demand for medical services. In addition, it is disabling, causes work absenteeism, decreases quality of life and, finally, causes a high mortality rate due to its complications. Objectives: To determine the frequency of chronic complications in patients with type 2 diabetes mellitus. Methods: Observational, descriptive, cross-sectional study carried out in adult male and female patients with type 2 diabetes mellitus, admitted to the Hospital Nacional of Itauguá in the 2020-2021 period. The study was based on the collection of data from clinical records. Results: One hundred and six patients were evaluated, with an mean age of 59±13 years, 60% were male, 80% came from urban areas and only 3% had a university education level. Eighty two percent were known carriers of diabetes mellitus, of which only 87% received some treatment, being irregular in 58% of them. Seventy five percent of the cases were associated with other comorbidities such as high blood pressure and obesity. Regarding laboratory control, most had poor glycemic control at admission, only 19% had glycated hemoglobin less than 7%, 15% had hypercholesterolemia, and 50% hypertriglyceridemia. Regarding chronic complications, they were present in 96% of the patients. Conclusion: There is a high frequency of chronic complications in type 2 diabetics, predominantly retinopathy, followed by nephropathy and structural heart disease.
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Objective:To explore and analyze the correlation between miR-31 in peripheral blood and oxidative stress indicators of diabetic nephropathy.Methods:A total of 94 patients with diabetic nephropathy who were admitted to Affiliated Hospital of Jining Medical College from September 2019 to September 2020 were selected. Patients were divided into mild diabetic nephropathy [estimated glomerular filtration rate (eGFR) 60-90 ml/min, 36 cases] group, moderate diabetic nephropathy (eGFR 30-60 ml/min, 27 cases) group and severe diabetic nephropathy (eGFR 0-30 ml/min, 31 cases) group according to the severity of the disease, and 30 healthy people in the same period were selected as the control group. Real time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-31 in peripheral blood. Serum superoxide dismutase (SOD), malondialdehyde (MDA), advanced oxidation protein products (AOPP) and other oxidative stress indicators, as well as serum urea nitrogen, creatinine and glomerular filtration rate. Pearson was used to analyze the correlation between peripheral blood miR-31 and oxidative stress indexes and renal function.Results:The expression of miR-31 in peripheral blood of patients with diabetic nephropathy was significantly lower than that in the control group, and the expression of miR-31 in peripheral blood of patients in severe and moderate diabetic nephropathy group was significantly lower than that in the mild diabetic nephropathy group (all P<0.05), with statistically significant difference (all P<0.05). Pearson correlation analysis showed that serum miR-31 expression was negatively correlated with the severity of diabetic nephropathy ( r=-0.526, P<0.05). The levels of serum MDA, SOD and AOPP in the diabetic nephropathy group were significantly higher than those in the control group, and the levels of serum MDA, SOD and AOPP in the severe and moderate diabetic nephropathy groups were higher than those in the mild diabetic nephropathy group, with statistically significant difference (all P<0.05). The levels of serum creatinine and blood urea nitrogen in the diabetic nephropathy group were higher than those in the control group, and the glomerular filtration rate was lower than that in the control group (all P<0.05). The levels of serum creatinine and blood urea nitrogen in the severe and moderate diabetic nephropathy group were higher than those in the mild diabetic nephropathy group, while the level of glomerular filtration rate was lower than that in the mild diabetic nephropathy group, with statistically significant difference (all P<0.05). Pearson correlation analysis showed that the expression of miR-31 in peripheral blood was negatively correlated with the levels of MDA, SOD, AOPP, serum creatinine and urea nitrogen (all P<0.05), but positively correlated with glomerular filtration rate ( P<0.05). Conclusions:The expression of miR-31 in peripheral blood gradually decreases with the severity of renal damage. Its level is negatively correlated with oxidative stress indicators of diabetic nephropathy, and positively correlated with glomerular filtration rate, which can be used for for clinical treatment and disease evaluation.
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Objective:To explore the correlation between the level of serum free light chain and renal function indexes in patients with diabetic kidney disease (DKD).Methods:The clinical data of 120 patients with DKD (study group) and 80 patients with simple diabetes (diabetes group) in the Beijing Sixth Hospital from October 2017 to October 2020 were retrospectively analyzed. Five ml of fasting peripheral venous blood were collected, the levels of serum uric acid, creatinine, homocysteine (Hcy) and free light chain (including free light chain κ, free light chain λ, ratio of free light chain κ and free light chain λ and total free light chain) were detected, and the estimated glomerular filtration rate (eGFR) was calculated. The correlation between total free light chain and renal function indexes in patients with DKD was analysis by Pearson method.Results:The free light chain κ, free light chain λ, ratio of free light chain κ and free light chain λ, total free light chain, uric acid, creatinine and Hcy in DKD group were significantly higher than those in diabetes group: (33.92 ± 9.06) mg/L vs. (17.65 ± 4.72) mg/L, (17.52 ± 2.83) mg/L vs. (9.81 ± 3.20) mg/L, 1.93 ± 0.23 vs. 1.80 ± 0.25, (51.44 ± 12.31) mg/L vs. (27.46 ± 7.92) mg/L, (383.69 ± 96.11) μmol/L vs. (345.93 ± 93.94) μmol/L, (117.57 ± 22.39) μmol/L vs. (75.06 ± 14.73) μmol/L and (17.64 ± 5.76) μmol/L vs. (11.66 ± 5.46) μmol/L, the eGFR was significantly lower than that in diabetes group: (103.95 ± 22.58) ml/(min·1.73 m 2) vs. (142.65 ± 26.50) ml/(min·1.73 m 2), and there were statistical differences ( P<0.01). Pearson correlation analysis results showed that serum total free light chain in patients with DKD was positively correlated with uric acid, creatinine and Hcy ( r = 0.707, 0.709 and 0.820; P<0.01), and negatively correlated with eGFR ( r = -0.730, P<0.01). Conclusions:The expression level of serum free light chain is obviously increased in patients with DKD, it has a certain correlation with renal function indexes. It can be used as one of the evaluation indicators for disease monitoring.
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Objective:To investigate the risk factors of hyperuricemia (HUA) in non-dialysis diabetic nephropathy (DN) patients, and to observe the protective effect of febuxostat on kidney.Methods:The clinical data of 317 DN patients without dialysis in Affiliated Hospital of Hebei University from January 2018 to February 2021 were analyzed retrospectively. Among them, HUA occurred in 148 cases (HUA group), the incidence of HUA was 46.69%, and no HUA occurred in 169 cases (non-HUA group). In HUA group, 74 patients were treated with febuxostat (observation subgroup), and 74 patients with allopurinol (control subgroup). Multivariate Logistic regression analysis was used to analyze the independent risk factors of HUA in patients with DN; a nomogram model for predicting the occurrence of HUA in patients with DN was established by R 4.0.2 software, the predictive ability of the nomogram model was evaluated by receiver operating characteristic (ROC) curve, and the calibration and validity of the prediction model were verified by correction curve and deviation correction C-index.Results:There were no significant difference in gender composition and the incidence of diabetic retinopathy, diabetic peripheral neuropathy, diabetic foot between the two groups ( P>0.05); the age, body mass index (BMI), DN course>3 years rate, smoking rate, drinking rate, family history of diabetes rate, seafood consumption more than 2 times a week rate, and the incidences of hypertension, hyperlipidemia, coronary heart disease, nephrolithiasis, stroke in HUA group were significantly higher than those in non-HUA group: (57.96 ± 5.25) years old vs. (56.14 ± 4.71) years old, (24.18 ± 3.95) kg/m 2 vs. (23.06 ± 3.12) kg/m 2, 78.38% (116/148) vs. 30.77% (52/169), 84.46% (125/148) vs. 28.99% (49/169), 93.92% (139/148) vs. 40.24% (68/169), 62.84% (93/148) vs. 50.30% (85/169), 46.62% (69/148) vs. 15.38% (26/169), 41.89% (62/148) vs. 20.71% (35/169), 73.65% (109/148) vs. 45.56% (77/169), 39.86% (59/148) vs. 18.34% (31/169), 45.95% (68/148) vs. 26.04% (44/169) and 50.68% (75/148) vs. 8.28% (14/169), and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that age, BMI, course of DN, smoking, drinking, hypertension, hyperlipidemia, coronary heart disease, nephrolithiasis, stroke and weekly seafood consumption were independent risk factors for HUA in patients with DN ( OR = 1.053, 1.062, 3.192, 3.638, 5.397, 1.371, 1.690, 1.404, 1.392, 2.295 and 2.581; 95% CI 1.028 to 1.078, 1.031 to 1.093, 2.517 to 3.867, 2.754 to 4.522, 4.169 to 6.625, 1.253 to 1.489, 1.482 to 1.898, 1.237 to 1.571, 1.284 to 1.501, 1.730 to 2.860 and 1.862 to 3.300; P<0.01), but the family history of diabetes was not related to the occurrence of HUA in DN patients ( P>0.05). A nomogram model was established based on age, BMI, course of DN, smoking, drinking, hypertension, hyperlipidemia, coronary heart disease, nephrolithiasis, stroke and weekly seafood consumption as predictors of HUA in patients with DN; the results of correction curve analysis show that the actual curve was consistent with the ideal curve, and the prediction of HUA in patients with DN by the nomogram model was consistent with the actual situation (C-index was 0.931, 95% CI 0.895 to 0.967). The results of ROC curve analysis show that the nomogram model had a strong ability to predict the occurrence of HUA in patients with DN (the area under the curve was 0.855, 95% CI 0.842 to 0.868). The total effective rate in observation subgroup was significantly higher than that in control subgroup: 93.24% (69/74) vs. 70.27% (52/74), the levels of uric acid, creatinine and urea nitrogen after treatment were significantly lower than those in control subgroup: (314 ± 65) μmol/L vs. (392 ± 75) μmol/L, (227 ± 46) μmol/L vs. (271 ± 53) μmol/L and (13.52 ± 2.47) mmol/L vs. (16.80 ± 3.05) mmol/L, and there were statistical differences ( P<0.01). Conclusions:The age, BMI, course of DN, smoking, drinking, hypertension, hyperlipidemia, coronary heart disease, nephrolithiasis, stroke and weekly seafood consumption are independent risk factors for HUA in patients with DN. Febuxostat can effectively protect the renal function of patients with DN complicated with HUA.
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Objective:To investigate the effect of Yiqi Dihuang Decoction assisting conventional western medicine therapy in the treatment of early diabetic nephropathy (DN) with deficiency of qi and yin.Methods:A total of 117 patients with early DN who met the inclusion criteria from June 2018 to December 2020 in Beijing Hospital of Traditional Chinese Medicine Shunyi Branch were divided into a control group of 58 patients and a treatment group of 59 patients according to the random number table method. The control group was treated with conventional western medicine therapy, and the treatment group was additionally treated with Yiqi Dihuang Decoction on the basis of the control group. Both groups were treated for 1 month. Serum levels of IL-1, macrophage scavenger receptor A (SR-A), TNF-α, C-C motif chemokine 2 (CCL2), GSH-Px and SOD were detected by ELISA before and after treatment. Cystatin C (Cys C) and SCr levels were detected by automatic biochemical analyzer. The urinary albumin was determined by radioimmunoassay, urinary creatinine determined by rate method, and urinary albumin/creatinine ratio (UACR) and glomerular filtration rate (eGFR) were calculated. The adverse events during treatment and clinical efficacy were evaluated.Results:The total effective rate was 94.92% (56/59) in the treatment group and 81.03% (47/58) in the control group, and the difference between the two groups was statistically significant ( χ2=5.35, P=0.021). After treatment, UACR [(92.28±15.42) mg/g vs. (108.42±20.76)mg/g, t=4.78], eGFR [(91.42±13.18) m·min -1·1.73m -2vs. (95.30±15.94) m·min -1·1.73m -2, t=2.02], SCr [(65.30±9.54) μmol/L vs. (70.18±12.53) μmol/L, t=5.42], Cys C [(0.65±0.12)mg/L vs. (1.07±0.26)mg/L, t=11.25] in the treatment group were significantly lower than those in the control group ( P<0.05). Serum SR-A [(37.18±6.10) μg/L vs. (51.51±7.12) μg/L, t=11.70], CCL2 [(13.12±1.63) μg/L vs. (19.68±2.90) μg/L, t=15.12], TNF-α [(20.57±3.50) ng/L vs. (29.68±4.17) ng/L, t=12.81], IL-1 [(8.47±0.97) ng/L vs. (13.12±1.57) ng/L, t=19.31] levels in the treatment group were significantly lower than those in the control group ( P<0.01); serum SOD [(24.09±3.12) mg/L vs. (18.72±2.76) mg/L, t=9.85] activity and GSH-Px [(231.57±25.38) mg/L vs. (174.58±22.96) mg/L, t=12.73] in the treatment group were significantly higher than those in the control group ( P<0.01). During the treatment period, the incidence of adverse events was 10.34% (6/58) in the control group and 6.78% (4/59) in the treatment group, and there was no significant difference between the two groups ( χ2=0.48, P=0.490). Conclusion:Yiqi Dihuang Decoction assisted with conventional western medicine can effectively improve the renal function of patients with early DN syndrome of qi and yin deficiency, inhibit the body's inflammatory response and oxidative stress response, and improve clinical efficacy.
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Objective:To investigate the diagnostic value of triglyceride/cystatin C (TG/Cys-C) ratio combined with diabetic retinopathy, diabetes course and systolic pressure in patients with diabetic kidney disease (DKD).Methods:Patients with type 2 diabetes and renal insufficiency, who underwent renal biopsy in four Grade A tertiary hospitals in Xuzhou from January 2013 to February 2021 were included in this retrospective study. Patients were divided into DKD group ( n=51) and non-DKD (NDKD) group ( n=49) based on renal biopsy results. Another 50 patients with type 2 diabetes mellitus without renal dysfunction were selected as control group. The first admission information and blood biochemical indexes were collected, and the TG/Cys-C ratio was calculated. The differences of clinical indexes between the DKD and NDKD groups were compared. The correlative factors of DKD in type 2 diabetes patients with renal dysfunction were analyzed by logistic regression. The ROC curve was used to evaluate the diagnostic value of TG/Cys-C ratio, diabetic retinopathy, duration of diabetes, systolic blood pressure and combined detection for DKD in patients with type 2 diabetes and renal dysfunction. Results:Among patients with type 2 diabetes with renal dysfunction, renal biopsy results showed that membranous nephropathy was the most common pathological type in NDKD group, accounting for 63.3% (31/49) of all NDKD patients. Compared with Type 2 diabetes mellitus without renal injury, type 2 diabetic patients with kidney injury had higher systolic blood pressure, higher total cholesterol, higher low-density lipoprotein, higher cystatin, higher creatinine, higher uric acid, higher fibrinogen level, more hypertension, more changes of urinary active sediment, lower hemoglobin, lower albumin, and the lower the glomerular filtration rate (all P<0.05). Compared with NDKD group, patients in DKD group had higher systolic and diastolic blood pressure, higher cystatin C and creatinine, more hypertension, more diabetic retinopathy, longer course of diabetes, lower concentration of hemoglobin, lower glomerular filtration rate, lower triglyceride and lower TG/Cys-C ratio (all P<0.05). Multivariate logistic regression analysis showed that TG/Cys-C ratio was associated with DKD in patients with type 2 diabetes mellitus and renal impairment ( OR=0.298, P=0.007), diabetic retinopathy ( OR=12.209, P=0.005), duration of diabetes ( OR=1.016, P=0.034) and systolic blood pressure ( OR=1.049, P=0.006) were independent risk factors for DKD in type 2 diabetic patients with renal dysfunction. The ROC curve showed that AUC of the TG/Cys-C ratio was 0.866 (the cot-off point was 2.06), and the sensitivity was 88.2% and the specificity was 71.4% for the diagnosis of DKD, and AUC of the TG/Cys-C ratio in combination with diabetic retinopathy, diabetes duration and systolic blood pressure was 0.952, and the sensitivity was 92.2% and the specificity was 89.8% for the diagnosis of DKD. Conclusion:TG/Cys-C ratio has significant clinical value in the diagnosis of DKD. Combined detection of TG/Cys-C ratio with diabetic retinopathy, course of diabetes and systolic blood pressure could further improve the diagnostic efficacy of DKD.
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Objective:To observe and analyze the correlation between macular microvascular parameters and urinary albumin to creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study. From October 2017 to April 2018, 100 eyes of 100 patients (T2DM) and 27 eyes of 27 healthy controls (the control group) were enrolled in Xuzhou First People’s Hospital. All subjects underwent anterior segment examination via slit-lamp biomicroscopy, dilated fundus examination, 7-field fundus photographs, OCT angiography (OCTA), the fasting glucose test, glycosylated hemoglobin (HbA1c), urinary albumin, urinary creatinine and UACR levels determination. Height and weight measurement were taken for calculating body mass index (BMI). Diabetic retinopathy was ruled out by fundoscopic examinations and 7-field fundus photographs in T2DM patients. According to the UACR, patients in the T2DM group were subdivided into A1 group (UACR< 30 mg/g), A2 group (UACR 30-300 mg/g), and A3 group (UACR>300 mg/g), with 38 cases and 38 eyes respectively , 40 cases with 40 eyes, 22 cases with 22 eyes. A 6 mm×6 mm scanning area centered on the macular fovea were scanned for right eye using a frequency domain OCTA instrument, which were divided into three concentric circles centered on the macular fovea by the software automatically. The foveal zone was defined as a circular area measuring 1 mm in diameter, the parafoveal zone was described as a middle circle area measuring 1-3 mm in diameter, and the perifoveal zone was an outer circle area measuring 3-6 mm in diameter. The vessel density of superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular area (FAZ) and perimeter (PERIM), non-circularity index (AI) were measured. The correlation between the macular vessel density, FAZ and UACR was analyzed by Spearman correlation analysis.Results:A1 group, A2 group, A3 group, and normal control group. The macular area SCP and DCP ( F=13.722, 5.644), foveal area ( F=4.607, 4.719), parafoveal area ( H=23.142, F=2.904), the blood flow density of the area around the fovea ( F=12.292, H=10.946), the difference was statistically significant ( P<0.05); with the increase of UACR, the blood flow density of each area of SCP and DCP showed a downward trend. The results of correlation analysis showed that the blood flow density of the whole SCP, parafoveal area, and surrounding area of T2DM patients was negatively correlated with UACR ( r=-0.376, -0.240, -0.364,-0.347, P<0.05). There were no correlation among fasting plasma glucose, HbAlc and UACR ( r=0.179, 0.085, P>0.05). There were no correlation among blood flow density in BMI, SCP foveal area, DCP and UACR (| r|<0.3, P>0.05). Conclusion:The whole, parafovea and perifovea vessel density values of SCP in T2DM eyes without DR are negatively correlated with UACR.