MICROVASCULAR AND MACROVASCULAR DISEASES IN DIABETIC NEPHROPATHY

Introduction: Diabetes mellitus (DM) can be described as a metabolic disorder which is characterized by hyperglycemia which develops as a consequence of defects in insulin secretion or its action, or both. Diabetes is strongly associated with microvascular and macrovascular diseases and its complications, which includes nephropathy, retinopathy, microvascular neuropathy and ischemic heart disease, peripheral vascular disease, and macrovascular cerebrovascular disease which results in organ and tissue damage in about one third to one half of people with diabetes. The early manifestation of DN is microalbuminuria, which eventually progresses to overt albuminuria that is increased albumin levels in the urine, which indicates more severe renal dysfunction, and ultimately leading to renal failure. Material and Methods: Patients were screened and clinically diagnosed accor­ding to World Health Organization (WHO) criteria. Demographic characteristics of the patients were taken, height and weight were recorded, and body mass index (BMI) was calculated in metrics units. Blood investigations were carried out like blood glucose, HbA1C, cholesterol, Triglycerides (TG), serum creatinine, creatinine clearance, and24-hour uri­nary protein were investigated for each patient. Glomerular filtration rate (GFR) was calcu­lated. Rate of change of GFR was calculated. Duration of follow-up, age at onset of diabetes, duration of complications, and time for doubling of serum creatinine were recorded and calculated. Results: A total of 50 patients were included in the study who were diagnosed as DN by the physician. Mean age of the patients with DN was observed as 64.24 ± 13.68. There were 31 (62%) male and 19 (38%) and female. Mean duration of nephro­pathy was 7.2 ± 2.9 years. Family history of DN was shown in 5 (10%). Diabetic complications were recorded and tabulated. Retinopathy was observed in 23 (46%) of the cases, Coronary artery disease in 28 (56%), Angina in 22 (44%), stroke in 6(12%), Diabetic foot in 4 (8%), Hypertension in 43 (86%), blindness in 3 (6%) and end stage renal disease was observed in 12 (24%) of the cases. There were 2 (4%) deaths. The mean time to onset of diabetic com­plications from the diagnosis of diabetes in present study was 9.6 ± 2.9 (Mean± SD) years for coronary artery disease, 15.3 ± 7.3 years, for retinopathy, 11.3 ± 3.4 years for neuropathy, and 6.3 ± 2.9 years for diabetic foot. Patients those who were diagnosed >20 years, end stage renal disease was observed in them. The mean proteinuria was 2.34 ± 1.88 gm/L. Protein excretion < 0.5 was found in 15 (30%) patients, mean HbA1C was 9.7 ± 1.5(Mean± SD). Conclusion: Age, male gender, duration of diabetes, baseline HbA1C, blood pressure, and renal function are risk factors for diabetic complications and nephropathy. Keywords: microvascular, diabetes mellitus, diabetic nephropathy