Association of somatic and N-domain angiotensin-converting enzymes from Wistar rat tissue with renal dysfunction in diabetes mellitus

: Type 2 diabetes mellitus is one of the most common forms of the disease worldwide. Hyperglycemia and insulin resistance play key roles in type 2 diabetes mellitus. Renal glucose reabsorption is an essential feature in glycaemic control. Kidneys filter 160 g of glucose daily in healthy subjects under euglycaemic conditions. The expanding epidemic of diabetes leads to a prevalence of diabetes-related cardiovascular disorders, in particular, heart failure and renal dysfunction. Cellular glucose uptake is a fundamental process for homeostasis, growth, and metabolism. In humans, three families of glucose transporters have been identified, including the glucose facilitators GLUTs, the sodium-glucose cotransporter SGLTs, and the recently identified SWEETs. Structures of the major isoforms of all three families were studied. Sodium-glucose cotransporter (SGLT2) provides most of the capacity for renal glucose reabsorption in the early proximal tubule. A number of cardiovascular outcome trials in patients with type 2 diabetes have been studied with SGLT2 inhibitors reducing cardiovascular morbidity and mortality. : The current review article summarises these aspects and discusses possible mechanisms with SGLT2 inhibitors in protecting heart failure and renal dysfunction in diabetic patients. Through glucosuria, SGLT2 inhibitors reduce body weight and body fat, and shift substrate utilisation from carbohydrates to lipids and, possibly, ketone bodies. These pleiotropic effects of SGLT2 inhibitors are likely to have contributed to the results of the EMPA-REG OUTCOME trial in which the SGLT2 inhibitor, empagliflozin, slowed down the progression of chronic kidney disease and reduced major adverse cardiovascular events in high-risk individuals with type 2 diabetes. This review discusses the role of SGLT2 in the physiology and pathophysiology of renal glucose reabsorption and outlines the unexpected logic of inhibiting SGLT2 in the diabetic kidney.

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Resistive Index of Intrarenal Artery in Evaluation of Diabetic Nephropathy

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v41i3.29888 ◽

2016 ◽

Vol 41 (3) ◽

pp. 125-130

Author(s):

Mahbuba Shirin ◽

Mofazzal Sharif ◽

Ayeshna Gurung ◽

Anindita Datta

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Serum Creatinine ◽

Renal Dysfunction ◽

Doppler Ultrasonography ◽

Resistive Index ◽

Diabetic Patients ◽

Type I ◽

The Mean ◽

Duplex Doppler

Diabetes mellitus is one of the systemic diseases affecting the kidneys. Diabetic nephropathy is a serious microvascular complication of diabetes mellitus. It is the most important cause of death in type I diabetic patients, of whom 30%-40% eventually develop end-stage renal failure and 40% of type II diabetics are at risk of developing diabetic nephropathy. So, diagnosis of diabetic nephropathy is paramount for the survivability of the diabetic patients not only because of the consequences of renal progression but also because of the strong association with the risk of developing cardiovascular disease. A total number of 53 subjects were enrolled in this present cross sectional study in the department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration of Nephrology and Medicine of the same institution during two years (2011-13) aim to evaluate the diagnostic usefulness of renal resistive index (RI) by duplex Doppler ultrasonography for detection of renal dysfunction in diabetic patients. Clinically diagnosed diabetic patients having diabetic nephropathy referred to the department of Radiology and Imaging in BSMMU for ultrasonography of Kidneys, Ureters and Bladder (KUB) region or whole abdomen were selected as sample. Biochemical reports (Serum creatinine and Urinary albumin) and the RI value of intrarenal artery were correlated and analyzed. Only those patients biochemically were diagnosed as having diabetic nephropathy was included. Those with incomplete data, hydro nephrosis and renal calculus were excluded. Both the kidneys were visualized by commercially available real time scanner (GE Voluson) equipped with a curvilinear transducer operating at 3.5 MHz First Gray scale ultrasonography was done followed by Color Doppler of intra renal artery and then RI was measured. Majority (45.3%) patients were in 6th decade with the mean age was of 52.66±7.4 years and ranging from 38 to 65 years in patients. Male was found to be 54.7% of diabetic patients with male to female ratio 1.2:1. Resistive index of (? 0.7) was found in 73.6% patients with diabetes with the mean resistive index of 0.71±0.04. Positive correction between resistive index with serum creatinine (r=0.581, p<0.01) and albuminuria (r=0.725, p<0.01) were observed. It can be concluded that Resistive Index measured by duplex Doppler ultrasonography is useful diagnostic modality for detection of renal dysfunction in diabetic nephropathy patients. Resistive Index has value in identifying diabetic patients who are developing nephropathy and can be used as an additional diagnostic tool. Also it is well correlated with Serum Creatinine and Albuminuria which are the biochemical parameters to diagnose diabetic nephropathy.

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Chronic heart failure as multimorbid state

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2019.4.90101 ◽

2019 ◽

Vol 26 (4) ◽

pp. 90-101 ◽

Cited By ~ 1

Author(s):

L. G. Voronkov ◽

A.V. Liashenko ◽

N. A. Tkach ◽

L. P. Paraschenyuk

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Cognitive Impairment ◽

Chronic Heart Failure ◽

Iron Deficiency ◽

Arterial Hypertension ◽

Renal Dysfunction ◽

Life Quality ◽

High Class ◽

High Level

Regulatory, structural and functional disturbances of other organs and systems (kidney, hepar, vessels, skeletal muscles, brain etc) play the substantial role in CHF. These disturbances may be the conseguences of pre-existing states (hypertension, diabetes, hypo- or hyperthyreoidism etc) and from, other side, may reflect the progressive inherent changes in chronic heart failure (CHF) per se. In particular, currently relevant comorbidities in this syndrome are insulin resistance, diabetes mellitus, renal dysfunction, cognitive impairment, depression peripheral myopathy. Every of them demonstrate the close pathophysiologic interplay with CHF which results in clinical prognosis impairment and in decrease of life quality. Prevalence of renal dysfunction described in 39 % of patients with CHF in our research. Renal dysfunction connected with older age, high class of NYHA, diabetes mellitus, arterial hypertension, higher level of citrulline and uric acid in patients with CHF. Patients with iron deficiency characterized with high class of NYHA, low functionality and poor quality of life. In patients with iron deficiency noted high level of mortality and many critical clinical events. Prevalence of cognitive impairment described in 85 % of patients with CHF in our research. Cognitive dysfunction associated with older age, high class of NYHA, diabetes mellitus, arterial hypertension, bad life quality, high level of ceruloplasmin in patients with CHF. Taking to account above-mentioned comorbidities in quideline-recommended management of CHF and the use of additional therapeutic approaches targeted to its treatment represent the contemporary strategy of personalized treatment in this syndrome.

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Hyperkalemia in chronic heart failure with renal dysfunction or diabetes mellitus: Results from the TREAT HF study

Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology ◽

10.5543/tkda.2021.58675 ◽

2021 ◽

Vol 49 (3) ◽

pp. 198-205

Author(s):

Selda Murat ◽

◽

Hakki Kaya ◽

Yuksel Cavusoglu ◽

Mehmet Birhan Yilmaz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Chronic Heart Failure ◽

Renal Dysfunction

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BLOOD GLUCOSE LEVELS AND THE MICROSCOPIC STRUCTURE OF KIDNEY WISTAR RAT DIABETES MELLITUS UNDER THE EFFECT OF LAWSONIA INERMIS (LINN.) LEAVES ETHANOLIC EXTRACT

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i4.23502 ◽

2018 ◽

Vol 11 (4) ◽

pp. 257

Author(s):

Mutiara Indah Sari ◽

Maya Anjelir Antika ◽

Dwi Rita Anggraini

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Ethanolic Extract ◽

Wistar Rat ◽

Diabetic Control ◽

Diabetic Rats ◽

Control Group ◽

Lawsonia Inermis ◽

Control Group Design ◽

Glucose Levels

Objective: Lawsonia inermis (Linn.) leaves are one of the alternative medicines to treat diabetes mellitus in Indonesia. We investigated the blood glucose level (BGL) of the L. inermis (Linn.) leaves ethanolic extract (LLEE) leaves and evaluated the histopathological alterations in diabetic rats.Methods: This study was an experimental study with posttest - only control group design. Alloxan (120 mg/kg, intraperitoneally)-induced diabetic rats. 35 of Wistar rats (Rattus norvegicus) were divided randomly into five groups, i.e. K: Normal control, P1: Diabetic control, and P2, P3, and P4 (200 mg/kg body weight [BW], 400 mg/kg BW, and 600 mg/kg BW of LLEE, orally) for 28 days. At the end of the treatment, the rats were sacrificed to obtain the kidney for histopathological evaluation using hematoxylin and eosin technique. BGLs were conducted using a glucose meter (GlucoDR).Results: One-way ANOVA test showed that dose 400 mg/kg BW of the LLEE was related to BGL of alloxan-induced diabetic rats (p=0.000). The histopathological of kidney showed glomerular inflammation (GI), epithelial membrane lining degeneration, vascular congestion, and interstitial tubule hemorrhage at diabetic control (P1). Meanwhile, treated with 600 mg/kg BW of LLEE (P4) showed increase cellular regeneration as normal architecture of the kidney.Conclusion: The LLEE at dose 400 mg/kg BW effective decreased BGL and was able to restore the kidney destruction of alloxan-induced diabetic rats at dose 600 mg/kg BW.

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P0766ACUTE KIDNEY INJURY INCREASES THE RISK OF PROGRESSION OF RENAL DISEASE AFTER CARDIAC SURGERY : A SINGLE CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0766 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Mahesh Kota

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiac Surgery ◽

Renal Disease ◽

Serum Albumin ◽

Renal Dysfunction ◽

Study Group ◽

Protein Loss ◽

Progression Of Renal Disease ◽

Low Serum

Abstract Background and Aims With increasing global burden of cardiovascular diseases and advances in managing them, the number of cardiac surgeries performed in India has been increasing in the last couple of decades.A lot of western data from the last 5 to 10 years say that AKI episodes can cause significant renal damage and progress to chronic kidney disease (CKD) ,however the association between acute kidney injury (AKI) and chronic kidney disease (CKD) remains elusive in cardiac surgery. We investigated the association between postoperative AKI and CKD development, emphasizing the role of AKI in post cardiac surgery patients. Method We observed the incidence of cardiac surgery associated AKI (CSA-AKI), determinants of progressive kidney disease after CSA-AKI and followed the patients with CSA-AKI for three months to find out the incidence of CKD or progressive renal dysfunction. Results 150 consecutive post cardiac surgery patients were included in the study. CSA-AKI incidence was 35.4%[Figure 1].Incidence of AKI was significant with prior AKI episodes(P<0.01) and with pre-existing CKD (P<0.01)[Figure 2].Among intraoperative risk factors for CSA-AKI, need for CPB(P-0.01), prolonged pump time(P-0.01), blood transfusion(P-0.04) and ultrafiltration(P-0.01) during surgery were found to be significant[Figure 3,4].Duration of ICU stay (P<0.01), hospital stay (P<0.01) and death rate (P-0.04) was higher in patients with AKI[Table 1]. Out of 53 patients who developed CSA-AKI, follow up for the progression of renal disease was done for 50 patients, as 3 patients with AKI died during hospital stay. Progressive renal dysfunction (new development of CKD or progressive CKD ) after 90 days was seen in 48% of patients with CSA-AKI. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multi factorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant[Table 2]. Conclusion AKI is not uncommon after cardiac surgery, progressive renal dysfunction was seen in 48% of patients after CSA-AKI and progressive renal dysfunction was common in those with increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multi factorial AKI. Mean age of patients with AKI in the study group was found to be 61±10 years and for NO AKI group mean age was found to be 58±12 years. This variation was not found to be statistically significant. Among other pre-operative risk factors, though there was some difference in percentage for many risk factors, but the percentage variation was quite significant for subjects with prior AKI episodes and those with existing CKD. The increased incidence of AKI in patients with prior AKI episodes (P<0.01) and in those with pre-existing CKD (P<0.01) was found to be statistically significant. Low socioeconomic status was found to be high in NO AKI group, however this was not found to be statistically significant (P-0.11). When compared to both the groups, duration of stay in ICU (P<0.01), overall duration of hospital stay (P<0.01) and death rate (P-0.04) was higher in AKI group and this variation was found to be statistically significant. All the risk factors for the progression of renal disease after AKI like increased age, low serum albumin, presence of hypertension, diabetes mellitus, protein loss in urine, severe AKI(KDIGO stage>2) and multifactorial AKI was higher in patients who had progressive renal disease after AKI in the study group, however the relation was not statistically significant.

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