Kidney hemodynamic function in men and postmenopausal women with type 2 diabetes and preserved kidney function

Background Progression of kidney disease may differ between sexes in type 2 diabetes (T2D), with studies reporting slower decline in women. Glomerular hyperfiltration is a key factor driving kidney function decline. The current study aims to investigate the differences in kidney hemodynamic function between men and women with T2D. Methods A cross-sectional analysis of pooled data from three studies comparing kidney hemodynamic function between men and postmenopausal women with T2D without overt nephropathy. The outcome measures were GFR (inulin clearance), effective renal plasma flow (ERPF; para-aminohippurate clearance), filtration fraction (GFR/ERPF) and renal vascular resistance (RVR; mean arterial pressure/RBF). Glomerular hydraulic pressure (PGLO), afferent and efferent vascular resistance were estimated by Gomez-formulae. Sex differences were assessed with linear regression models adjusted for systolic blood pressure, glucose, use of renin-angiotensin-system blockers and body mass index. Results 101 men (age: 63[58-68] years; BMI 31.5±3.9 kg/m2; GFR 111±18 mL/min; HbA1c 7.4±0.7%) and 27 women (age: 66[62-69] years; BMI 30.9±4.5 kg/m2; GFR 97±11 mL/min; HbA1c 7.1±0.5%) were included. GFR was higher in men versus women (11.0 mL/min; [95%CI; 3.6;18.4]). Although statistically non-significant, PGLO trended higher in men (1.9 mmHg [95%CI; -0.1;4.0], while RVR (-0.012 mmHg/L/min [95%CI; -0.022;-0.002]) and afferent vascular resistance were lower (-361 dyne/sec/cm5 [95%CI;-801;78]). Conclusions In adults without overt nephropathy, GFR was higher in men compared to women. PGLO also trended to be higher in men. Both findings are possibly related to afferent vasodilation and suggest greater prevalence of hyperfiltration. This could contribute to accelerated GFR loss over time in men with T2D.

Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events in patients with diabetes and overt nephropathy: a meta-analysis of randomised controlled trials

Objective: The efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing cardiovascular outcomes in patients with diabetes and overt nephropathy is still a controversial issue. Methods: We systematically searched MEDLINE, Embase and Cochrane Library for randomised controlled trials. Results: Thirteen trials containing 4638 patients with diabetes and overt nephropathy were included. Compared with controls, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment did not reduce the risk of cardiovascular events (odds ratio 0.94, 95% confidence interval 0.86 to 1.03, P=0.18; I2=0.0%, P=0.75). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy reduced the odds of heart failure events by 29% (0.71, 0.61 to 0.83, P<0.001; I2=0%, P=0.78). The results indicated no significant differences between the two treatment regimens with regard to the frequency of MI (0.95, 0.76 to 1.19, P=0.64), stroke (1.20, 0.83 to 1.74, P=0.32), cardiovascular death (1.26, 0.96 to 1.65, P=0.09) and all-cause mortality (0.98, 0.86 to 1.12, P=0.73). Among all kinds of adverse effects, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy increased the incidence of hyperkalemia (2.26, 1.42 to 3.61, P=0.001). Conclusion: This study demonstrated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers did not reduce cardiovascular events in patients with diabetes and overt nephropathy.

Diabetic nephropathy and retinopathy in a 15 years old child: a case report

Non communicable diseases like type 1 diabetes mellitus (DM) are increasing in children. Ten persent of diabetes are type 1. Diabetic nephropathy(DN) and diabetic retinopathy (DR) are the most common complications in DM Diabetic nephropathy is characterized by persistent proteinuria leading to end stage renal disease Around 25-45% of patient with type 1 diabetes will develop overt nephropathy over 10-15 years Hence it is very rare to develop diabetic nephropathy and retinopathy after 2 years of arising symptom in the paediatric age group .In this case report we describe a 15 years old boy who was diagnosed to have type 1 DM 7 days back and symptoms of DM started 2 years back . Patient develop overt nephropathy manifested by edema and proteinuria and retinopathy manifested by dimness of vision, microaneurysm with dot and blot haemorhage after 2 years of complaining symptoms suggestive of DM. The patient was managed accordingly with insulin therapy for tight glycaemic control and supportive therapy for chronic kidney disease (stage IV). As retinopathy preceed nephropathy, so renal biopsy was not done. It is recommended that all children should be screened for type 1 DM periodically to ensure good glycaemic control as well as reduce the complication like DR and DN.J Shaheed Suhrawardy Med Coll, 2014; 6(2):93-95