FREQUENCY OF NEPHROPATHY AND ITS RELATION TO METABOL-IC CONTROL IN PATIENTS WITH DIABETES MELLITUS

Abstract    INTRODUCTION: Diabetic nephropathy is a serious complication of both type ۱ and type ۲ diabetes, and unless arrested, leads to end-stage renal disease. The aim of this study was to find the prevalence of kidney dysfunction in patients with diabetes mellitus and to determine its correlation with metabolic control.    METHODS: We randomly selected ۱۲۰۳ cases with diabetes mellitus presenting to the Institute of Endocrinology and Metabolism. Urinary protein and creatinine were determined in a sample of ۲۴-hour urine collection by the enzymatic methods and spot urine dipstick blood urea nitrogen, serum creatinine, HbA۱c and fasting blood glucose were assessed.    RESULTS: In this study, ۱۲۰۳ patients (۴۳۸ patients with type ۱ diabetes mellitus [T۱DM] and ۷۷۷ with type ۲ diabetes mellitus [T۲DM]) were randomly selected. They consisted of ۵۱۲ females and ۷۲۱ males. Mean ± SD (standard deviation) of HbA۱c was ۷.۹±۳.۴ in T۱DM and ۷.۴±۳.۵ in T۲DM. Based on HbA۱c levels, good control was detected in ۵۰.۲% of patients, fair control in ۲۰.۴% and bad control in ۲۹.۴%. Of ۱۰۲۲ patients who were evaluated for proteinuria, ۲۰۱ (۱۹.۷%) had albuminuria or clinical proteinuria. Of ۹۳۱ patients, ۱۹% had high levels of blood urea nitrogen and serum creatinine. End-stage renal disease (ESRD) was seen in ۱۰ (۰.۸%) of all the cases. A statistically significant positive correlation was found between duration of DM, serum creatinine and ۲۴-hour urinary protein (P< ۰.۰۰۱).    CONCLUSION: We found a high prevalence of clinical proteinuria in diabetic patients. Duration of diabetes and poor metabolic control were identified as a strong predictors of kidney damage in patients with diabetes.      Keywords: Diabetic nephropathy, albuminuria, end-stage renal disease.