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Wang H, Xu W, Huang C, Liu Y, Wang L, Wang J, Zhang F, Xu H. High ACR level is a strong risk factor for renal tubular impairment in patients with type 2 diabetes: A longitudinal observational study. Diabetes Res Clin Pract 2020; 165:108272. [PMID: 32561454 DOI: 10.1016/j.diabres.2020.108272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/03/2020] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have indicated that high albuminuria is associated with renal function decline. However, the relationship between the urinary albumin-to-creatinine ratio (ACR) and risk of developing tubular injury remains unclear. Our aim was to investigate the association of ACR with the risk of developing tubular impairment in patients with type 2 diabetes. METHODS This longitudinal observational study compared baseline with follow-up data in 183 patients with type 2 diabetes. ACR, urinary alpha-1-microglobulin-to-creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were used to evaluate albuminuira, tubular injury and glomerular filtration function, respectively. RESULTS Levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and A1MCR were significantly different at the two-year follow-up compared with baseline levels. Among patients both with baseline ACR above and below 30 mg/g, the percentage with A1MCR > 15 mg/g clearly increased after follow-up (P < 0.05). The risk of A1MCR rising from normal ranges to >15 mg/g over the follow-up increased with increasing baseline ACR values lower baseline eGFR. Among the patients with baseline ACR > 63.10 mg/g, all showed increased A1MCR values at follow-up compared with baseline. In the multivariate regression analysis, the patients with baseline ACR > 63.10 mg/g had a strong risk of A1MCR rising from normal to >15 mg/g (odds ratio (OR) = 11.12, P = 0.001) over the follow-up, while the males had a 2.89-fold risk of A1MCR increasing from normal to >15 mg/g compared with females. CONCLUSION Baseline ACR level is related to increased risk of developing renal tubular injury; in particular, this association is much stronger in patients with type 2 diabetes and baseline ACR > 63.10 mg/g.
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Affiliation(s)
- Huabin Wang
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Wenxia Xu
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Caiqun Huang
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Ying Liu
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Lude Wang
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Jing Wang
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Feng Zhang
- Central Laboratory, Jinhua Municipal Central Hospital, People's Republic of China
| | - Huimin Xu
- Department of Grass-roots Guidance, Jinhua Municipal Central Hospital, People's Republic of China.
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152
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Schnell O, Valensi P, Standl E, Ceriello A. Comparison of mechanisms and transferability of outcomes of SGLT2 inhibition between type 1 and type 2 diabetes. Endocrinol Diabetes Metab 2020; 3:e00129. [PMID: 32704554 PMCID: PMC7375088 DOI: 10.1002/edm2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/31/2020] [Accepted: 02/22/2020] [Indexed: 12/21/2022] Open
Abstract
Diabetes mellitus (DM) is a major chronic disease with ever-increasing prevalence and a variety of serious complications for persons with DM, such as cardiovascular and/or renal complications. New glucose-lowering therapies like DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors have undergone cardiovascular outcome trials (CVOTs) for type 2 diabetes (T2DM), as by the guidance of the FDA. However, CVOTs for type 1 diabetes (T1DM) are generally lacking. Both, persons with T1DM and T2DM, are burdened with a high incidence of cardiovascular and renal disease such as atherosclerotic cardiovascular disease (ASCVD) and diabetic kidney disease (DKD). Although pathologies of the two types of diabetes cannot be compared, similar mechanisms and risk factors like sex, hyperglycaemia, hypertension, endothelial damage and (background) inflammation have been identified in the development of CVD and DKD in T1DM and T2DM. Recent CVOTs in T2DM demonstrated that SGLT-2 inhibitors, besides exerting a glucose-lowering effect, have beneficial effects on cardiovascular and renal mechanisms. These mechanisms are reviewed in detail in this manuscript and evaluated for possible transferability to, and thus efficacy in, T1DM. Our review of current literature suggests that SGLT-2 inhibitors have cardioprotective benefits beyond their glucose-lowering effects. As this mainly has been observed in CVOTs in T2DM, further investigation in the adjunctive therapy for type 1 diabetes is suggested.
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Affiliation(s)
| | - Paul Valensi
- Department of Endocrinology Diabetology NutritionAPHP, Jean VERDIER Hospital, Paris Nord University, CINFO, CRNH‐IdFBondyFrance
| | | | - Antonio Ceriello
- Department of Cardiovascular and Metabolic DiseasesIRCCS MultiMedicaSesto San Giovanni (MI)Italy
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153
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Opazo-Ríos L, Plaza A, Sánchez Matus Y, Bernal S, Lopez-Sanz L, Jimenez-Castilla L, Carpio D, Droguett A, Mezzano S, Egido J, Gomez-Guerrero C. Targeting NF-κB by the Cell-Permeable NEMO-Binding Domain Peptide Improves Albuminuria and Renal Lesions in an Experimental Model of Type 2 Diabetic Nephropathy. Int J Mol Sci 2020; 21:ijms21124225. [PMID: 32545818 PMCID: PMC7352510 DOI: 10.3390/ijms21124225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetic nephropathy (DN) is a multifactorial disease characterized by hyperglycemia and close interaction of hemodynamic, metabolic and inflammatory factors. Nuclear factor-κB (NF-κB) is a principal matchmaker linking hyperglycemia and inflammation. The present work investigates the cell-permeable peptide containing the inhibitor of kappa B kinase γ (IKKγ)/NF-κB essential modulator (NEMO)-binding domain (NBD) as therapeutic option to modulate inflammation in a preclinical model of type 2 diabetes (T2D) with DN. Black and tan, brachyuric obese/obese mice were randomized into 4 interventions groups: Active NBD peptide (10 and 6 µg/g body weight); Inactive mutant peptide (10 µg/g); and vehicle control. In vivo/ex vivo fluorescence imaging revealed efficient delivery of NBD peptide, systemic biodistribution and selective renal metabolization. In vivo administration of active NBD peptide improved albuminuria (>40% reduction on average) and kidney damage, decreased podocyte loss and basement membrane thickness, and modulated the expression of proinflammatory and oxidative stress markers. In vitro, NBD blocked IKK-mediated NF-κB induction and target gene expression in mesangial cells exposed to diabetic-like milieu. These results constitute the first nephroprotective effect of NBD peptide in a T2D mouse model that recapitulates the kidney lesions observed in DN patients. Targeting IKK-dependent NF-κB activation could be a therapeutic strategy to combat kidney inflammation in DN.
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Affiliation(s)
- Lucas Opazo-Ríos
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
| | - Anita Plaza
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
| | - Yenniffer Sánchez Matus
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
| | - Susana Bernal
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
| | - Laura Lopez-Sanz
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
| | - Luna Jimenez-Castilla
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
| | - Daniel Carpio
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
| | - Alejandra Droguett
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
| | - Sergio Mezzano
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, 5090000 Valdivia, Chile; (L.O.-R.); (A.P.) (Y.S.M.); (D.C.); (A.D.); (S.M.)
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
| | - Carmen Gomez-Guerrero
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (S.B.); (L.L.-S.); (L.J.-C.); (J.E.)
- Correspondence: or
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Cheng Y, Shang J, Liu D, Xiao J, Zhao Z. Development and validation of a predictive model for the progression of diabetic kidney disease to kidney failure. Ren Fail 2020; 42:550-559. [PMID: 32524865 PMCID: PMC7946054 DOI: 10.1080/0886022x.2020.1772294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: A good prediction model plays an important role in determining the progression to diabetic kidney disease. We aimed to create a model to predict progression to kidney failure in patients with diabetic kidney disease.Methods: We retrospectively assessed 641 patients with type 2 diabetic kidney disease as derivation cohort and 280 patients as external out time validation cohort. We used a combination of clinical guidance and univariate logistic regression to select the relevant variables. We calculated the discrimination and calibration of different models. The best model was selected according to the optimal combination of discrimination and calibration.Results: During the 3 years follow up, there were 272 outcomes (42%) in derivation cohort and 138 outcomes (49%) in external validation cohort. The final variables selected in the multivariate logistics regression were age, gender, hemoglobin, NLR, serum cystatin C, eGFR, 24-h urine protein, and the use of oral hypoglycemic drugs. We developed four different models as clinical, laboratory, lab-medication, and full models according to these independent risk factors. Laboratory model performed well in both discrimination and calibration among all the models (C-statistics: external validation 0.863; p value of the Hosmer-Lemeshow, .817). There was no significant difference in NRI among laboratory model, lab-medication model, and full model (p > .05). So, we chose the laboratory model as the optimal model.Conclusion: We constructed a nomogram which contained hemoglobin, NLR, serum cystatin C, eGFR, and 24-h urine protein to predict the risk of patients with diabetic kidney disease initiating renal replacement in 3 years.
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Affiliation(s)
- Yaqi Cheng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Shang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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155
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Omics research in diabetic kidney disease: new biomarker dimensions and new understandings? J Nephrol 2020; 33:931-948. [DOI: 10.1007/s40620-020-00759-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
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156
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Fanni G, Rosato R, Gentile L, Anselmino M, Frea S, Ponzo V, Pellegrini M, Broglio F, Pivari F, De Ferrari GM, Ghigo E, Bo S. Is HDL cholesterol protective in patients with type 2 diabetes? A retrospective population-based cohort study. J Transl Med 2020; 18:189. [PMID: 32375888 PMCID: PMC7203837 DOI: 10.1186/s12967-020-02357-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The protective role of high HDL cholesterol levels against cardiovascular diseases has been recently questioned. Limited data are available on this specific topic in patients with type 2 diabetes mellitus (T2DM). We aimed to evaluate the association of HDL cholesterol concentrations with all-cause and cause-specific mortality in a historical cohort of T2DM patients with 14 years of follow-up. METHODS This is a retrospective population-based cohort study involving 2113 T2DM patients attending the Diabetic Clinic of Asti. Survival analyses were performed to assess hazard ratios for overall and specific-cause mortality by HDL cholesterol tertiles, using the middle HDL cholesterol tertile as a reference. RESULTS The mean age was 66 ± 11 years; 51.4% of patients had low HDL-cholesterol levels. After a 14-year follow-up, 973/2112 patients had died (46.1%). The HDL cholesterol tertile cut-off points were 37.5 and 47.5 mg/dL (males) and 41.5 and 52.0 mg/dL (females). No associations between lower and upper HDL cholesterol tertiles respectively and all-cause (HR = 1.12; 95% CI 0.96-1.32; HR = 1.11; 0.95-1.30), cardiovascular (HR = 0.97; 0.77-1.23; HR = 0.94; 0.75-1.18) or cancer (HR = 0.92; 0.67-1.25; HR = 0.89; 0.66-1.21) mortality were found. A significantly increased risk for infectious disease death was found both in the lower (HR = 2.62; 1.44-4.74) and the upper HDL-cholesterol tertiles (HR = 2.05; 1.09-3.85) when compared to the reference. Individuals in the upper tertile showed an increased risk for mortality due to diabetes-related causes (HR = 1.87; 1.10-3.15). CONCLUSIONS Our results corroborate the hypothesis that HDL cholesterol levels are nonprotective in T2DM patients. The U-shaped association between HDL-cholesterol levels and mortality associated with infectious diseases should be verified by further studies.
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Affiliation(s)
- Giovanni Fanni
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Matteo Anselmino
- Cardiology Unit, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Simone Frea
- Cardiology Unit, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy
| | - Marianna Pellegrini
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy
| | - Fabio Broglio
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy
| | - Francesca Pivari
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gaetano Maria De Ferrari
- Cardiology Unit, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 14 10126, Turin, To, Italy.
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157
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Yokoyama H, Araki SI, Kawai K, Yamazaki K, Shirabe SI, Sugimoto H, Minami M, Miyazawa I, Maegawa H. The Prognosis of Patients With Type 2 Diabetes and Nonalbuminuric Diabetic Kidney Disease Is Not Always Poor: Implication of the Effects of Coexisting Macrovascular Complications (JDDM 54). Diabetes Care 2020; 43:1102-1110. [PMID: 32144168 DOI: 10.2337/dc19-2049] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes. RESEARCH DESIGN AND METHODS A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 mL/min/1.73 m2) at baseline, participants were classified into the four DKD phenotypes-no-DKD, albuminuric DKD without reduced eGFR, nonalbuminuric DKD with reduced eGFR, and albuminuric DKD with reduced eGFR-to assess the risks of mortality, cardiovascular disease (CVD), and renal function decline. RESULTS During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher. CONCLUSIONS Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.
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Affiliation(s)
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | | | | | | | | | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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158
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The Role of Chemokines and Chemokine Receptors in Diabetic Nephropathy. Int J Mol Sci 2020; 21:ijms21093172. [PMID: 32365893 PMCID: PMC7246426 DOI: 10.3390/ijms21093172] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
Kidney function decline is one of the complications of diabetes mellitus and may be indicated as diabetic nephropathy (DN). DN is a chronic inflammatory disease featuring proteinuria and a decreasing glomerular filtration rate. Despite several therapeutic options being currently available, DN is still the major cause of end-stage renal disease. Accordingly, widespread innovation is needed to improve outcomes in patients with DN. Chemokines and their receptors are critically involved in the inflammatory progression in the development of DN. Although recent studies have shown multiple pathways related to the chemokine system, the specific and direct effects of chemokines and their receptors remain unclear. In this review, we provide an overview of the potential role and mechanism of chemokine systems in DN proposed in recent years. Chemokine system-related mechanisms may provide potential therapeutic targets in DN.
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159
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Zelt JGE, Hossain A, Sun LY, Mehta S, Chandy G, Davies RA, Contreras-Dominguez V, Dunne R, Doyle-Cox C, Wells G, Stewart DJ, Mielniczuk LM. Incorporation of renal function in mortality risk assessment for pulmonary arterial hypertension. J Heart Lung Transplant 2020; 39:675-685. [PMID: 32336606 DOI: 10.1016/j.healun.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Risk assessment is important for prognostication and individualized treatment decisions for patients with pulmonary arterial hypertension (PAH). The purpose was (1) to compare contemporary risk assessment tools and (2) to determine the prognostic significance of risk parameters of kidney function and whether they can further improve risk prediction for patients with PAH. METHODS We identified a cohort of treatment-naive patients (n = 211) who received an incident diagnosis of PAH at the University of Ottawa Heart Institute. Using demographics, disease characteristics, and hemodynamic data at diagnosis, we categorized patients as low, intermediate, or high risk according to current European guidelines (European Society of Cardiology [ESC]) and registry to evaluate early and long-term pulmonary arterial hypertension disease management (REVEAL) risk scores. The primary end-point was transplant-free survival (TFS). RESULTS Patients were predominantly women (64.6%) with World Health Organization function Class III symptoms (66.5%). The median TFS was 7.09 years. There was little agreement between ESC- and REVEAL-based risk estimates (weighted kappa = 0.21-0.34). Although both the ESC (log-rank, p = 0.0002) and REVEAL algorithms stratified TFS risk (p < 0.0001), the REVEAL score provided superior discrimination (C-statistic = 0.70 vs 0.59, p = 0.004). Renal function at diagnosis (p < 0.0001) and Δ renal function at 6 months (p < 0.0001) were identified as novel risk parameters and served to reclassify some patients in the intermediate-risk category to a lower or higher risk stratum (p < 0.0001). CONCLUSION REVEAL-based strategies provide superior TFS risk discrimination to ESC/European Respiratory Society-based approaches. However, the classification of intermediate-risk patients varied significantly across tools. We demonstrate the importance of renal function, which further improved the stratification of risk in patients with PAH, particularly in patients who are considered intermediate risk.
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Affiliation(s)
- Jason G E Zelt
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Louise Y Sun
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sanjay Mehta
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George Chandy
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Division of Respirology and Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ross A Davies
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Rosemary Dunne
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Caroyln Doyle-Cox
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - George Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Duncan J Stewart
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa M Mielniczuk
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada.
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160
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Alemu H, Hailu W, Adane A. Prevalence of Chronic Kidney Disease and Associated Factors among Patients with Diabetes in Northwest Ethiopia: A Hospital-Based Cross-Sectional Study. CURRENT THERAPEUTIC RESEARCH 2020; 92:100578. [PMID: 32190131 PMCID: PMC7068620 DOI: 10.1016/j.curtheres.2020.100578] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/06/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is increasingly recognized as a global health issue and it affects 10% to 15% of the world population. Diabetes mellitus is the leading cause of end-stage renal disease. More than 422 million adults in the world populations are living with diabetes mellitus, 40% of whom will develop CKD. CKD in diabetes increases the risk of early death and cardiovascular morbidity and mortality. There is a paucity of published data on the prevalence of CKD and its associated factors among patients with diabetes in northwest Ethiopia. OBJECTIVE The aim of this study is to determine the prevalence and factors associated with CKD among patients with diabetes at University of Gondar Hospital, Northwest Ethiopia. METHODS A hospital-based cross-sectional study was conducted from April 2 to July 31, 2018. Using convenience sampling, a total of 272 consecutive patients with diabetes were recruited for the study. Data regarding the patients' sociodemographic information, clinical characteristics, and laboratory parameters were collected using patient interview and review of medical records. Serum creatinine was measured and used to calculate estimated glomerular filtration rate using modification of diet in renal disease and chronic kidney disease epidemiology equations. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analyses were used to identify predictors of CKD in patients with diabetes. RESULT The prevalence of CKD, defined by estimated glomerular filtration rate <60 mL/min/1.73 m2, was found to be 17.3% and 14.3% by modification of diet in renal disease and chronic kidney disease epidemiology equations, respectively. The proportion of stage 3 CKD by modification of diet in renal disease equation was 14.7%, whereas the proportions of stage 4 and stage 5 CKD were 2.2% and 0.4%, respectively. Among those who were diagnosed with CKD, 85.1% had pre-existing hypertension. Multivariate logistic regression analysis revealed that the presence of retinopathy (adjusted odds ratio = 14; 95% CI, 4-36; p < 0.001), pre-existing hypertension (adjusted odds ratio = 8.2; 95% CI, 2-23; P < 0.001), current systolic blood pressure >140 mm Hg (adjusted odds ratio = 6; 95% CI, 4-22; P = 0.001), and duration of diabetes >10 years (adjusted odds ratio = 3.2; 95% CI, 2-7; P = 0.004) were significantly associated with CKD in patients with diabetes. CONCLUSIONS The prevalence of CKD in patients with diabetes is high and comparable with previous studies from low- and middle-income countries. Pre-existing hypertension, current systolic blood pressure >140 mm Hg, duration of diabetes >10 years, and presence of retinopathy were significantly associated with CKD. Regular screening for CKD, retinopathy, and optimal blood pressure management should be practiced.
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Affiliation(s)
| | - Workagegnehu Hailu
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar City, Ethiopia
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161
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Plausible diagnostic value of urinary isomeric dimethylarginine ratio for diabetic nephropathy. Sci Rep 2020; 10:2970. [PMID: 32076062 PMCID: PMC7031402 DOI: 10.1038/s41598-020-59897-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/23/2020] [Indexed: 01/12/2023] Open
Abstract
Altered circulatory asymmetric and symmetric dimethylarginines have been independently reported in patients with end-stage renal failure suggesting their potential role as mediators and early biomarkers of nephropathy. These alterations can also be reflected in urine. Herein, we aimed to evaluate urinary asymmetric to symmetric dimethylarginine ratio (ASR) for early prediction of diabetic nephropathy (DN). In this cross-sectional study, individuals with impaired glucose tolerance (IGT), newly diagnosed diabetes (NDD), diabetic microalbuminuria (MIC), macroalbuminuria (MAC), and normal glucose tolerance (NGT) were recruited from Dr. Mohans’ Diabetes Specialties centre, India. Urinary ASR was measured using a validated high-throughput MALDI-MS/MS method. Significantly lower ASR was observed in MIC (0.909) and MAC (0.741) in comparison to the NGT and NDD groups. On regression models, ASR was associated with MIC [OR: 0.256; 95% CI: 0.158–0.491] and MAC [OR 0.146; 95% CI: 0.071–0.292] controlled for all the available confounding factors. ROC analysis revealed ASR cut-point of 0.95 had C-statistic of 0.691 (95% CI: 0.627-0.755) to discriminate MIC from NDD with 72% sensitivity. Whereas, an ASR cut-point of 0.82 had C-statistic of 0.846 (95% CI: 0.800 - 0.893) had 91% sensitivity for identifying MAC. Our results suggest ASR as a potential early diagnostic biomarker for DN among the Asian Indians.
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162
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Kleinaki Z, Agouridis AP, Zafeiri M, Xanthos T, Tsioutis C. Epicardial adipose tissue deposition in patients with diabetes and renal impairment: Analysis of the literature. World J Diabetes 2020; 11:33-41. [PMID: 32064034 PMCID: PMC6969709 DOI: 10.4239/wjd.v11.i2.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates. Renal disease in patients with diabetes is associated with increased morbidity and premature mortality, particularly attributed to their very high cardiovascular risk. Since this group of patients frequently lacks specific symptomatology prior to the adverse events, a screening tool for the identification of high-risk patients is necessary. The epicardial adipose tissue (EAT) is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease. Superior to conventional cardiovascular risk factors and anthropometric measures, including body mass index and waist circumference, the EAT can early predict the development of coronary artery disease. Assessment of EAT can be performed by two-dimensional echocardiography, magnetic resonance imaging or computer tomography. However, its role and significance in patients with DM and nephropathy has not been thoroughly evaluated. The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment. Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements, uncontrolled underlying disease, high body mass index and raised cardiovascular risk markers. Acknowledging the practical implications of this test, EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.
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Affiliation(s)
- Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - Maria Zafeiri
- Diabetes and Obesity Center, Konstantopouleio Hospital, Athens 14233, Greece
| | - Theodoros Xanthos
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
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163
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Gerstein HC, Paré G, McQueen MJ, Lee SF, Bangdiwala SI, Kannt A, Hess S. Novel Biomarkers for Change in Renal Function in People With Dysglycemia. Diabetes Care 2020; 43:433-439. [PMID: 31727687 DOI: 10.2337/dc19-1604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a major risk factor for renal function decline and failure. The availability of multiplex panels of biochemical markers provides the opportunity to identify novel biomarkers that can better predict changes in renal function than routinely available clinical markers. RESEARCH DESIGN AND METHODS The concentration of 239 biochemical markers was measured in stored serum from participants in the biomarker substudy of Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Repeated-measures mixed-effects models were used to compute the annual change in eGFR (measured as mL/min/1.73 m2/year) for the 7,482 participants with a recorded baseline and follow-up eGFR. Linear regression models using forward selection were used to identify the independent biomarker determinants of the annual change in eGFR after accounting for baseline HbA1c, baseline eGFR, and routinely measured clinical risk factors. The incidence of the composite renal outcome (i.e., renal replacement therapy, renal death, renal failure, albuminuria progression, doubling of serum creatinine) and death within each fourth of change in eGFR predicted from these models was also estimated. RESULTS During 6.2 years of median follow-up, the median annual change in eGFR was -0.18 mL/min/1.73 m2/year. Fifteen biomarkers independently predicted eGFR decline after accounting for cardiovascular risk factors, as did 12 of these plus 1 additional biomarker after accounting for renal risk factors. Every 0.1 mL/min/1.73 m2 predicted annual fall in eGFR predicted a 13% (95% CI 12, 14%) higher mortality. CONCLUSIONS Adding up to 16 biomarkers to routinely measured clinical risk factors improves the prediction of annual change in eGFR in people with dysglycemia.
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Affiliation(s)
- Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matthew J McQueen
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Aimo Kannt
- Sanofi Aventis Deutschland GmbH Research and Development, Frankfurt, Germany
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164
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A Patient with Complex Gout with an Autoinflammatory Syndrome and a Sternoclavicular Joint Arthritis as Presenting Symptoms. Case Rep Rheumatol 2020; 2020:5026490. [PMID: 32082683 PMCID: PMC7013360 DOI: 10.1155/2020/5026490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 12/27/2022] Open
Abstract
A 50-year-old man presented to the emergency department with widespread pain, especially at the chest level, fever, and night sweats. Physical examinations revealed a swelling with localized pain in the left sternoclavicular joint. Laboratory tests showed a CPR of 134 mg/l and an ESR of 70 mm/h. The patient's anamnesis is, for a chronic gouty arthritis, poorly controlled type 2 diabetes and a lumbosacral radicular syndrome. Home therapy includes metformin, sitagliptin, gliclazide, naproxen with partial benefit on pain, and febuxostat. Differential diagnoses of sternoclavicular swelling include infection, crystal or psoriatic arthropathy, tumor pathology, SAPHO syndrome, and osteoarthritis. An ultrasound scan performed at the thoracic level showed the presence of effusion in the sternoclavicular joint. A thoracoabdominal CT scan, performed in doubt of neoplasias, shows no masses but osteostructural nonspecific alterations of the sternoclavicular joint. We performed a dual energy CT (DECT) which reports a gouty arthropathy at the sternoclavicular joints (in the literature, only three similar cases are proved). Because of the poor therapeutic effects using febuxostat and systemic corticosteroids, the patient was treated with anakinra, an interleukin 1 receptor antagonist, which led, 6 months after the event, to a total remission.
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165
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Song X, Waitman LR, Yu AS, Robbins DC, Hu Y, Liu M. Longitudinal Risk Prediction of Chronic Kidney Disease in Diabetic Patients Using a Temporal-Enhanced Gradient Boosting Machine: Retrospective Cohort Study. JMIR Med Inform 2020; 8:e15510. [PMID: 32012067 PMCID: PMC7055762 DOI: 10.2196/15510] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Artificial intelligence-enabled electronic health record (EHR) analysis can revolutionize medical practice from the diagnosis and prediction of complex diseases to making recommendations in patient care, especially for chronic conditions such as chronic kidney disease (CKD), which is one of the most frequent complications in patients with diabetes and is associated with substantial morbidity and mortality. OBJECTIVE The longitudinal prediction of health outcomes requires effective representation of temporal data in the EHR. In this study, we proposed a novel temporal-enhanced gradient boosting machine (GBM) model that dynamically updates and ensembles learners based on new events in patient timelines to improve the prediction accuracy of CKD among patients with diabetes. METHODS Using a broad spectrum of deidentified EHR data on a retrospective cohort of 14,039 adult patients with type 2 diabetes and GBM as the base learner, we validated our proposed Landmark-Boosting model against three state-of-the-art temporal models for rolling predictions of 1-year CKD risk. RESULTS The proposed model uniformly outperformed other models, achieving an area under receiver operating curve of 0.83 (95% CI 0.76-0.85), 0.78 (95% CI 0.75-0.82), and 0.82 (95% CI 0.78-0.86) in predicting CKD risk with automatic accumulation of new data in later years (years 2, 3, and 4 since diabetes mellitus onset, respectively). The Landmark-Boosting model also maintained the best calibration across moderate- and high-risk groups and over time. The experimental results demonstrated that the proposed temporal model can not only accurately predict 1-year CKD risk but also improve performance over time with additionally accumulated data, which is essential for clinical use to improve renal management of patients with diabetes. CONCLUSIONS Incorporation of temporal information in EHR data can significantly improve predictive model performance and will particularly benefit patients who follow-up with their physicians as recommended.
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Affiliation(s)
- Xing Song
- University of Kansas Medical Center, Department of Internal Medicine, Division of Medical Informatics, Kansas City, KS, United States
| | - Lemuel R Waitman
- University of Kansas Medical Center, Department of Internal Medicine, Division of Medical Informatics, Kansas City, KS, United States
| | - Alan Sl Yu
- University of Kansas Medical Center, Division of Nephrology and Hypertension and the Kidney Institute, Kansas City, KS, United States
| | - David C Robbins
- University of Kansas Medical Center, Diabetes Institute, Kansas City, KS, United States
| | - Yong Hu
- Jinan University, Big Data Decision Institute, Guangzhou, China
| | - Mei Liu
- University of Kansas Medical Center, Department of Internal Medicine, Division of Medical Informatics, Kansas City, KS, United States
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166
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Adelusi TI, Du L, Hao M, Zhou X, Xuan Q, Apu C, Sun Y, Lu Q, Yin X. Keap1/Nrf2/ARE signaling unfolds therapeutic targets for redox imbalanced-mediated diseases and diabetic nephropathy. Biomed Pharmacother 2020; 123:109732. [PMID: 31945695 DOI: 10.1016/j.biopha.2019.109732] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 12/22/2022] Open
Abstract
Hyperglycemia/oxidative stress has been implicated in the initiation and progression of diabetic complications while the components of Keap1/Nrf2/ARE signaling are being exploited as therapeutic targets for the treatment/management of these pathologies. Antioxidant agents like drugs, nutraceuticals and pure compounds that target the proteins of this pathway and their downstream genes hold the therapeutic strength to put the progression of this disease at bay. Here, we elucidate how the modulation of Keap1/Nrf2/ARE had been exploited for the treatment/management of end-stage diabetic kidney complication (diabetic nephropathy) by looking into (1) Nrf2 nuclear translocation and phosphorylation by some protein kinases at specific amino acid sequences and (2) Keap1 downregulation/Keap1-Nrf2 protein-protein inhibition (PPI) as potential therapeutic mechanisms exploited by Nrf2 activators for the modulation of diabetic nephropathy biomarkers (Collagen IV, Laminin, TGF-β1 and Fibronectin) that ultimately lead to the amelioration of this disease progression. Furthermore, we brought to limelight the relationship between diabetic nephropathy and Keap1/Nrf2/ARE and finally elucidate how the modulation of this signaling pathway could be further explored to create novel therapeutic milestones.
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Affiliation(s)
- Temitope Isaac Adelusi
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Lei Du
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Meng Hao
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Xueyan Zhou
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Qian Xuan
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Chowdhury Apu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Ying Sun
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Qian Lu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Xiaoxing Yin
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, China.
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167
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Niazpour F, Bahiraee A, Esfahani EN, Abdollahi M, Bandarian F, Razi F. Comparison of glomerular filtration rate estimation using Jaffé and enzymatic creatinine assays in diabetic patients. J Diabetes Metab Disord 2019; 18:551-556. [PMID: 31890681 PMCID: PMC6915165 DOI: 10.1007/s40200-019-00462-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diabetic kidney disease (DKD) develops an end-stage renal failure and is a major cause of death in diabetic patients. A GFR below 60 ml/min per 1.73 m2 is one of the main markers of DKD. Therefore, the development of an accurate test for diagnosis and monitoring of the mentioned disease would be essential. Here, we examined the impacts of two different kits with different methods for creatinine measurement on the GFR values. METHODS Blood samples were collected from 80 diabetic patients referring to the clinical laboratory. The levels of serum creatinine were assessed using Jaffé and enzymatic assays by kits from two different manufacturers. Then to assess the eGFR levels, the MDRD equation was used. Further descriptive parameters of both methods and correlation of methods were also calculated. RESULTS Descriptive analysis of the data demonstrates a slight increase in the serum creatinine measured by Jaffé assay which leads to a substantial decrease in the levels of eGFR compared to the eGFR calculated by the enzymatic assay. Moreover, eGFR over 60 mL/min/1.73 m 2 in enzymatic assay was observed in 27.5% of participants while eGFR of the same participants was below 60 mL/min/1.73 m 2 when it was measured by Jaffé method. Consequently, 27.5% positive discordant cases were reported by Jaffé assay followed by misclassifying them as DKD patients compared with the enzymatic assay. CONCLUSION While using Jaffé assay, a low level of eGFR is observed which generates more misclassification into the DKD group and demands to an inclusive consideration by physicians in order to diagnose and monitor the DKD patients.
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Affiliation(s)
- Farshad Niazpour
- 1Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Bahiraee
- 2Department of Medical Genetics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ensieh Nasli Esfahani
- 3Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abdollahi
- 3Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bandarian
- 4Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Razi
- 5Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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168
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Thongnak L, Pongchaidecha A, Lungkaphin A. Renal Lipid Metabolism and Lipotoxicity in Diabetes. Am J Med Sci 2019; 359:84-99. [PMID: 32039770 DOI: 10.1016/j.amjms.2019.11.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/13/2019] [Accepted: 11/20/2019] [Indexed: 12/27/2022]
Abstract
The pathogenesis of diabetic kidney disease is a complex process caused by both glucotoxicity and lipotoxicity due to lipid accumulation. In cases of diabetic animals, lipid deposition is found in both tubular and glomerular portions of the kidneys, which are the major sites of diabetic nephropathy lesions. The aim of this review was to provide insights into the mechanisms that lead to the development of renal lipid accumulation and the effects of renal lipotoxicity in the diabetic condition. An increased number of lipogenic genes and a decreased number of lipid oxidation genes are also detected in diabetic kidneys, both of which lead to lipid accumulation. The induction of oxidative stress, inflammation, fibrosis and apoptosis caused by lipid accumulation and lipid metabolites is called lipotoxicity. Renal lipotoxicity due to derangement in lipid metabolism may be a pathogenic mechanism leading to diabetic nephropathy and renal dysfunction.
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Affiliation(s)
- Laongdao Thongnak
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anchalee Pongchaidecha
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anusorn Lungkaphin
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Functional Food Research Center for Well-Being, Chiang Mai University, Chiang Mai, Thailand.
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169
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Xiong Q, Liu J, Xu Y. Effects of Uric Acid on Diabetes Mellitus and Its Chronic Complications. Int J Endocrinol 2019; 2019:9691345. [PMID: 31737070 PMCID: PMC6815590 DOI: 10.1155/2019/9691345] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/26/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
With the deepening of the researches on uric acid, especially in the study of metabolic diseases, uric acid has been found to be closely related to obesity, metabolic syndrome, nonalcoholic fatty liver disease, diabetes, and other metabolic diseases. Uric acid causes a series of pathophysiological changes through inflammation, oxidative stress, vascular endothelial injury, and so on and thus subsequently promotes the occurrence and development of diseases. This review confirmed the positive correlation between uric acid and diabetes mellitus and its chronic complications through the pathogenesis and clinical studies aspects.
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Affiliation(s)
- Qing Xiong
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
- Department of Endocrinology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, Hainan 570208, China
| | - Jie Liu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yancheng Xu
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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170
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Eid S, Sas KM, Abcouwer SF, Feldman EL, Gardner TW, Pennathur S, Fort PE. New insights into the mechanisms of diabetic complications: role of lipids and lipid metabolism. Diabetologia 2019; 62:1539-1549. [PMID: 31346658 PMCID: PMC6679814 DOI: 10.1007/s00125-019-4959-1] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
Diabetes adversely affects multiple organs, including the kidney, eye and nerve, leading to diabetic kidney disease, diabetic retinopathy and diabetic neuropathy, respectively. In both type 1 and type 2 diabetes, tissue damage is organ specific and is secondary to a combination of multiple metabolic insults. Hyperglycaemia, dyslipidaemia and hypertension combine with the duration and type of diabetes to define the distinct pathophysiology underlying diabetic kidney disease, diabetic retinopathy and diabetic neuropathy. Only recently have the commonalities and differences in the metabolic basis of these tissue-specific complications, particularly those involving local and systemic lipids, been systematically examined. This review focuses on recent progress made using preclinical models and human-based approaches towards understanding how bioenergetics and metabolomic profiles contribute to diabetic kidney disease, diabetic retinopathy and diabetic neuropathy. This new understanding of the biology of complication-prone tissues highlights the need for organ-specific interventions in the treatment of diabetic complications.
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Affiliation(s)
- Stephanie Eid
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kelli M Sas
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven F Abcouwer
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Patrice E Fort
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
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171
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Go J, Ko K, Jun D, Kwon SK, Han S, Kim YH, Kim MH, Jun KW, Hwang J, Kim SD, Park SC, Kim JI, Yun SS, Moon I. A Half-Century 3000 Cases of Kidney Transplant Experiences in a Single Hospital: the Longest Registry in Korea. Transplant Proc 2019; 51:2559-2567. [PMID: 31439328 DOI: 10.1016/j.transproceed.2019.04.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/18/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to analyze the entire registry of kidney transplant over the past 50 years and understand the clinical significance. METHODS From the data on 3012 kidney transplants performed at our center between March 1969 and September 2018, we analyzed retrospectively clinical variables. RESULTS Until September 2018, there have been 3012 kidney transplants performed. The number of primary transplant cases was 2755 (91.8%), which included 16 cases of simultaneous liver-kidney transplant, and the number of repeated transplants was 245 (225 second transplants [7.5%] and 20 third transplants [0.7%]). There were 3 simultaneous pancreas kidney transplants, and 3 small bowel-kidney transplants, one of them being transplanted at the same time. There was a single simultaneous heart-kidney transplant. The viability rates of a transplanted kidney for 1, 5, 10, 20, and 30 years were 97%, 92%, 90%, 51%, and 36%, respectively, and the patient survival rates were 96%, 89%, 82%, 64%, and 52%, respectively. Five-year graft survival rate of the first 1000 cases was 64.6%; those of the 1001st to 2000th cases and 2001st to 3012th cases were 87.6% and 88.8%, respectively. There are statistically significant differences among the groups. CONCLUSION This study has identified the appropriate selection or control of immunotherapy, based on the risk level of kidney transplant recipient, is needed to minimize chronic rejection, which is the key cause of transplanted kidney failure.
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Affiliation(s)
- Jin Go
- Department of Surgery, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - KyungJai Ko
- Department of Surgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Dami Jun
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su-Kyung Kwon
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sanghyeop Han
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Young Hwa Kim
- Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Mi-Hyeong Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Kang Woong Jun
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Gyeonggi, Republic of Korea
| | - JeongKye Hwang
- Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sang Dong Kim
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Cheol Park
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Ji-Il Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Seob Yun
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - InSung Moon
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Coskun ZM, Ersoz M, Adas M, Hancer VS, Boysan SN, Gonen MS, Acar A. Kruppel-Like Transcription Factor-4 Gene Expression and DNA Methylation Status in Type 2 Diabetes and Diabetic Nephropathy Patients. Arch Med Res 2019; 50:91-97. [PMID: 31495395 DOI: 10.1016/j.arcmed.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/12/2019] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIM Diabetic nephropathy (DN) is one of the most serious microvascular complications in diabetic patients. The kruppel-like transcription factor-4 (KLF-4) affects the expression of genes involved in the pathogenesis of DN. The present study aims to identify the KLF-4 expression and DNA methylation (DNAMe) status in patients with type-2 diabetes (T2D) and DN and to reveal the contribution of the KLF-4 to the development of DN. MATERIAL AND METHODS The cohort study was performed with blood samples from 120 individuals; T2D group (n = 40), DN group (n = 40) and control group (n = 40). The expression level of the KLF-4 gene was analyzed using the real-time polymerase chain reaction (qRT-PCR) and the methylation profile detected using the methylation-specific PCR (MS-PCR) technique. RESULTS According to our findings, KLF-4 mRNA expression in the T2D group was 1.60 fold lower than in the control group (p = 0.001). In the DN group, the expression of KLF-4 mRNA was 2.92-fold less than that of the T2D group (p = 0.001). There was no significant alteration in the DNAMe status among the groups. CONCLUSION Our findings showed that regardless of the DNAMe status, KLF-4 gene expression may play a role in the development of T2D and DN. This suggests that the KLF-4 gene may be the target gene in understanding the mechanism of nephropathy, which is the most important complication of diabetes, and planning nephropathy-related treatments, but the data should be supported with more studies.
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Affiliation(s)
- Zeynep Mine Coskun
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Demiroglu Bilim University, Istanbul, Turkey.
| | - Melike Ersoz
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Demiroglu Bilim University, Istanbul, Turkey
| | - Mine Adas
- Department of Endocrinology, Ministry of Health Okmeydani Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Veysel Sabri Hancer
- Department Medical Genetics, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Serife Nur Boysan
- Department of Endocrinology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Mustafa Sait Gonen
- Department of Endocrinology, Faculty of Cerrahpasa Medicine, Istanbul University, Istanbul, Turkey
| | - Aynur Acar
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Demiroglu Bilim University, Istanbul, Turkey
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Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, Probstfield J, Botros FT, Riddle MC, Rydén L, Xavier D, Atisso CM, Dyal L, Hall S, Rao-Melacini P, Wong G, Avezum A, Basile J, Chung N, Conget I, Cushman WC, Franek E, Hancu N, Hanefeld M, Holt S, Jansky P, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Cardona Munoz EG, Pirags V, Pogosova N, Raubenheimer PJ, Shaw JE, Sheu WHH, Temelkova-Kurktschiev T. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet 2019; 394:131-138. [PMID: 31189509 DOI: 10.1016/s0140-6736(19)31150-x] [Citation(s) in RCA: 342] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Two glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide on renal outcomes in an exploratory analysis of the REWIND trial of the effect of dulaglutide on cardiovascular disease. METHODS REWIND was a multicentre, randomised, double-blind, placebo-controlled trial at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo and followed up at least every 6 months for outcomes. Urinary albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were estimated from urine and serum values measured in local laboratories every 12 months. The primary outcome (first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes), secondary outcomes (including a composite microvascular outcome), and safety outcomes of this trial have been reported elsewhere. In this exploratory analysis, we investigate the renal component of the composite microvascular outcome, defined as the first occurrence of new macroalbuminuria (UACR >33·9 mg/mmol), a sustained decline in eGFR of 30% or more from baseline, or chronic renal replacement therapy. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01394952. FINDINGS Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). At baseline, 791 (7·9%) had macroalbuminuria and mean eGFR was 76·9 mL/min per 1·73 m2 (SD 22·7). During a median follow-up of 5·4 years (IQR 5·1-5·9) comprising 51 820 person-years, the renal outcome developed in 848 (17·1%) participants at an incidence rate of 3·5 per 100 person-years in the dulaglutide group and in 970 (19·6%) participants at an incidence rate of 4·1 per 100 person-years in the placebo group (hazard ratio [HR] 0·85, 95% CI 0·77-0·93; p=0·0004). The clearest effect was for new macroalbuminuria (HR 0·77, 95% CI 0·68-0·87; p<0·0001), with HRs of 0·89 (0·78-1·01; p=0·066) for sustained decline in eGFR of 30% or more and 0·75 (0·39-1·44; p=0·39) for chronic renal replacement therapy. INTERPRETATION Long-term use of dulaglutide was associated with reduced composite renal outcomes in people with type 2 diabetes. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | | | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Québec City, QC, Canada
| | - Rafael Diaz
- ECLA, Estudios Clínicos Latinoamérica, Rosario, Argentina
| | | | - Prem Pais
- St John's Research Institute, Bangalore, India
| | | | | | - Matthew C Riddle
- Department of Medicine, Oregon Health & Science University Portland, OR, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Leanne Dyal
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Stephanie Hall
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Gloria Wong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia and University Santo Amaro, São Paulo, Brazil
| | - Jan Basile
- Medical University of South Carolina, Charleston, SC, USA
| | - Namsik Chung
- Yonsei University Health System, Seoul, South Korea
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic i Universitari, Barcelona, Spain
| | | | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences and Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Nicolae Hancu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Markolf Hanefeld
- Department of Internal Medicine, Dresden Technical University, Dresden, Germany
| | - Shaun Holt
- Victoria University of Wellington, Wellington, New Zealand
| | - Petr Jansky
- University Hospital Motol, Prague, Czech Republic
| | - Matyas Keltai
- Semmelweis University, Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Patricio Lopez-Jaramillo
- Research Institute, FOSCAL and Medical School, Universidad de Santander UDES, Bucaramanga, Colombia
| | | | | | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Detection and Characterization of a Biochemical Signature Associated with Diabetic Nephropathy Using Near-infrared Spectroscopy on Tissue Sections. J Clin Med 2019; 8:jcm8071022. [PMID: 31336850 PMCID: PMC6678121 DOI: 10.3390/jcm8071022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Histological evaluation of renal biopsies is currently the gold standard for acquiring important diagnostic and prognostic information in diabetic nephropathy (DN) patients. Nevertheless, there is an unmet clinical need for new biomarkers that allow earlier diagnosis and risk stratification. As biochemical changes in tissues must precede any symptomatic or morphological expression of a disease, we explored the potential of near-infrared (NIR) spectroscopy in the detection of a biochemical signature associated with DN. Kidney tissue sections were investigated using NIR spectroscopy, followed by principal component analysis and soft independent modelling of class analogy. A biochemical signature indicative of DN was detected, which enabled perfect discrimination between tissue sections with normal histological findings (n = 27) and sections obtained from DN patients (n = 26). Some spectral changes related to carbamoylation and glycation reactions appeared to be similar to the ones obtained in patients with DN. In addition, treatment with the deglycating enzyme fructosamine-3-kinase resulted in partial to pronounced restorations of the spectral pattern. Significant relationships were found between spectral features and laboratory parameters indicative of glycemic and uremic load, such as hemoglobin A1c, urea, creatinine, estimated glomerular filtration rate, and proteinuria. The presented method could be a useful tool to complement histopathological analysis in order to prevent or delay further disease progression, especially in the setting of post-transplant surveillance kidney biopsies.
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175
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Jamal Shahwan M, Hassan NAG, Shaheen RA. Assessment of kidney function and associated risk factors among type 2 diabetic patients. Diabetes Metab Syndr 2019; 13:2661-2665. [PMID: 31405691 DOI: 10.1016/j.dsx.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023]
Abstract
AIM diabetic patients are required for continuous monitoring programs hence continuous assessment of kidney function parameters is crucial. So, we aimed to determine the prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters, with poorly controlled type 2 diabetes mellitus pateints MATERIALS AND METHODS: A cross-sectional study was carried out at private health care centre. A total of 300 diabetic patients aged 18 years and above attended the clinic from February 2018 to Dec 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23). RESULTS out of the 300 diabetes patients recruited 42% of patients with type 2 diabetes had abnormal Creatinine Serum levels and 22.3% had abnormal glomerular filtration rate (GFR). Abnormal albumin urine levels were found in 28.3% and 11.3% had abnormal creatinine in urine. Abnormal Albumin: Creatinine Ratios (Alb/Cr), were found in 23%. Of the total, 77% (n = 231) had normal Alb: Cr Ratio, 20% had risk of nephropathy and 9% had nephropathy. CONCLUSION Current study revealed a high prevalence of abnormal renal parameters in patients with type 2 diabetes Mellitus. This necessitates the need for early and universal screening of renal functions. There is also an urgent demand for measures that target tight glycaemic, Vitamin D level and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.
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Affiliation(s)
- Moyad Jamal Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates.
| | | | - Rima Ahd Shaheen
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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176
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Álvarez-Cilleros D, López-Oliva E, Goya L, Martín MÁ, Ramos S. Cocoa intake attenuates renal injury in Zucker Diabetic fatty rats by improving glucose homeostasis. Food Chem Toxicol 2019; 127:101-109. [DOI: 10.1016/j.fct.2019.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 12/26/2022]
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Song X, Waitman LR, Hu Y, Yu ASL, Robins D, Liu M. Robust clinical marker identification for diabetic kidney disease with ensemble feature selection. J Am Med Inform Assoc 2019; 26:242-253. [PMID: 30602020 PMCID: PMC7792755 DOI: 10.1093/jamia/ocy165] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/05/2018] [Accepted: 11/21/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Diabetic kidney disease (DKD) is one of the most frequent complications in diabetes associated with substantial morbidity and mortality. To accelerate DKD risk factor discovery, we present an ensemble feature selection approach to identify a robust set of discriminant factors using electronic medical records (EMRs). Material and Methods We identified a retrospective cohort of 15 645 adult patients with type 2 diabetes, excluding those with pre-existing kidney disease, and utilized all available clinical data types in modeling. We compared 3 machine-learning-based embedded feature selection methods in conjunction with 6 feature ensemble techniques for selecting top-ranked features in terms of robustness to data perturbations and predictability for DKD onset. Results The gradient boosting machine (GBM) with weighted mean rank feature ensemble technique achieved the best performance with an AUC of 0.82 [95%-CI, 0.81-0.83] on internal validation and 0.71 [95%-CI, 0.68-0.73] on external temporal validation. The ensemble model identified a set of 440 features from 84 872 unique clinical features that are both predicative of DKD onset and robust against data perturbations, including 191 labs, 51 visit details (mainly vital signs), 39 medications, 34 orders, 30 diagnoses, and 95 other clinical features. Discussion Many of the top-ranked features have not been included in the state-of-art DKD prediction models, but their relationships with kidney function have been suggested in existing literature. Conclusion Our ensemble feature selection framework provides an option for identifying a robust and parsimonious feature set unbiasedly from EMR data, which effectively aids in knowledge discovery for DKD risk factors.
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Affiliation(s)
- Xing Song
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lemuel R Waitman
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yong Hu
- Big Data Decision Institute, Jinan University, Guangzhou, PRC
| | - Alan S L Yu
- Division of Nephrology and Hypertension and the Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David Robins
- Diabetes Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mei Liu
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
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178
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Abstract
BACKGROUND This study aimed to analyze the scientific outputs of diabetic kidney disease (DKD) research and explore its hotspots and frontiers from 2000 to 2017, using bibliometric methods. METHODS Articles in DKD research between 2000 and 2017 were retrieved from the Web of Science Core Collection (WoSCC). We used the VOSviewer 1.6.8 and CiteSpace 5.2 to analyze publication years, journals, countries, institutions, authors, references, and keywords. Keywords with citation bursts were used to analyze the research hotspots and emerging trends. RESULTS We identified 27,577 publications in DKD research from 2000 to 2017. The annual publication number increased with time. Nephrology Dialysis Transplantation published the highest number of articles. The United States was the most influential country with most publications and collaborations with other countries. Harvard University was the leading institute. Parving had the most cited publications. Keywords analysis indicated that the renin-angiotensin system inhibition used to be the most prevalent research topic, while recent research hotspots were podocyte, inflammation, and biomarker. The biomarkers for DKD screening, diagnosis, and prognosis could be a research frontier. CONCLUSIONS The number of DKD related publications rapidly increased over the past 2 decades. Our study revealed the structure, hotspots, and evolution trends of DKD research. Further studies and more collaborations are needed.
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Affiliation(s)
- Lu-Xi Zou
- School of Management, Zhejiang University, Hangzhou, Zhejiang
| | - Ling Sun
- Department of Nephrology, Xuzhou Central Hospital, Medical College of Southeast University, Xuzhou, Jiangsu, China
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179
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Sankrityayan H, Kulkarni YA, Gaikwad AB. Diabetic nephropathy: The regulatory interplay between epigenetics and microRNAs. Pharmacol Res 2019; 141:574-585. [PMID: 30695734 DOI: 10.1016/j.phrs.2019.01.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/20/2022]
Abstract
Diabetic nephropathy (DN) is still one of the leading causes of end-stage renal disease despite the emergence of different therapies to counter the metabolic, hemodynamic and fibrotic pathways, implicating a prominent role of genetic and epigenetic factors in its progression. Epigenetics is the study of changes in the expression of genes which may be inheritable and does not involve a change in the genome sequence. Thrust areas of epigenetic research are DNA methylation and histone modifications. Noncoding RNAs (ncRNAs), particularly microRNAs (miRNAs) control the expression of genes via post-transcriptional mechanisms. However, the regulation by epigenetic mechanisms and miRNAs are not completely distinct. A number of emerging reports have revealed the interplay between epigenetic machinery and miRNA expression, particularly in cancer. Further research has proved that a feedback loop exists between miRNA expression and epigenetic regulation in disorders including DN. Studies showed that different miRNAs (miR-200, miR-29 etc.) were found to be regulated by epigenetic mechanisms viz. DNA methylation and histone modifications. Conversely, miRNAs (miR-301, miR-449 etc.) themselves modulated levels of DNA methyltranferases (DNMTs) and Histone deacetylases (HDACs), enzymes vital to epigenetic modifications. With already few FDA approved epigenetic -modulating drugs (Vorinostat, Decitabine) in the market and miRNA therapeutic drugs under clinical trial it becomes imperative to analyze the possible interaction between the two classes of drugs in the modulation of a disease process. The purpose of this review is to articulate the interplay between miRNA expression and epigenetic modifications with a particular focus on its impact on the development and progression of DN.
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Affiliation(s)
- Himanshu Sankrityayan
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Rajasthan, 333031, India
| | - Yogesh A Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India
| | - Anil Bhanudas Gaikwad
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Rajasthan, 333031, India.
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180
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Histamine and diabetic nephropathy: an up-to-date overview. Clin Sci (Lond) 2019; 133:41-54. [PMID: 30606813 DOI: 10.1042/cs20180839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023]
Abstract
The classification of diabetic nephropathy (DN) as a vascular complication of diabetes makes the possible involvement of histamine, an endogenous amine that is well known for its vasoactive properties, an interesting topic for study. The aim of the present review is to provide an extensive overview of the possible involvement of histamine in the onset and progression of DN. The evidence collected on the role of histamine in kidney function together with its well-known pleiotropic action suggest that this amine may act simultaneously on glomerular hyperfiltration, tubular inflammation, fibrosis development and tubular hypertrophy.
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181
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Torres Crigna A, Daniele C, Gamez C, Medina Balbuena S, Pastene DO, Nardozi D, Brenna C, Yard B, Gretz N, Bieback K. Stem/Stromal Cells for Treatment of Kidney Injuries With Focus on Preclinical Models. Front Med (Lausanne) 2018; 5:179. [PMID: 29963554 PMCID: PMC6013716 DOI: 10.3389/fmed.2018.00179] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Within the last years, the use of stem cells (embryonic, induced pluripotent stem cells, or hematopoietic stem cells), Progenitor cells (e.g., endothelial progenitor cells), and most intensely mesenchymal stromal cells (MSC) has emerged as a promising cell-based therapy for several diseases including nephropathy. For patients with end-stage renal disease (ESRD), dialysis or finally organ transplantation are the only therapeutic modalities available. Since ESRD is associated with a high healthcare expenditure, MSC therapy represents an innovative approach. In a variety of preclinical and clinical studies, MSC have shown to exert renoprotective properties, mediated mainly by paracrine effects, immunomodulation, regulation of inflammation, secretion of several trophic factors, and possibly differentiation to renal precursors. However, studies are highly diverse; thus, knowledge is still limited regarding the exact mode of action, source of MSC in comparison to other stem cell types, administration route and dose, tracking of cells and documentation of therapeutic efficacy by new imaging techniques and tissue visualization. The aim of this review is to provide a summary of published studies of stem cell therapy in acute and chronic kidney injury, diabetic nephropathy, polycystic kidney disease, and kidney transplantation. Preclinical studies with allogeneic or xenogeneic cell therapy were first addressed, followed by a summary of clinical trials carried out with autologous or allogeneic hMSC. Studies were analyzed with respect to source of cell type, mechanism of action etc.
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Affiliation(s)
- Adriana Torres Crigna
- Medical Faculty Mannheim, Institute of Transfusion Medicine and Immunology, University of Heidelberg, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Cristina Daniele
- Medical Faculty Mannheim, Medical Research Centre, University of Heidelberg, Mannheim, Germany
| | - Carolina Gamez
- Department for Experimental Orthopaedics and Trauma Surgery, Medical Faculty Mannheim, Orthopaedic and Trauma Surgery Centre (OUZ), Heidelberg University, Mannheim, Germany
| | - Sara Medina Balbuena
- Department of Medicine (Nephrology/Endrocrinology/Rheumathology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Diego O. Pastene
- Department of Medicine (Nephrology/Endrocrinology/Rheumathology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniela Nardozi
- Medical Faculty Mannheim, Medical Research Centre, University of Heidelberg, Mannheim, Germany
| | - Cinzia Brenna
- Medical Faculty Mannheim, Medical Research Centre, University of Heidelberg, Mannheim, Germany
| | - Benito Yard
- Department of Medicine (Nephrology/Endrocrinology/Rheumathology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Norbert Gretz
- Medical Faculty Mannheim, Medical Research Centre, University of Heidelberg, Mannheim, Germany
| | - Karen Bieback
- Medical Faculty Mannheim, Institute of Transfusion Medicine and Immunology, University of Heidelberg, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
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182
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Hyperglycemia does not affect tissue repair responses in shear stress-induced atherosclerotic plaques in ApoE-/- mice. Sci Rep 2018; 8:7530. [PMID: 29760458 PMCID: PMC5951920 DOI: 10.1038/s41598-018-25942-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/30/2018] [Indexed: 12/31/2022] Open
Abstract
The mechanisms responsible for macrovascular complications in diabetes remain to be fully understood. Recent studies have identified impaired vascular repair as a possible cause of plaque vulnerability in diabetes. This notion is supported by observations of a reduced content of fibrous proteins and smooth muscle cell mitogens in carotid endarterectomy from diabetic patients along with findings of decreased circulating levels of endothelial progenitor cells. In the present study we used a diabetic mouse model to characterize how hyperglycemia affects arterial repair responses. We induced atherosclerotic plaque formation in ApoE-deficient (ApoE−/−) and heterozygous glucokinase knockout ApoE-deficient mice (ApoE−/− GK+/−) mice with a shear stress-modifying cast. There were no differences in cholesterol or triglyceride levels between the ApoE−/− and ApoE−/− GK+/− mice. Hyperglycemia did not affect the size of the formed atherosclerotic plaques, and no effects were seen on activation of cell proliferation, smooth muscle cell content or on the expression and localization of collagen, elastin and several other extracellular matrix proteins. The present study demonstrates that hyperglycemia per se has no significant effects on tissue repair processes in injured mouse carotid arteries, suggesting that other mechanisms are involved in diabetic plaque vulnerability.
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183
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Osama M, Mahmoud R, Said A. Microalbuminuria besides to urinary enzymatic protein levels increase in Diabetic kidney disease with type II diabetics. SANAMED 2018. [DOI: 10.24125/sanamed.v13i2.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Diabetic kidney disease (DKD) is a time progressive problem, give rise in uncontrolled Diabetics increasing risks for chronic kidney disease (CKD) and/or end-stage renal disease (ESRD). The vulnerability to renal dysfunction manifested with sudden glomerular hypofiltration associated with micro-to macroalbuminuria passing to renal failure. So that, screening of specific enzymes shifts, or urinary albumin may predict onset diabetic nephropathy. Objective: The assessment of urinary alkaline phosphatase (ALP), alanine aminopeptidase (AAP), acid phosphatase (ACP) and microalbuminuria (MAU) for type II diabetic patients. Patients and Methods: In this study,120 type II diabetic patients were compared to 90 healthy volunteers of matched age and sex in Al-Leith General Hospital, Al-Leith Kidney Unit (AKU), Al-Leith, Makkah area, KSA in which random urine samples were collected for testing of MAU, ALP, AAP, ACP and Cr. Results: Mean values of measured biomarkers in patient group for MAU, ALP, AAP, ACP and Cr were 51.92 mg/I, 41.55 U/L, 20.17 U/L, 570.10 U/L and 2.92 mg/dl VS in control group were 12.59 mg/I, 8.84 U/L, 6.94 U/L, 385.87U/L and 1.07 mg/dl respectively. Additionally, there were statistically positive correlation between AAP with MAU and ALP; ACP with MAU, ALP and AAP; Cr level with MAU, ALP, AAP and ACP; on the other hand, there were positive significant correlation between duration of diabetes with all studied markers. Conclusion: Using of MAU in addition to other urinary enzymes could be beneficial non-invasive indicators for renal deterioration in type II diabetics.
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