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Ovwasa H, Aiwuyo HO, Okoye OA, Umuerri EM, Obasohan A, Unuigbe E, Rajora N. Risk Assessment of Pre-dialysis Chronic Kidney Disease (CKD) Patients for Cardiovascular Disease (CVD) in a Tertiary Hospital in Nigeria: A Case-Controlled Cross-Sectional Study. Cureus 2023; 15:e36725. [PMID: 37123714 PMCID: PMC10132851 DOI: 10.7759/cureus.36725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the chronic kidney disease (CKD) population. CKD patients are more likely to die from CVD before ever reaching end-stage renal disease (ESRD). The study, therefore, seeks to identify the prevalence of risk factors of CVD in CKD patients such as systemic hypertension, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products. METHODS The study was a case-control cross-sectional study where one hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. RESULTS The findings of the study revealed the mean ages of cases and controls to be 48.91±11.93 years and 51.0±15.45 years respectively (p-value 0.182). There was an equal number of males and females among the study group and controls (92 males and 58 females) making a male-to-female ratio of 3:2. The prevalence of CVD risk factors such as diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein, anemia, hypocalcemia, hyperphosphatemia, albuminuria, and hypoalbuminemia was significantly higher among the CKD group compared to controls. Similarly, the prevalence of reduced high-density lipoprotein (HDL) was higher among cases than controls, the difference was however not statistically significant. CONCLUSION The study has shown that systemic hypertension, diabetes, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products increases the risk for CVD in the general population but is more expressed and significant in CKD patients.
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Chikoti S, Najiya U, Sumanlatha G, Jahan P. Cytokine gene variants of TNF-α and IL-10 in the propensity of type 2 diabetes in south Indian population. J Diabetes Complications 2022; 36:108304. [PMID: 36148706 DOI: 10.1016/j.jdiacomp.2022.108304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/14/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
Chronic inflammation plays an important role in type 2 diabetes mellitus (T2DM), a common endocrinological pro-inflammatory disorder associated with insulin resistance. The objective of the present study is to see individual and combined effect of TNF-α (rs361525, rs1800629) and IL-10 (rs1800872, rs1800896) genes on T2DM susceptibility The genotyping was carried out in 200 T2DM patients and 200 healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using suitable primers. The results shown that TNF-α (GA of rs361525 & rs1800629) and IL-10 (AA of rs1800872 & GA of rs1800896) genes are significantly linked with T2DM development. The presence of AA-GA genotype combination for both TNF-α and IL-10 genes were elevating the risk of T2DM. Moreover, individuals bearing haplotypes AAAA, AACA and AAAG experience the increased risk of T2DM. Furthermore, gene-gene interaction analysis shown that TNF-α (GA of rs361525 & rs1800896) gene redundantly confer 3.4-fold elevated risk for T2DM. In gene-environment interaction, GA of TNF-α -1800896, W/H ratio and TG/HDL ratio were redundantly interacted each other and increase the risk of T2DM by 67-times. In conclusion, our results reveal that there is a significant association between foresaid TNF-α, IL-10 gene promoter polymorphisms and T2DM development. To the best of our knowledge this study is the first of its kind in the literature reporting the epistatic association of TNF-α (rs1800629G/A) gene with TG/HDL ratio and W/H ratio over IL-10 gene polymorphisms for T2DM susceptibility among south Indians.
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Affiliation(s)
- Swetha Chikoti
- Department of Genetics, Osmania University, Hyderabad, India
| | - Umme Najiya
- Department of Genetics, Osmania University, Hyderabad, India
| | | | - Parveen Jahan
- School of Sciences, Maulana Azad National Urdu University, Hyderabad, India.
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Rajasekaran A, Kalaivani M. Protective effect of Monascus fermented rice against STZ-induced diabetic oxidative stress in kidney of rats. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2015; 52:1434-43. [PMID: 25745211 PMCID: PMC4348320 DOI: 10.1007/s13197-013-1191-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 09/21/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
In the present study, anti-diabetic activity and nephroprotective effect of MMFR was evaluated by using STZ-induced diabetic rats. Administration of MMFR at 100 and 200 mg/kg bw showed significant (P < 0.01) anti-hyperglycemic activity by lowering blood glucose level, HbA1C and increasing body weight. Altered lipid profiles in diabetic rats were restored to normal level on treatment with MMFR and showed significant (P < 0.01) decrease in the elevated levels of biochemical parameters. MMFR produced significant (P < 0.01) improvement in antioxidant levels in kidney. Food safety of MFR produced by using mutant Monascus purpureus 254 (MMFR) was evaluated for genotoxicity and oral acute toxicity. In Ames mutagenicity assay MMFR doesn't showed any toxicity to the test strain S. typhimurium till 5 mg/plate. Acute toxicity study also recorded no toxicity till the dose of 5,000 mg/kg bw. The study concluded that MMFR, not only possess anti-diabetic activity but also prevents nephropathy and hypercholesterolemia due to diabetes.
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Affiliation(s)
| | - M. Kalaivani
- />Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Govt. of India, Sector-23, Raj Nagar, Ghaziabad, 201 002 India
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Roy R, Das MK, Pal BP, Ganesan S, Raman R, Sharma T. The effects of renal transplantation on diabetic retinopathy: clinical course and visual outcomes. Indian J Ophthalmol 2014; 61:552-6. [PMID: 24212305 PMCID: PMC3853450 DOI: 10.4103/0301-4738.121067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. DESIGN Retrospective study. MATERIALS AND METHODS A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. RESULTS The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 ± 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. CONCLUSIONS RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.
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Affiliation(s)
- Rupak Roy
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Kanasaki K, Nagai T, Nitta K, Kitada M, Koya D. N-acetyl-seryl-aspartyl-lysyl-proline: a valuable endogenous anti-fibrotic peptide for combating kidney fibrosis in diabetes. Front Pharmacol 2014; 5:70. [PMID: 24782774 PMCID: PMC3995071 DOI: 10.3389/fphar.2014.00070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/25/2014] [Indexed: 12/11/2022] Open
Abstract
Fibroproliferative diseases are responsible for 45% of deaths in the developed world. Curing organ fibrosis is essential for fibroproliferative diseases. Diabetic nephropathy is a common fibroproliferative disease of the kidney and is associated with multiorgan dysfunction. However, therapy to combat diabetic nephropathy has not yet been established. In this review, we discuss the novel therapeutic possibilities for kidney fibrosis in diabetes focusing on the endogenous anti-fibrotic peptide, N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP), which is the substrate for angiotensin-converting enzyme and exhibits meaningful anti-fibrotic effects in various experimental models of fibrotic disease.
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Affiliation(s)
- Keizo Kanasaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University Uchinada, Ishikawa, Japan
| | - Takako Nagai
- Department of Diabetology and Endocrinology, Kanazawa Medical University Uchinada, Ishikawa, Japan
| | - Kyoko Nitta
- Department of Diabetology and Endocrinology, Kanazawa Medical University Uchinada, Ishikawa, Japan
| | - Munehiro Kitada
- Department of Diabetology and Endocrinology, Kanazawa Medical University Uchinada, Ishikawa, Japan
| | - Daisuke Koya
- Department of Diabetology and Endocrinology, Kanazawa Medical University Uchinada, Ishikawa, Japan
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Pathania M, Rathaur VK, Yadav N, Jayara A, Chaturvedi A. Quantitative Micro-albuminuria Assessment from 'Random Voided Urinary Albumin: Creatinine Ratio' Versus '24 hours Urinary Albumin Concentration' for Screening of Diabetic Nephropathy. J Clin Diagn Res 2013; 7:2828-31. [PMID: 24551649 DOI: 10.7860/jcdr/2013/6589.3768] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/05/2013] [Indexed: 11/24/2022]
Abstract
AIMS This study aims at assessing the predictive value of random urine A:C ratio as a screening method for Micro-albuminuria assessment in DM patients as compared to 24 hours urine albumin. SETTINGS AND DESIGN A cross sectional observational study was conducted at a tertiary care centre. One hundred ninty three patients diagnosed with DM were enrolled in the study but 14 participants didn't turn up with 24 hours urine sample. Thus, 179 people actually participated in the study. MATERIAL AND METHODS All DM patients who attended Out Patient Departments (OPDs) and In Patient Departments (IPDs) of Medicine, Surgery and Orthopaedics, were enrolled. Proper history about development and duration of DM was taken from the patients. Examination in the form of height and weight measurement to know Body Mass Index (BMI), the Waist: Hip Ratio (W:H ratio) calculated from waist and hip circumference and blood pressure measurement was done. Fasting blood sugar was measured in the study group. [Urine analysis was done for urinary albumin and urinary creatinine]. Two urine samples were collected from each participant; one, 24 hours sample and the other random urine sample. 24 hours urine samples were used to measure urinary albumin concentration while urinary albumin to creatinine ratio was measured from random urine sample. STATISTICAL ANALYSIS USED SPSS 17. RESULTS Twenty four hours RUA:C ratio has very good sensitivity and specificity of Sensitivity and specificity of 84.9% and 95.8% respectively,which makes it a better alternative to 24 hours UAC. Negative and positive predictive values of RUA:C ratio method are 0.93 and 0.090 respectively with false negative and false positive rates, 15.1% and 4.2 % respectively. CONCLUSION Twenty four hours UAC is considered gold standard for screening of Micro-albuminuria but is cumbersome to collect 24 hours urine sample especially in OPD setup and in female patients. This leads to loss of compliance thereby preventing early diagnosis of diabetic nephropathy. This problem is more impracticable in hilly regions of India. By using random urine sample for screening of Micro-albuminuria in the form of RUA: C in random urine sample that correlates well with 24 hours UAC in 24 hours urine sample,is easier and more practical in Indian scenario especially in diabetics residing in hills.
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Affiliation(s)
- Monika Pathania
- Assistant Professor, Department of Medicine, VCSGGMS & RI , Uttrakhand, India
| | - Vyas Kumar Rathaur
- Assistant Professor, Department of Paediatrics, VCSGGMS & RI , Uttrakhand, India
| | - Neeraj Yadav
- Intern, Department of Medicine VCSGGMS & RI , Srinagar, Uttrakhand, India
| | | | - Aditi Chaturvedi
- Associate Professor, Department of Pharmacology, VCSGGMS & RI , Uttrakhand, India
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Kanasaki K, Taduri G, Koya D. Diabetic nephropathy: the role of inflammation in fibroblast activation and kidney fibrosis. Front Endocrinol (Lausanne) 2013; 4:7. [PMID: 23390421 PMCID: PMC3565176 DOI: 10.3389/fendo.2013.00007] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/16/2013] [Indexed: 12/13/2022] Open
Abstract
Kidney disease associated with diabetes mellitus is a major health problem worldwide. Although established therapeutic strategies, such as appropriate blood glucose control, blood pressure control with renin-angiotensin system blockade, and lipid lowering with statins, are used to treat diabetes, the contribution of diabetic end-stage kidney disease to the total number of cases requiring hemodialysis has increased tremendously in the past two decades. Once renal function starts declining, it can result in a higher frequency of renal and extra-renal events, including cardiovascular events. Therefore, slowing renal function decline is one of the main areas of focus in diabetic nephropathy research, and novel strategies are urgently needed to prevent diabetic kidney disease progression. Regardless of the type of injury and etiology, kidney fibrosis is the commonly the final outcome of progressive kidney diseases, and it results in significant destruction of normal kidney structure and accompanying functional deterioration. Kidney fibrosis is caused by prolonged injury and dysregulation of the normal wound-healing process in association with excess extracellular matrix deposition. Kidney fibroblasts play an important role in the fibrotic process, but the origin of the fibroblasts remains elusive. In addition to the activation of residential fibroblasts, other important sources of fibroblasts have been proposed, such as pericytes, fibrocytes, and fibroblasts originating from epithelial-to-mesenchymal and endothelial-to-mesenchymal transition. Inflammatory cells and cytokines play a vital role In the process of fibroblast activation. In this review, we will analyze the contribution of inflammation to the process of tissue fibrosis, the type of fibroblast activation and the therapeutic strategies targeting the inflammatory pathways in an effort to slow the progression of diabetic kidney disease.
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Affiliation(s)
- Keizo Kanasaki
- Division of Diabetology and Endocrinology, Kanazawa Medical UniversityKahoku, Japan
- *Correspondence: Keizo Kanasaki and Daisuke Koya, Division of Diabetology and Endocrinology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku Ishikawa 920-0293, Japan. e-mail: ; ; Gangadhar Taduri, Department of Nephrology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 500082, Andhra Pradesh, India. e-mail:
| | - Gangadhar Taduri
- Department of Nephrology, Nizam’s Institute of Medical SciencesHyderabad, India
- *Correspondence: Keizo Kanasaki and Daisuke Koya, Division of Diabetology and Endocrinology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku Ishikawa 920-0293, Japan. e-mail: ; ; Gangadhar Taduri, Department of Nephrology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 500082, Andhra Pradesh, India. e-mail:
| | - Daisuke Koya
- Division of Diabetology and Endocrinology, Kanazawa Medical UniversityKahoku, Japan
- *Correspondence: Keizo Kanasaki and Daisuke Koya, Division of Diabetology and Endocrinology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku Ishikawa 920-0293, Japan. e-mail: ; ; Gangadhar Taduri, Department of Nephrology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 500082, Andhra Pradesh, India. e-mail:
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Naresh VVS, Reddy ALK, Sivaramakrishna G, Sharma PVGK, Vardhan RV, Kumar VS. Angiotensin converting enzyme gene polymorphism in type II diabetics with nephropathy. Indian J Nephrol 2011; 19:145-8. [PMID: 20535249 PMCID: PMC2875703 DOI: 10.4103/0971-4065.59335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nephropathy is an important and a frequent complication of long-term type II diabetic nephropathy. Strong evidence exists that genetic predisposition plays a major role in the development of diabetic nephropathy. Recent studies have implicated association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and nephropathy. The deletion gene polymorphism of ACE gene has been shown to be associated with increased activity of this enzyme. This study examines the association of ACE I/D polymorphism with type II diabetes without nephropathy in 30 patients and type II diabetes with nephropathy in 30 patients. The results of the study suggest the association between the DD polymorphism and type II diabetes with nephropathy.
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Affiliation(s)
- V V S Naresh
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Sri Venkateswara University, Tirupati - 517 507, India
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Wong TYH, Choi PCL, Szeto CC, To KF, Tang NLS, Chan AWH, Li PKT, Lai FMM. Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies. Diabetes Care 2002; 25:900-5. [PMID: 11978688 DOI: 10.2337/diacare.25.5.900] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the risk factors for adverse renal outcome in type 2 diabetic patients who underwent renal biopsy and were followed-up longitudinally. RESEARCH DESIGN AND METHODS We examined 68 consecutive patients with type 2 diabetes during the period of 1985-1999 who underwent renal biopsy for proteinuria > or =1 g/day, renal involvement (proteinuria or renal impairment) at the absence of retinopathy, renal involvement with duration of diabetes < 5 years, or unexplained hematuria of glomerular origin. Their clinical features and underlying renal lesion were correlated with the renal outcome after longitudinal follow-up. Three groups of patients were defined based on their renal pathology: group I consisted of 24 patients (35%) with diabetic glomerulosclerosis (DGS) alone, group II consisted of 13 patients (19%) with nondiabetic nephropathy (NDN) superimposed on DGS, and group III consisted of 31 patients (46%) with NDN alone without evidence of DGS. RESULTS After a mean follow-up of 123 months from the diagnosis of type 2 diabetes (74 months from the time of renal biopsy), univariate analysis showed that risk factors for reaching end-stage renal disease (requiring maintenance dialysis, or a serum creatinine [SCr] > or =700 micromol/l) included proteinuria > or = 2g/day (P = 0.0087), SCr >120 micromol/l (P = 0.0005), presence of retinopathy (P < 0.00001) at the time of biopsy, and biopsy showing DGS (groups I and II) (P = 0.035). On multivariate analysis, retinopathy was the only independent variable correlated with end-stage renal failure. This study also showed that the association of hematuria or proteinuria with the absence of retinopathy constitutes the strongest indication for a nondiabetic lesion (positive predictive values of 94%). CONCLUSIONS Patients with type 2 diabetes undergoing renal biopsy constitute a heterogeneous group by their clinical presentations and underlying pathology, but longitudinal studies on the renal outcome of these patients remain limited. Our study showed that renal biopsy is indicated in selective diabetic patients because of potentially treatable nephropathy and of a better prognosis than DGS.
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Affiliation(s)
- Teresa Yuk Hwa Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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