Diabetes and Endocrinology

Biography

Biography: Punit Gupta

Abstract

Introduction: The incidence of diabetes kidney disease continues to rise and has quickly become one of the most prevalent and costly chronic diseases worldwide. A close link exists between diabetes kidney disease and Cardiovascular Disease (CVD), which is the most prevalent cause of morbidity and mortality in diabetic patients.

Material & Methods: The present study was conducted in the Nephrology Unit Department of Medicine, Dr B.R.A.M. Hospital Raipur (C.G.) on 42 patients which included 20 patients of Diabetic Nephropathy as cases and 22 non diabetic patients as controls. The results was only a slight predominance of males over females in cases group (11:9). Mean age for 20 cases was 55.05 years. Maximum no. of patients (45%) were in stage IV diabetic nephropathy while there were no patients in stage I or II diabetic nephropathy.

Result: 70% of cases had hemoglobin >11 gm%. Mean hemoglobin was 11.75±2.88 gm%. Mean TLC count was 8615 cells/cumm. 80% of patients of diabetic nephropathy had normal TLC counts. Mean eGFR was 68.97±25.75 ml/min/1.73 sq. m in patients of diabetic nephropathy. Maximum number of cases (45%) had eGFR between 60-89 ml/min/1.73 sq. m. Mean serum creatinine was 1.23±0.62 in cases and 1.12±0.26 in controls with the difference between two groups being non-significant (p>0.05). About one third of patients of diabetic nephropathy had hypoalbuminemia. Hypercholesterolemia was present in about only 15% of cases. Mean serum cholesterol was 163±48.77 mg%. Hypertriglyceridemia was present in about only 15% of cases. Mean triglycerides was 138.75±78 mg%. All the patients of diabetic nephropathy in our study had some echocardiographic abnormality. Left Ventricular Diastolic Dysfunction (LVDD) was the most common abnormality present in 55% of patients while LV systolic dysfunction was present in 45% of cases. Mean EF was 47.67%. Coronary and renal angiography was done in 15 cases and 22 controls. Out of these 60% cases and 72% controls had significant coronary artery disease. Difference between two groups was non-significant (p>0.5, odds ratio=0.56). 87.5% of males in cases group had coronary artery disease in comparison to 57.14% female patients. Renal artery stenosis was found in 26.67% cases and 22.72% controls. This difference was statistically insignificant (odds ratio=1.23). In cases group, 80% of hypertensive patients had significant coronary artery disease as compared to 50% in normotensive patients. 40% of hypertensive patients had renal artery stenosis as compared to 20% in normotensive patients in cases group. Only 22.22% of patients having significant coronary artery disease had high serum cholesterol. 25% of patients having renal artery stenosis had high serum triglycerides. 33% of patients from cases group having significant coronary artery disease had hypoalbuminemia. Out of 9 patients in cases group having significant coronary artery disease none had hypothyroidism while 1 (11.11%) had hyperthyroidism.

Conclusion: Coronary artery disease is the most common abnormality seen. Male were most suffered from artery disease as compared to females. Renal artery stenosis was most common in disease. Coronary artery disease was common in patients with hypertension. Renal artery stenosis was most commonly associated with higher serum triglycerides. Hypothyroidism was more common in patients with significant coronary artery disease. Patients with diabetic nephropathy with geriatric age group had significant coronary artery disease.