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Diabetic nephropathy and associated risk factors for renal deterioration

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Abstract

Predominantly diabetic nephropathy starts with glomerulosclerosis, when plasma molecules cross the dismantled glomerular basement membrane (GBM) and subsequently appear in urine. Therefore proteinuria is a sensitive criterion to diagnose progressive renal impairment and the presence of immunoglobulin like large molecules is potentially able to predict severity of nephropathy. Directly, or indirectly hyperglycemia induces proteinuria and high urinary excretion of IgG appears with progression of glomerular injury. This is an observational study of 683 patients with type 2 diabetes mellitus. Patients with varying degree of proteinuria were enrolled and classified into three groups according to the urinary albumin creatinine ratio (UACR, <29, 30–299, >300 mg/g creatinine.) and each group was further sub-classified into the low and high urinary IgG creatinine ratio (UIgGCR) based on the median value. Biochemical parameters were analyzed by standard laboratory methods. The association of proteinuria and odds ratio for risk factors of diabetic nephropathy was estimated using multinomial logistic regression models. The normoalbuminuric and microalbuminuric patients with high UIgGCR had shown lower eGFR (p < 0.05). There was no interaction observed between higher UIgGCR and lower eGFR in regression model analysis. Multinomial logistic regression model estimated the odds ratio for the AGEs, AOPP, lipid hydroperoxides and lipid peroxidation products were increased; 5.64 (95% CI 3.52–9.04), 1.03 (95% CI 1.02–1.04), 2.71 (95% CI 2.05–3.57) and 13.72 (95% CI 6.98–26.95) respectively with high UIgGCR in diabetic patients. High UIgGCR has shown a significant association with decreased eGFR and increased odds for potential hazardous factors. The current study has shown UIgGCR as an increased relative risk, and threat for rapid progression of diabetic nephropathy, possibly because GBM is the primary vulnerable site for deterioration by several hazardous metabolites. In conclusion, association between fractional clearance of IgG and relative risk of GBM threatening factors should be useful for prediction of progressive nature of diabetic nephropathy.

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Acknowledgement

We are thankful to Prof. Arvind Pandey (Director), and Dr. Tulsi Adhikari (Research Officer), from Institute for Research in Medical Statistics (ICMR), New Delhi India, for their assistance in statistical analysis and Dr Khan, Department of English, Sardar Patel University for revising the English language of the manuscript. We also acknowledge to GSBTM Gandhinagar, Gujarat and UGC New Delhi, India, to provide Financial assistance for the accomplishment of this work. We wish to sincerely thank all the patients for their cooperation during this study.

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Authors and Affiliations

  1. Laboratory of Biochemistry, BRD School of Biosciences, Sardar Patel University, Post Box No. 39, Vallabh Vidyanagar, 388 120, Anand, Gujarat, India

    Sandesh Mohan & Kiran Kalia

  2. Department of Medicine, Shree Krishna Hospital and Pramukh Swami Medical Collage, Karamsad, 388325, Gujarat, India

    Jyoti Mannari

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  1. Sandesh Mohan
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  2. Kiran Kalia
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Correspondence to Kiran Kalia.

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Mohan, S., Kalia, K. & Mannari, J. Diabetic nephropathy and associated risk factors for renal deterioration. Int J Diabetes Dev Ctries 32, 52–59 (2012). https://doi.org/10.1007/s13410-011-0047-x

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