Assessment for markers of nephropathy in newly diagnosed type 2 diabetics

Abstract

Background: Type 2 diabetics account for a large proportion of patients presenting in end-stage kidney disease (ESKD). Although diabetic renal disease can be predicted, a lot of diabetics present to Nephrologists in ESKD.

Objective: To assess for markers of nephropathy in newly diagnosed type 2 diabetics, using blood pressure levels, endogenous creatinine clearance and urinary protein excretion as markers of renal disease.

Study design: Ninety newly diagnosed type 2 diabetics were studied within 6 weeks of diagnosis. They were in good glycaemic control during the period of study. Seventy-two age and sex-matched and apparently healthy non-diabetics served as controls. Blood pressure was recorded in all subjects. 24 hours urine sample was collected for estimation of urinary protein excretion and endogenous creatinine clearance.

Results: Systolic and diastolic blood pressures were consistently higher in diabetics than in controls (p=0.001 and p=0.001 respectively). High-normal and midly elevated blood pressure were more prevalent in diabetics (p=0.001). Mean creatinine clearance in diabetics was significantly lower than in non-diabetics (p=0.037). 7% of diabetics had supra-normal creatinine clearance of >125mls/minute. The prevalence of microproteinuria was 40% in diabetics and 33% in non-diabetics, while macroproteinuria was present in 44% of diabetics but absent in non-diabetics (p=0.000).

Conclusion: High-normal, mildly elevated blood pressure and microproteinuria were commonly encountered in newly diagnosed diabetics studied. The phenomenon of hyperfiltration was present in type 2 diabetics. These tools should be assessed at diagnosis of diabetes as this will help in identifying those who are at an increased risk for developing diabetic nephropathy.

Keywords: diabetics, blood pressure, proteinuria, hyperfiltration, nephropathy

West African Journal of Medicine Vol. 24(2) 2005: 134-138