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Jul22
MICROALBUMINURIA IN DIABETES MELLITUS AND ITS PROGNOSTIC SIGNIFICANCE
AIM OF THE STUDY:
Microalbuminuria is well established as the earliest detectable marker of nephropathy in Diabetes. Persistent microalbuminuria leads to nephropathy, cardiovascular changes and other complications. The present study was undertaken to correlate microalbuminuria in both type of Diabetes with complications.

METHODOLOGY:
One hundred cases of DM were studied during the period of January 2003 to December 2003. Urine samples of all cases were subjected to boiling test for detection of albumin (Microalbuminuria). Negative samples were subjected to micral test for microalbuminuria. Cases having definite previous history of Renal, Thyroid and Hepatic disease and Nephrotoxic drugs exposure were excluded from the study. All cases were subjected to detailed history, clinical and laboratory examination.

OBSERVATION:
In the present study out of 36 cases of Type 1 DM , 5 had microalbuminuria(13.8%) and out of 64 cases of type – 2 DM, 11 cases had microalbuminuria(17.1%). In both groups there was male preponderance (Type I, 17.3:7.6%; Type 2 21.5:12.5%). The 24 hour protein excretion was 14956.5 mg% in microalbuminuria cases. The mean systolic blood pressure was 145 19.95mm of HG in micral positive cases compared to 12622.83 mm of Hg in negative cases. The mean Blood pressure was 105.213.5mm of Hg in micral positive groups as compared to 91.312.63 mm of Hg in control group. The FBS and 2 hours PGBS was higher in micral positive groups. The creatinine clearance was 14712.9ml/min in micral group as compared to 12613.10 ml/min in negative groups indicating a significant increase in GFR in microalbuminuria cases. The serum cholesterol was high i.e 202.334.45 mg% in microalbuminuria cases indicating association of dyslipidemia specially in Type – 2 DM. Peripheral neuropathy, retinopathy and cardiovascular diseases were larger in patient with microalbuminuria <100 mg/24 hours suggesting renal hypertrophy is an early feature of diabetic renal disease and GFR was more in these patients. Renal biopsy showed basement membrane thickening in 11 cases and mesangial cell proliferation in 9 cases.
CONCLUSION:
In the present study microalbuminuria was correlated with different complications irrespective of the type of DM the systolic, diastolic and mean blood pressure was high. Neuropathy, retinopathy and cardiovascular complications were more in microalbuminuria cases and directly correlated with the duration of diseases. Renal hypertrophy was an early feature if nephropathy. Renal hisopathology was found to have a direct correlation with duration of disease and severity of microalbuminuria.


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