23.dr abhay kumar.cdr BACKGROUND Diabetes mellitus is a group of clinical syndrome charac terized by hyperglycemia due to defects in insulin action, insulin secretion, or both causing diabetes mellitus. The chronic hyperglycemia of diabetes leading to long-term damage, dysfunction and failure of various organs, especially the kidneys, eyes, heart, nerves, and blood vessels. Type 2 diabetes mellitus has quickly become a global health problem due to rapidly increasing population growth, urbanization, aging and increasing prevalence of physical inactivity and obesity .These complications are due to long lasting effects of diabetes mellitus on the glomerular microvasculature of the kidney causing Diabetic nephropathy. Diabetic nephropathy (DN) develops in patients with several years of medical history of diabetes and uncontrolled hyperglycemia. Diabetes is the leading cause of end-stage renal disease (ESRD) in most countries of the world . Type 2 DM showed that intensive blood glucose control early in the course of disease exhibits a long-lasting favorable effect on the risk of Diabetic Kidney disease development. In diabetes, the cells do not receive glucose and most of it is accumulated in the blood causing hyperglycemia. Creatinine, Urea, uric acid, are the parameters to diagnose functioning of the kidney. However, Changes in serum creatinine concentration more reliably reect changes in Glomerular ltration rate than changes in serum urea concentrations. As Diabetes mellitus is the major cause of renal dysfunction, so a good control over the sugar level can halt the progression of renal damage. Serum BUN has a negative relationship with serum triglycerides in patients with diabetes mellitus, therefore a decrease in serum BUN may increase serum triglycerides. In the other hand, serum creatinine has a positive relationship with serum triglycerides, thus the increase in serum creatinine can also increase serum triglycerides in patients with diabetes mellitus. AIM AND OBJECTIVES : 1. To determine the frequency of abnormal kidney function test in patients with diabetes mellitus type 2 . 2. To study the relationship between abnormal kidney function test and glycemic prole. 3. To study the relationship between abnormal kidney function test and sociodemographic variable in patient with diabetes mellitus type 2. MATERIALS AND METHOD : This is prospective study which will be conducted on 83 patients of type 2 diabetes mellitus with age > 18 year. It will be collected with meticulous detailed history and thorough physical examination as indicated for a particular case will be done along with appropriate investigations. Relevant blood investigation will be performed and Kidney function test will be performed for each patient. Other investigation as needed for a patient will also be performed . Each patient in the study group will be followed till discharge. The following parameters will be looked in: a. Blood investigations cbc, Rbs,Hba1c , Urine complete examination, Abnormal kidney function test which include S.creatinine, B.urea ,S.uric acid ,S.Electrolytes, BUN , Estimated glomerular ltration rate (e GFR) by Cockcroft gault formula. INCLUSION CRITERIA : All patient of diabetes mellitus type 2 on treatment either insulin or hypoglycaemic drugs. , Newly diagnosed diabetes mellitus , Patient aged more than 18 year of age , Patient admitted in ward and Patient or relatives who sign an informed consent . EXCLUSION CRITERIA : Gestational diabetes mellitus patients , Drug induce diabetes mellitus patient and patients admitted in ICU. RESULTS : With 83 no of cases ,the mean age with standard deviation was 56.45±13.397 years. The mean and standard deviation Hb for all patients 12.4804±2.03323 .The mean creatinine with standard deviation was 1.453±1.337 ,.the mean urea with standard deviation was 57.54±42.14 , the mean uric acid with standard deviation was 6.06±1.377 , the mean BUN with standard deviation was 26.909±19.705 ,the mean EGFR with standard deviation was 71.912±41.16 , the mean HbA1C with standard deviation was 10.211±2.72 and the mean RBS with standard deviation was 240.70±97.64. There was no statistically signicant difference among the mean of normal FREQUENCY OF ABNORMAL KIDNEY FUNCTION TESTS IN PATIENTS WITH DIABETES MELLITUS TYPE 2 Original Research Paper Dr. Abhay Kumar Resident, Department Of General Medicine, Geetanjali Medical College And Hospital, Udaipur, Rajasthan, India Medicine BACKGROUND : In this study, we determined frequency of abnormal kidney function tests in patients with diabetes mellitus type 2 and its glycemic prole . METHOD : This is an prospective study on patients diagnosed with diabetes mellitus type 2 in Geetanjali Medical College and Hospital, Udaipur.83 cases were included in the study.Kidney function tests along with other blood routine tests were done. RESULTS : The mean creatinine with standard deviation was 1.453±1.337 .The mean uric acid with standard deviation was 6.06±1.37 . The mean RBS with standard deviation was 240.70±97.64 . There was no statistically signicant difference among the mean of normal and abnormal KFT patients for Hb, TLC, PC, Na, k, Cl and RBS as their p value was >0.05. However, there was statistically signicant difference among the mean values of normal and abnormal KFT patients as the p value for the following was <0.05. CONCLUSION : This study concludes that biochemical parameters of kidney functions are associated with a worsening in insulin action and predicts the development of Type 2 diabetes. The study also revealed that in order to prevent the progression of diabetes mellitus to diabetic nephropathy, vigilant monitoring of serum urea and creatinine would help in the early diagnosis of renal failure and could make treatment possible. ABSTRACT KEYWORDS : Kidney Function Tests, Diabetes Mellitus Type 2 VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Damodar Parikh* Associate Professor, Department Of General Medicine, Geetanjali Medical College And Hospital, Udaipur, Rajasthan, India *Corresponding Author 8 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS and abnormal KFT patients for Hb, TLC, PC, Na, k, Cl and RBS as their p value was >0.05. However, there was statistically signicant difference among the mean values of normal and abnormal KFT patients as the p value for the following was <0.05 . Out of 51 patients with normal KFT, 19 were male and the remaining 32 were female. Furthermore, out of 32 patients with abnormal KFT, 14 were female and 18 were male. There was no statistically signicant difference between gender of the normal and the abnormal KFT patients p value was >0.05 Out of 51 patients with normal KFT, majority of them belonged to 61-70 years of age group. Furthermore, out of 32 patients with abnormal KFT majority of them belonged to 51-60 years of age group. There was no statistically signicant difference between age group of the normal and the abnormal KFT patients p value was >0.05. DISCUSSION : In the current study the number of males was 50 and the number of females was 33. This implied that the study showed male predominance. Similarly according to the study of Caramori et al, (2013) and Al Salhen, (2016) also showed that the number of males was greater than that of the females depicting that males were more affected as compared to females. In the current study the mean age with standard deviation was 56.45±13.397 years. It was identied that the current mean age was higher than that of the study conducted by Caramori et al, (2013) where it was 35.0±9.9 years. However, the current mean age was at par with that of Al Salhen, (2016) where the mean age was 56.10±7.82 years. In the current study it was identied that majority of the diabetic patients had the disease from 0-5 years. Similar results were found in the study of Al Salhen, (2016) where the majority of the diabetic patients had the disease for <5 years. Furthermore, in the current study the mean create with standard deviation was 1.453±1.337, the mean urea with standard deviation was 57.54±42.14 and the mean uric acid with standard deviation was 6.06±1.377. Therefore, it was identied that there was a statistically signicant correlation among these factors and diabetes. Similar results were found in the study of Bamanikar et al, (2016)13 where a strong positive correlation between the serum urea levels and blood sugar levels. However, the study contrasted the current ndings as it was found in the study that there was a weak positive correlation between serum creatinine levels and blood sugar. CONCLUSION : It has been identied in the current study that biochemical parameters of kidney functions are associated with a worsening in insulin action and predicts the development of Type 2 diabetes. The study also revealed that in order to prevent the progression of diabetes mellitus to diabetic nephropathy, vigilant monitoring of serum urea and creatinine would help in the early diagnosis of renal failure and could make treatment possible. REFERENCES : 1. Steinke JM, Sinaiko AR, Kramer MS, Suissa S, Chavers BM, Mauer M. The early natural history of nephropathy in type 1 diabetes: III. Predictors of 5- year urinary albumin excretion rate patterns in initially normoalbuminuric patients. Diabetes. 2005 Jul 1;54(7):2164-71. 2. Rossing P, Rossing K, Gæde P, Pedersen O, Parving HH. Monitoring kidney function in type 2 diabetic patients with incipient and overt diabetic nephropathy. Diabetes care. 2006 May 1;29(5):1024-30. 3. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clinical Journal of the American Society of Nephrology. 2017 Dec 7;12(12):2032-45. 4. Keane WF, Zhang Z, Lyle PA, Cooper ME, de Zeeuw D, Grunfeld JP, Lash JP, McGill JB, Mitch WE, Remuzzi G, Shahinfar S. Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy: the RENAAL study. Clinical journal of the American Society of Nephrology. 2006 Jul 1;1(4):761-7. 5. Bamanikar SA, Bamanikar AA, Arora A. Study of Serum urea and Creatinine in Diabetic and nondiabetic patients in a tertiary teaching hospital. The Journal of Medical Research. 2016;2(1):12-5. 6. Najaan B, Kim Y, Crosson JT, Mauer M. Atubular glomeruli and glomerulotubular junction abnormalities in diabetic nephropathy. Journal of the American Society of Nephrology. 2003 Apr 1;14(4):908-17 7. Sulaiman MK. Diabetic nephropathy: recent advances in pathophysiology and challenges in dietary management. Diabetology & metabolic syndrome. 2019 Dec 1;11(1):7. 8. Al Salhen KS, Mahmoud AY. Determinants of abnormal kidney function tests in diabetes patient type 2 in Libya. International Journal of Scientic Study. VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra KFT N Mean Std. Deviation P-value Hb Normal 51 12.8033 1.96285 >0.05 Abnormal 32 11.9656 2.06782 TLC Normal 51 9.0033 2.74426 >0.05 Abnormal 32 9.5063 2.76766 PC Normal 51 2.1025 .73371 >0.05 Abnormal 32 1.9584 .62853 Create Normal 51 0.8927 0.19134 <0.05 Abnormal 32 2.3466 1.82522 Urea Normal 51 36.4853 15.11315 <0.05 Abnormal 32 91.0994 49.38233 U. Acid Normal 51 5.8224 1.01920 <0.05 Abnormal 32 6.4469 1.76031 Na Normal 51 136.84 6.754 >0.05 Abnormal 32 134.94 7.080 K Normal 51 5.1216 5.44949 >0.05 Abnormal 32 6.0625 7.66848 Cl Normal 51 99.494 5.8100 >0.05 Abnormal 32 101.469 11.0512 BUN Normal 51 17.0561 7.06063 <0.05 Abnormal 32 42.6141 23.07431 EGFR Normal 51 81.3441 31.64191 <0.05 Abnormal 32 56.8816 49.87343 RBS Normal 51 229.351 93.5787 >0.05 Abnormal 32 258.800 102.6894 KFT Total P-value Normal Abnormal Sex Female Count 19 14 33 >0.05 % within KFT 37.3% 43.8% 39.8% Male Count 32 18 50 % within KFT 62.7% 56.3% 60.2% Total Count 51 32 83 % within KFT 100.0% 100.0% 100.0% KFT N Mean Std. Deviation P-value HbA1C Normal 51 9.6639 2.25479 <0.05 Abnormal 32 11.0844 3.19325 KFT Total P-value Normal Abnormal Age Group (Years) 31-41 Count 8 4 12 >0.05 % within KFT 15.7% 12.5% 14.5% 41-50 Count 11 8 19 % within KFT 21.6% 25.0% 22.9% 51-60 Count 9 10 19 % within KFT 17.6% 31.3% 22.9% 61-70 Count 18 6 24 % within KFT 35.3% 18.8% 28.9% 71-80 Count 2 3 5 % within KFT 3.9% 9.4% 6.0% >80 Count 3 1 4 % within KFT 5.9% 3.1% 4.8% Total Count 51 32 83 % within KFT 100.0% 100.0% 100.0% X 9GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS 2016 Sep 1;4(6):99-103. 9. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clinical Chemistry. 1992 Oct 1;38(10):1933-53. 10. Judykay T. Nutrition for reducing urea and creatinine in the blood. Diabetes care. 2007;27:2191-2. 11. Kodama S, Saito K, Yachi Y, Asumi M, Sugawara A, Totsuka K, Saito A, Sone H. Association between serum uric acid and development of type 2 diabetes. Diabetes care. 2009 Sep 1;32(9):1737-42. 12. Del Prato S, Bonadonna RC, Bonora E, Gulli G, Solini A, Shank M, DeFronzo RA. Characterization of cellular defects of insulin action in type 2 (noninsulin- dependent) diabetes mellitus. The Journal of clinical investigation. 1993 Feb 1;91(2):484-94 13. Cordonnier DJ, Zmirou D, Benhamou PY, Halimi S, Ledoux F, Guiserix J. Epidemiology, development and treatment of end-stage renal failure in type 2 diabetes. The case of mainland France and of overseas French territories. Diabetologia, 1993;36:1109-12 14. Olivarius ND, Andreasen AH, Keiding N, Mogensen CE. Epidemiology of renal involvement in newly-diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study “Diabetes Care in General Practice”, Denmark. Diabetologia. 1993 Oct 1;36(10):1007-16 15. Gulab K, Neelam J, Nidhi S, Monika S, Juber A, Rahul K. Signicance of serum urea and creatinine levels in Type 2 diabetic patients. IOSR J Dent Med Sci. 2015;14:65-7. 16. Caramori ML, Parks A, Mauer M. Renal lesions predict progression of diabetic nephropathy in type 1 diabetes. Journal of the American Society of Nephrology. 2013 Jul 1;24(7):1175-81. VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 10 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS