الفهرس 
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Abstract
Diabetes mellitus is the most common non-communicable disease worldwide and considered to be the fourth to fifth leading cause of death in developed countries. There are two major forms of diabetes : type 1 and type 2 diabetes mellitus, type 1 diabetes mellitus is primarily due to autoimmune mediated destruction of pancreatic β cell islets resulting in absolute insulin deficiency, type 2 diabetes is more common and results from a combination of defects in insulin secretion and insulin action, either of which may predominate, people with type 2 diabetes are not dependent on exogenous insulin, but may require it for the control of blood glucose levels if this is not achieved with diet alone or with oral hypoglycemic agents, this type of diabetes accounts for 90 to 95% of all diabetic patients. Diabetes is one of the leading causes of CKD, about 10-20% of people with diabetes die of CKD, diabetic nephropathy affects approximately 30% of type 1 diabetic patients and approximately20 to 40% of those with type 2 diabetes, type 2 diabetes and diabetic nephropathy are clearly chronic progressive diseases that are associated with a combination of genetic, lifestyle and environmental factors, while many risk factors have been identified, such as obesity, diet and other lifestyle factors. Diabetic nephropathy is the most common cause of end stage renal disease, due to the increasing prevalence of type 2 diabetes mellitus, screening for diabetic nephropathy is done by detecting microalbuminuria. Annual screening for microalbuminuria will allow the identification of patients with nephropathy at a point very early in its course, improving glycemic control, aggressive antihypertensive treatment, and the use of 93 Angiotensin converting enzyme inhibitors (ACEI) or Angiotensin receptor blockers (ARBs) will slow the rate of progression of nephropathy. Accurate estimation of glomerular filtration rate is essential for the diagnosis, staging, and management of chronic kidney disease, there is no simple and practical way to measure GFR directly, so it is estimated. Serum Creatinine-based equations that are used to estimate GFR are not precise, limitation of creatinine is that the GFR is affected by muscle mass and dietary intake, lower serum creatinine levels may less reliably detect impaired GFR in patients with certain characters like older age, female sex, chronic illness with muscle wasting, amputation, or a vegetarian diet, higher serum creatinine levels are associated with African American race, and a high protein diet, while estimating equations attempt to adjust for these factors, the result is not precise. Serum cystatin C level is the rate at which it is filtered at the glomerulus making it an excellent GFR marker, cystatin C may detect mild to moderate decreases in GFR that are not evident with serum creatininebased measurements, cystatin C GFR is better than creatinine based estimates of GFR at GFR levels >60 ml/min/1.73m2 (CKD stages 1 and 2), serum cystatin C has been reported as a good biomarker in the prediction of AKI and to have a prognostic value of the need for kidney transplant. Previous studies have shown that serum cystatin C concentration is correlated with glomerular filtration rate, therefore, the aim of this work was to evaluate the use of serum cystatin C to detect early decline of renal function in type 2 diabetes mellitus. This study was done on 40 patients of type 2 diabetes mellitus who were collected from outpatient clinic and inpatient of Internal Medicine Department, in El-Mogama El-Tebby Hospital, they were classified 94 according to albumin creatinine ratio into three groups: consist of 16 patients with normo-albuminuria, urinary (A/C) ≤ 30 mg/g, 10 patients with microalbuminuria, urinary (A/C) 30 - 300 mg/g, 14 patients with macroalbuminuria, urinary (A/C) ≥ 300 mg/g, the three groups were compared to 20 apparently healthy control persons. The following were done for all: Full history taking, clinical examination, abdominal ultrasound, laboratory investigations include: Albumin/Creatinine ratio (A/C), fasting and post prandial blood glucose, complete urine analysis, glycated hemoglobin (HbA1c), complete blood picture, serum urea, serum creatinine, serum cystatin C, measurement of GFR. The result of this study revealed that: Serum cystatin C is significantly higher in patients with diabetes mellitus than the control group, and higher in macro-albuminuria than all other groups, also there was positive correlation between cystatin C and A/C ratio, HbA1c, FBS, 2HPP, blood urea, DM duration and serum creatinine, and there was negative correlation between cystatin C and glomerular filtration rate.