Renal tubular dysfunction in patients with non­ insulin dependent diabetes mellitus

Abstract

Diabetes has become the most common single cause of end-stage renal disease (ESRD); this is due to the facts that I) diabetes, particularly type 2, is increasing in prevalence; 2) diabetic patients now live longer; and 3) patients with diabetic ESRD are now being accepted for treatment in ESRD programs.

About 2()...30% of patients with type 1 or type 2 diabetes develop evidence of nephropathy. It is well established that the detection of microalbuminuria (2:30 mglday of albumin in the urine) in patients with diabetes mellitus indicates the presence of glomerular involvement in early renal damage. Recent studies have demonstrated that there is also a tubular component of renal complications in diabetes, as shown by the detection of renal tubular proteins and enzymes in urine.

So, the object of this study was I) To determine the activity of urinary enzymes [N-acetyl-j3-D-glucosaminidase (NAG), a lysosomal enzyme, y-glutamyltranspeptidase (GGT), alkaline phosphatase (ALP), brush border enzymes and p2 microglobulin (p 2MG) as one of the tubular proteins] as markers of tubular damage which may reflect early stage of diabetic nephropathy. 2) To clarifY the importance of estimation of these enzymes as noninvasive cheap tools in monitoring the course of ON (degree of proteinuria). 3) Also the serum levels of angiotensin converting enzyme (ACE) was studied to evaluate the endothelial disorder in diabetic patients that is thought to participate in the pathology ofDN and its level indicates the stage of nephropathy. The present study was conducted in the Biochemistry Department and the Internal Medicine Department at Assiut University Hospital.