Tip 2 siyabetik normoalbuminürik ve mikroalbuminürik hastalarda diyabetik nefropatinin belirteci olarak sistatin C ve TGF-B1

Bu çalışma normoalbuminürik ve mikroalbuminürik tip 2 diyabetli hastalarda serum sistatin C ile serum ve idrar TGF-β1 seviyelerini ölçmek yoluyla böbrek yetmezliğini belirlemek için yapıldı. 78 tip 2 diyabetik hasta çalışmaya alındı. Hastalar idrar albumin miktarı ve hesaplanan GFR’ye (eGFR) göre 4 gruba ayrıldı. (MDRD [Modification of Diet in Renal Disease] ile eGFR hesaplandı). Grup 1 (n=20); eGFR <60 ml/dk/1,73 m2 ve normoalbuminürik hastalar, grup 2 (n=21): eGFR 60 ml/dk/1,73 m2 ile mikroalbuminürik hastalar, grup 3 (n=17): eGFR >120 ml/dk/1,73 m2 ile normoalbuminürik hastalar ve grup 4 (n=20): eGFR 90- 120 ml/dk/1,73 m2 ile normoalbuminürik hastalardan oluştu. Serum kreatinin, idrar albumin düzeyleri, MDRD’ye göre eGFR, serum sistatin C, serum ve idrar TGF-β1 düzeyleri belirlendi. İstatistiksel analiz için Ki-kare testi, One-Way Anova and Tukey HDS testi kullanıldı. Makrovasküler komplikasyonlar grup 2 hastalarda diğerlerinden daha yüksek bulundu (p<0.01), fakat diğer diyabetik komplikasyonlar açısından gruplar arasında fark yoktu. Grup 1 hastalarda kan glukoz regülasyonu en iyi olmasına rağmen, kan üre (BUN), serum kreatinin daha yüksek ve eGFR anlamlı olarak daha düşüktü. Normoalbuminürik grup 1 hastalarda serum sistatin C belirgin olarak yüksek iken, serum ve idrar TGF-β1 düzeyleri mikroalbuminürik grup 2 hastalarda yüksekti. Grup 2 hastalarda eGFR ile serum sistatin C düzeyleri arasında negatif korelasyon bulundu (r=-0.892, P<0.001). Tüm hasta gruplarının değerlendirilmesinde eGFR ile sistatin C arasında negatif yönde anlamlı ilişki bulundu (r=-0,726 p=0,001). Tip 2 diyabetiklerde idrar albumin atılımı nefropati saptanmasında önerilmesine rağmen, bu çalışmada idrarda albumin atılımı artmamış, eGFR’si azalmış hasta grubunda artmış serum sistatin C düzeylerinin diyabetik nefropatinin erken belirteci olarak kullanılabileceğini gösterdik

Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study

Uzuncakmak, Tugba Kevser Ustunbas/0000-0001-8057-3463WOS: 000434665900005PubMed: 30374476OBJECTIVE: Obesity is known to be a risk factor for many diseases including dermatological problems. Here, we aimed to determine the cutaneous manifestations in obese patients and the frequency of the accompanying dermatoses and to investigate the effect of diabetes mellitus in obese patients on cutaneous manifestations compared with the control group. METHODS: Our study included a total of 600 adults: 450 obese volunteers and 150 healthy volunteers. The number of diabetic obese patients was 138 (30%), whereas that of nondiabetic obese patients was 312 (70%). A detailed dermatological examination was performed for each case, and accompanying dermatoses were compared. RESULTS: The mean body mass index (BMI) in the obese patients and control group was 37.22 kg/m(2) and 22.23 kg/m(2), respectively. The most common dermatoses in the obese patients were, according to their frequency: striae distensae (291 patients, 64.7%), acrochordon (236 patients, 52.4%), acanthosis nigricans (213 patients, 47.3%), plantar hyperkeratosis (209 patients, 46.4%), and venous insufficiency (202 patients, 44.9%). Although hirsutism was more frequently observed in the nondiabetic obese group than in the diabetic obese group, stasis dermatitis was less frequently observed (p<0.05). CONCLUSION: We found that many dermatoses are more frequently observed in the obese patients than in the controls. We observed that the effect of obesity on skin is different from that of diabetes mellitus and that cutaneous manifestations of obesity occur more frequently. More extensive, comprehensive, and advanced studies on this subject are required

Factors associated with glomerular filtration rate variation in primary hyperparathyroidism after parathyroidectomy

WOS: 000458367000043PubMed: 30761868Background/aim: Prolonged hypercalcemia impairs renal function, and a reduced glomerular filtration rate (GFR) is typical in advanced primary hyperparathyroidism (PHPT). There are scarce data related to predictors of renal impairment in patients with PHPT. Hence, we aimed to evaluate changes in kidney function in PHPT patients after parathyroidectomy (PTX) and identify factors associated with GFR variation in these patients. Materials and methods: One hundred and twenty-five patients with PHPT who underwent surgery between 2012 and 2014 were enrolled in the study. Patients were divided into two groups according to GFR values: patients whose GER was lower than 60 mL/min/1.73 m(2) and higher than 60 mL/min/1.73 m(2). Demographic and laboratory parameters were compared before and 6 months after parathyroidectomy. Results: Prevalence of antihypertensive drug users and patients with renal cysts and parathormone (PTH) and alkaline phosphatase levels were higher in patients with GFR of >60 than in GFR of = 60 but GFR did not change in the two groups after parathyroidectomy. After parathyroidectomy, calcium and PTH decreased but 25(OH)D3 and phosphorus increased in the two groups. In multiple regression analysis, age, calcium, and baseline GFR were independent predictors of GFR variation. Parathyroid adenoma volume and urinary calcium were not independent predictors of GFR change. Conclusion: Older age, higher preoperative calcium, and GFR were factors associated with GFR increase in PHPT patients after parathyroidectomy. Further renal impairment was prevented by parathyroidectomy in PHPT patients