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| Year : 2012 | Volume
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| Issue : 2 | Page : 286-289 |
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| Evaluation of high sensitivity creactive protein and glycated hemoglobin levels in diabetic nephropathy |
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MS Roopakala1, HR Pawan1, U Krishnamurthy2, CR Wilma Delphine Silvia3, Mahesh Eshwarappa4, KM Prasanna Kumar5
1 Department of Physiology, M. S. Ramaiah Medical College, Bangalore, India
2 Department of Biochemistry, M. S. Ramaiah Medical College, Bangalore, India
3 Department of Biochemistry, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India
4 Department of Nephrology, M. S. Ramaiah Medical College, Bangalore, India
5 Department of Endocrinology, M. S. Ramaiah Medical College, Bangalore, India
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| Date of Web Publication | 28-Feb-2012 |
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 Abstract | | |
Diabetic nephropathy (DN) is one of the major long-term complications of diabetes mellitus (DM). Type 2 DM is frequently associated with an inflammatory status, but limited information is available on the relationship between low-grade inflammation and DN. The aim of the study is to determine the serum level of high sensitivity C-reactive protein (hsCRP) in DN patients and to compare with that of normal subjects and to study the association between serum hsCRP levels and glycated hemoglobin (HbA1c) levels. Fifty DN patients in the age group of 50- 60 years with more than ten years of duration of diabetes were recruited for this study and 25 age-and sex-matched healthy subjects were included in this study as controls. Serum hsCRP levels were measured by turbidometry method. There was a statistically significant increase in serum hsCRP levels in DN cases as compared to normal controls. The hsCRP levels showed a positive correlation with HbA1c in DN. These results suggest that estimation of serum hsCRP levels and aiming at good glycemic control help in early intervention and prevention of further complications in diabetic patients.
How to cite this article:
Roopakala M S, Pawan H R, Krishnamurthy U, Wilma Delphine Silvia C R, Eshwarappa M, Prasanna Kumar K M. Evaluation of high sensitivity creactive protein and glycated hemoglobin levels in diabetic nephropathy. Saudi J Kidney Dis Transpl 2012;23:286-9 |
How to cite this URL:
Roopakala M S, Pawan H R, Krishnamurthy U, Wilma Delphine Silvia C R, Eshwarappa M, Prasanna Kumar K M. Evaluation of high sensitivity creactive protein and glycated hemoglobin levels in diabetic nephropathy. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2021 Feb 25];23:286-9. Available from: https://www.sjkdt.org/text.asp?2012/23/2/286/93155 |
| Introduction | |  |
Diabetic nephropathy (DN) is a progressive kidney disease caused by angiopathy of capillaries in glomeruli secondary to longstanding diabetes and is the major cause of morbidity and mortality in patients with Type 2 diabetes mellitus (DM). This emphasizes the importance of interventions that help patients with Type 2 diabetes to reduce the risk of nephro-pathy. Previous studies have proved that Type 2 DM is frequently associated with chronic inflammatory state. [1],[2] Chronic inflammation plays an important role in the development and progression of late complications of diabetes. [3],[4] C-reactive protein (CRP), an acute phase re-actant, is a highly sensitive marker of inflammation. Its level rises dramatically during an inflammatory processes. [5] CRP has a long half life, affordability of estimation, and stability of its levels with no circadian variation, and therefore is one of the best markers of vascular inflammation. [6] CRP has been found to be associated with disorders like DM, cardiovascular disorders, metabolic syndrome, renal failure, etc. [2],[7],[8] Serum high sensitivity CRP (hsCRP) level is higher in patients with Type 2 diabetes than in normal subjects and plays an important role in the development and progression of Type 2 DM. [9] It is also shown that the level of this marker of inflammation correlates with the levels of glycemic control, such as glycated hemoglobin A 1c (HbA 1c ). [10] But limited information is available on the relationship between low-grade inflammation and DN. Therefore, the present study was undertaken to evaluate serum hsCRP levels in DN.
| Materials and Methods | | |
Fifty clinically diagnosed DN patients in the age group of 50-65 years with more than ten years of duration of Type II DM, on conservative management, attending the outpatient departments of Endocrinology and Nephrology of M.S. Ramaiah Memorial Hospital, Bangalore, were included in the study group. Twenty-five age- and sex-matched healthy subjects constituted the control group. All the subjects completed a standard questionnaire regarding current medication and duration of diabetes. Subjects with history of any significant infections, trauma, malignancy, smoking, cancer, rheumatoid arthritis, those on any anti-inflammatory drug or with body mass index (BMI) >30 were excluded from the study. Patients on dialysis were also excluded. This study was approved by the institution's ethics committee, and informed consent was obtained from every subject. After 12 hours of fasting, blood samples were collected under aseptic precautions from median cubital vein using commercially available vacutainers. The level of HbA1c was determined by borate affinity assay (NycoCard, AXIS-SHIELD PoC AS, Norway). Serum creatinine was estimated by Modified Jaffe's method [11] using an autoanalyzer. Serum hsCRP concentration was measured by using a latex-enhanced immune-nephelometer (Biosystems, Barcelona, Spain).
| Statistical Analysis | | |
Analysis was done by using the statistical software SPSS 11.0 and Systat 8.0. The threshold of statistical significance was defined as P < 0.05. Pearson's correlation coefficient was used to find the relationship between hsCRP and HbA1c.
| Results | | |
The levels of serum creatinine, hsCRP, and glycated hemoglobin were higher than normal in the study group. Compared with the control group, these values were significantly higher in the study group (P < 0.001) [Table 1]. There was a statistically significant positive correlation between hsCRP and glycated hemoglobin in DN patients [Table 2]. In healthy controls, hsCRP showed no significant correlation with any of the parameters [Table 3]. | Table 1: Comparison of measured parameters in healthy controls and diabetic nephropathy cases.
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 | Table 2: Correlation of serum creatinine, HbA1c, and hsCRP in diabetic nephropathy.
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| Discussion | | |
In this study, the mean values of serum hsCRP levels were significantly elevated in DN patients when compared with healthy controls (P < 0.001). The results indicate the presence of inflammatory process in DN. Therefore, inflammation reflects the severity of the disease and signifies the presence of ongoing disease process. These observations are consistent with previous studies. [3],[12]
There are several possible mechanisms by which chronic low-degree inflammation might be induced in diabetes and its complications. In a hyperglycemic condition, the concentration of advanced glycation end products increases. Advanced glycation end products have been shown to activate macrophages, increase oxidative stress, and upregulate the synthesis of interleukin-1, interleukin-6 (IL-6), and tumor necrosis factor, resulting in the production of CRP. [13] Another possibility is that increase in CRP concentrations is related to adipose tissue derived cytokines. [14] However, the role of adipose tissue as a possible cause of the chronic inflammatory condition in patients with DN requires further investigation.
There was a statistically significant positive correlation of serum hsCRP levels with HbA1c indicating the role of poor glycemic control in the development of nephropathy. Studies have shown similar association between hyper-glycemia and inflammation. [15] It is known that glycation triggers the inflammatory process, leading to a rise in hsCRP levels. Thus, hsCRP can predict the onset of glycation-induced inflammatory process secondary to poor gly-cemic control. [3] It may not be just the burden of glucose exposure (long duration of diabetes) but also decreased insulin sensitivity plays a vital role, and they have a common denominator, low-grade inflammation; therefore, poor glycemic control along with decreased insulin sensitivity probably act in concert in the patho-genesis of DN. Low-grade inflammation may be a risk factor for the nephropathy in patients with type-2 diabetes. To evaluate this possibility, prospective studies are required. The limitation of the study was including nor-motensive healthy controls instead of patients with microalbuminuria and on angiotensin converting enzyme (ACE) inhibitors because ACE inhibitors inhibit the expression of pro-inflammatory cytokines such as IL-6, which suggests that some of the beneficial effects of ACE inhibitors could at least in part be mediated via pro-inflammatory genes.[16] From this study we conclude that there is a progressive increase in hsCRP levels in DN patients. The low-grade inflammation, indicated by hs-CRP, and hyperglycemia, indicated by HbA1c, together contribute to the pathoge-nesis of DN. Therefore, inflammation reflects the severity of the disease and signifies the presence of ongoing disease process. We also found a positive correlation between serum levels of hsCRP and HbA1c in DN patients. Thus, aiming at good glycemic control and estimation of serum hsCRP levels will possibly be of help in planning early intervention, thereby preventing further complications which in turn may help preserve renal function in DN patients.
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Correspondence Address:
M S Roopakala
Department of Physiology, M. S. Ramaiah Medical College, MSR Nagar, Bangalore - 54, Karnataka
India
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PMID: 22382220 
[Table 1], [Table 2], [Table 3] |
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