1. GLOMERULONEPHRITIS IN TYPE 2 DIABETES MELLITUS MOHAN DAS M.K, JACOB GEORGE,VIMALA.A. DEPARTMENT OF NEPHROLOGY, MEDICAL COLLEGE, THIRUVANANTHAPURAM 1

2. BACKGROUND INCREASING INCIDENCE OF NON DIABETIC RENAL DISEASE AS A CAUSE OF ACUTE RENAL FAILURE IN TYPE 2 DIABETES MELLITUS. SPECIFIC TREATMENT ALTERS OUTCOME. 2

3. OBJECTIVES INCIDENCE AND CLINICAL PROFILE OF NON DIABETIC RENAL DISEASE IN TYPE 2 DIABETES MELLITUS RENAL HISTOLOGY IDENTIFY NATURE OF GLOMERULAR DISEASE PROGNOSTIC FACTORS RESPONSE TO SPECIFIC TREATMENT 3

4. PATIENTS&METHODS PERIOD OF STUDY JUNE 1,2001-DEC 31,2004 INCLUSION CRITERIA PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ANY ONE OF THE FOLLOWING 1.ANTECEDENT INFECTION. 2.MICROSCOPIC OR MACROSCOPIC HAEMATURIA WITH NEGATIVE URINE CULTURE. 3.DISPROPORTIONATE DECLINE IN GFR. 4..LOW C3. 5.ABSENCE OF DIABETIC RETINOPATHY. 4

5. PATIENTS&METHODS(CONT.) GFR IS CALCULATED USING COCKROFT AND GAULT FORMULA DISPROPOTIONATE DECLINE IN GFR DEFINED AS DECREASE IN GFR MORE THAN 10ml/year 5

6. EXCLUSION CRITERIA 1. PATIENTS WITH CARDIAC FAILURE. 2. PATIENTS WITH ISCHAEMIC NEPHROPATHY. 3. IDENTIFIED PRECIPITATING FACTORS FOR DETERIORATION OF GFR LIKE DRUGS, HYPOVOLEMIA. 6

7. RESULTS TOTAL NUMBER OF PATIENTS -24 MEAN AGE OF PRESENTATION-51 MALE TO FEMALE RATIO -13:11 MEAN DURATION OF DIABETES-8yrs MEAN DURATION OF HYPERTENSION-5yrs MEAN BLOOD PRESSURE -150/100mmHg ALL PATIENTS HAD NON NEPHROTIC RANGE PROTEINURIA WITH A MAXIMUM OF 2.8gms. 7

8. CLINICAL PROFILE OF POST INFECTIOUS CRESCENTIC GN Mean age51.6 M : F4:1 Mean MAP103 Mean duration of DM10 Oliguria100% Pyoderma100% Low C33/5 35

9. CLINICAL PROFILE OF POST INFECTIOUS CRESCENTIC GN Dialysis requiring RF100% Underlying diabetic nephropathy100% TIN2/5 Type of crescentsCellular 2 Fibrocellular 3 Mortality100% 36

10. CharacterSurvivedDeath Mean age53.657.3 M : F2:1 Mean MAP95.6%99.6% Mean duration of DM1016 Oliguria100% Pyoderma66%100% Low C31/1 CLINICAL PROFILE OF DPGN WITHOUT CRESCENTS 37

11. CLINICAL PROFILE OF DPGN WITHOUT CRESCENTS Dialysis requiring RF 66.6%100% Underlying diabetic nephropathy 1/33/3 TIN33% Mean Serum Creatinine 3.87.1 38

12. Mean age48.6 M : F1:2 Mean MAP97.6% Mean duration of DM4.3 Oliguria66.6% Pyoderma66.6% Dialysis requiring RF66.6% CLINICAL PROFILE OF IgA 39

13. CLINICAL PROFILE OF IgA Underlying diabetic nephropathy1/3 TIN33% Mean Serum Creatinine6 Crescents1/3 Total No. of Patients3/24 Survival100% 40

14. CLINICAL PROFILE OF MGN, MPGN AND LN CharacterMGN (2/18)MPGN (1/18)LN(1/18) Mean age557341 M : F2:01:0 Mean MAP91.5106103 Mean duration of DM 2.528 Oliguria100% Dialysis requiring RF 1/200 41

15. CLINICAL PROFILE OF MGN, MPGN AND LN CharacterMGN (2/18)MPGN (1/18)LN(1/18) Underlying diabetic nephropathy 1/21/10/1 TINNIL1/10/1 Mean Serum Creatinine 4.31.42.3 Crescents½0/1 Survival100% 42

16. CLINICAL PROFILE OF PATIENTS WITH DN ALONE CharacterSurvivedDeath Mean age4743 M : F1:10:2 Mean MAP101.6105 Mean Duration of DM6.24.5 Oliguria100% Dialysis requiring RF0%100% TIN33% Mean Serum Creatinine 35 43

17. CLINICAL PROFILE OF PATIENTS WITH TIN AND TIN+DN CharacterTIN (1/24)TIN+DN (1/24) Mean age4647 M : F1:00:1 Mean MAP9192 Mean Duration of DM48 Oliguria0%100% Dialysis requiring RF0%100% Mean Serum Creatinine2.712 Survival100%0% 44

18. STATISTICAL ANALYSIS- GN IN TYPE 2 DM Mean value for oliguria and pyoderma in survived group was 0.615 and 0.538 respectively and in expired group 1.00 and 1.00 Standard error was 0.14 and 0.143 in survived group and 0.00 and 0.00 in expired group. p-value was 0.018 and 0.008 in survived group and 0.02 and 0.008 in expired group Statistically significant. 45

19. GN IN TYPE 2 DIABETES MELLITUS Variables Group CodeNoMean Std. Error Meanp.value Duration of DM12111310.7277.07692.331.510.1910.207 MAP121113104.83100.752.072.270.2050.198 Duration of HTN1211135.543.921.391.150.3750.38 46

20. GN IN TYPE 2 DIABETES MELLITUS Variables Group CodeNoMean Std. Error Meanp.value 24 hr Urine Protein 1211131229.11215.8124.8216.30.960.958 Oliguria12111310.61500.140.020.018 Pyoderma12111310.538500.1430.008 Serum Creatinine 1211136.374.0070.6560.3540.0030.006 47

21. STATISTICAL ANALYSIS - DPGN IN TYPE 2 DM No variables are found to be statistically significant. May be because of small sample size. 49

22. DPGN IN TYPE 2 DM Variables Group Code No.Mean Std. Error Mean p. value Age128353.7553.663.2663.480.9890.987 Duration of DM128312.62102.943.60.6360.598 MAP1283105.81108.862.795.560.6010.657 Duration of HTN 128375.331.622.330.5960.588 50

23. DPGN IN TYPE 2 DM Variables Group Code NoMean Std. Error Mean p. value 24 hr Urine Protein 1283 1140726.66161.2136.70.1780.089 Pyoderma1283 10.66600.3330.1040.423 Serum Creatinine 1283 6.1254.60.38950.6650.070.13 Dialysis requiring renal failure 1283 10.3330 0.0060.184 50