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P=0.0008), U24Glu and U24A (RS=0.461; P=0035), UA and miRNA-21 (RS=0.536;
P=0.032) were observed.
CONCLUSIONS: One cannot exclude that the iSGLT-2 may have some negative direct
effect on the kidneys. However, possible negative effects of these drugs on the kidneys
in diabetes mellitus may overlap its counteraction to hyperglycemia and glomerular
Nevi Pasko4, Ariana Strakosha3, Florian Toti2, Vilma Cadri3, Suela Mumajesi3,
Teuta Dedej1, Enkeleda Stefa3, Myftar Barbullushi3
Biochemistry University Hospital Center Tirana Albania, 2Endocrinology University
Hospital Center Tirana Albania, 3Nephrology University Hospital Center Tirana Albania
and 4Nephrology University Hospital Center, Tirana Tirana Albania
INTRODUCTION AND AIMS: Diabetes mellitus is a major health issue associated
with an increase of morbidity and mortality primarily due to micro and macro vascular
complications. The use of a reliable marker of diabetic nephropathy and cardiovascular
diseases in diabetic patients could help to identify individuals with high risk. Cystatin C
has recently been proposed as a marker of renal function and as a predictor of
cardiovascular risk. The aim of this study was to evaluate the serum cystatin C and its
correlation with cardiovascular risk factors in diabetic patients.
METHODS: The study was carried out in 86 type 2 diabetic patients divided in three
groups: with microalbuminuria (n = 26), macroalbuminuria (n = 28), and diabetic
patients without evidence of cardiovascular and renal complications (n = 32). A
detailed questionnaire was used to record the medical history of the patients. Serum
Cystatin C was measured by Elisa method while microalbuminuria by
immunoturdimetric assay. Lipid profile, C-reactive protein, fibrinogjen, and estimated
glomerular filtration rate were measured.
RESULTS: The study showed that serum cystatin C increased with increasing degree of
albuminuria and become statistically significant in patients with macroalbuminuria
versus microalbuminuria 2.5760.71 (p<0.001). The serum cystatin C level was higher
in patients with eGFR < 60 mL/min/1.73 m2 (2.8060.43 mg/l versus 1.2860.69 mg/l,
p<0.001). We found a positive correlation of serum cystatin C with cardiovascular risk
markers: C-reactive protein (r =0.85), HDL (r = 0.91), LDL (r = 0.75) and fibrinogjen
CONCLUSIONS: Cystatin C is a practical and non-invasive method for the evaluation
of renal impairment among diabetic patients especially in normoalbuminuric patients.
Serum Cystatin C can be used as an alternative to urinary albumin excretion and serum
creatine in screening for renal impairement in type 2 diabetic patients. Serum Cystatin
C may be used as potential predictor of cardiovascular disease in diabetic patients.
Filipa Brito Mendes1, Luısa Helena Pereira1, Ana Paula Silva1,2, Pedro Neves2,1
Nephrology Algarve Hospital Centre Faro Portugal and 2Biomedical Science Algarve
University Faro Portugal
INTRODUCTION AND AIMS: Diabetes Mellitus is the main cause of CKD and
consequently a cause of high morbidity and mortality. Albuminuria is an important
marker of disease progression and represents a target of control as well as a support for
iii614 | Abstracts
Nephrology Dialysis Transplantation
investigation, in order to find the optimal antiproteinuric drug. Vitamin D analogues,
such as paricalcitol has shown antiproteinuric effect in different animal models
through a renin suppression, regulation of inflammation, action on podocytes, and
antiapoptotic function. Other drug which is under investigation attending the
possibility of albuminuria reduction is the dipeptidyl peptidase 4 (DPP4) inhibitors.
Suggested mechanisms for it seems to be the anti oxidative effect and reduction of
reactive oxygen species through the up regulation of the renal cyclic adenosine
monophosphate (cAMP). The aim of this study is to investigate the role of paricalcitol
and DPP4 inhibitors in type 2 diabetic patients with renal disease having in mind the
albumin-creatinine ratio (ACR) at baseline, 3 months and 6 months.
METHODS: A randomized study included 120 patients, followed in diabetic
nephropathy clinic. The population was divided into four groups according to the
diabetic medication:G1= Linagliptin + gliclazide; G2=Paricalcitol + DPP4 inhibitors;
G3=paricalcitol + linagliptin and G4= unchanged medication (gliclazide+ metformin).
Continuous variables description, ANOVA and chi-square test were used for comparison between groups. ANCOVA, LSD post-Hoc test.
RESULTS: The mean age of these patients, the gender and the body mass index were
similar between groups. The groups presented with different time-evolution of diabetes, with G2 being the group with a shorter time-evolution diabetes 6.8 (61.6) years,
p=0.001 and G3 with the longer time-evolution diabetes 10.6 (64)years, p=0.001, statistically significant. At the baseline the mean ACR was: G1=257.3 (6119.4); G2=269.5
(6114.3); G3=292.8 (671.5); G4=189.2 (658.4).The adjusted mean ACR difference
revealed that ACR levels had significantly decreased 6 months after starting any medication, except for the group without medication alteration that showed a significant
increase in ACR levels. 3rd month: G1 Vs G4 -39.7, 95% CI: -75; -4.3 p=0.028; G2 Vs
G4 -71.3, 95% C.I: -106.7; -36.0 p<0.001; G3 Vs G4 -45.4 95% CI: -80.8; -10.1 p=0.012.
6th months G1 Vs G4 -102, 95% CI: -142.5; -61.4 p<0.001; G2 Vs G4 -153.2, 95% C.I: 106.7; -36 p<0.001; G3 Vs G4 -148.6, 95% CI: -189.2; -108.1 p<0.001.
CONCLUSIONS: According to our results, the association of paricalcitol and DPP4
inhibitors revealed a positive effect on the decrease of ACR. Nevertheless, more studies
should be designed in order to better understand the individual role of each drug.
Other question to be addressed is if the improvement of ACR comes together with an
improvement of GFR, culminating in a true renoprotective role.
Makiko Konishi1, Fumihiko Furuya1, Tetsuharu Oku1, Takeyuki Takamura1,
Kenichiro Kitamura1
Third Department of Internal Medicine University of Yamanashi Chuo Japan
INTRODUCTION AND AIMS: Angiopoietin-like protein 2 (Angptl2) is an adiopokine which was secreted by adipose tissue and that its circulating level was closely
related to adiposity, systemic insulin resistance, and inflammation in both mice and
humans. We assessed the relationship between Angptl2 and the prevalence of the progression of diabetic nephropathy (DN).
METHODS: One hundred forty eight diabetes patients were followed up for 7 years.
Logistic regression models for the progression at every stage of DN were used to
evaluate the predictive value of Angptl2. The potential benefit of using Angptl2 alone
or together with albumin excretion rate (AER) and eGFR was assessed by receiver
operating characteristic (ROC) curve analysis. Furthermore, we investigated the effects
of Angptl2 on podocyte in vitro. Progression of DN was defined as the passage from
one stage to the next based on AER. End-stage renal disease (ESRD) was defined as the
requirement of dialysis or kidney transplantation.
RESULTS: The odds ratio for the prevalence of the presence diabetes, fatty changes of
liver, and chronic kidney disease increased with higher serum Angptl2 levels. Cohort
study indicated that baseline of Anptl2 was an independent predictor of progression at
all stages of DN. In cultured podocytes, recombinant Angptl2 reduced the expression
of podocin and translocation of zona occludens-1 in the membrane.
CONCLUSIONS: Angptl2 is an independent predictor of progression of DN
irrespective of disease stage via modulation of oxidative stress in podocytes.
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