PREVALENCE OF NEPHROPATHY IN TYPE 2 DIABETIC PATIENTS

Introduction: Diabetic nephropathy can occur in 10-25% of patients with type 2 diabetes (DBT) at diagnosis. Objectives: 1) To investigate the prevalence of nephropathy in type 2 diabetic patients. 2) To determine the time between the diagnosis of DBT and evidence of nephropathy, and to establish the frequency of different risk factors. 3) To check the coexistence of other micro- and macroangiopathic complications, as well as the presence of neuropathy and diabetic foot. Material and Methods: A descriptive, analytical cross-sectional and retrospective study based on patient records at Junin Interzonal Hospital from January 2008 to December 2010. Patients of both sexes diagnosed with DBT gave their informed consent and took a structured survey. Laboratory variables were analyzed, and micro- and macroangiopathic complications were recorded. The data were analyzed using descriptive and inferential statistical techniques. Differences were considered significant if p <= 0.05. Results: Among 200 patients with DBT, 56% had diabetic nephropathy. Forty percent had microalbuminuria, 12.5% had macroalbuminuria, and 3.5% had chronic renal failure (CRF, with GFR <60 ml/min). Among patients with diabetic nephropathy (n= 112, 50.9% women), 80.4% were smokers, 64.3% were obese, 88.4% had hypertension, 68.8% had a time of diagnosed DBT >= 8 years and 63.4% presented ophthalmic vascular complications. Fifty six percent had neuropathy, 87.5% had macroangiopathic vascular complications, and 33% had diabetic foot. Among patients without nephropathy (n= 88, 50% female), 79.5% were smokers, 53.4% were obese, 52.3% had hypertension, and 54.5% had a time of diagnosed DBT <8 years; 77.3% were free of ophthalmic vascular complications. Eighty six percent had no neuropathy, whereas macroangiopathy was present in 88.6%, and diabetic foot in 22.7% of patients. The relationship between diabetic nephropathy and time of diagnosed DBT was significant (p <0.05). The relationship between diabetic nephropathy and hypertension was highly significant (p <0.001). The relationship between diabetic nephropathy and both vascular complications and neuropathy was highly significant (p <0.001). Among patients with ophthalmic vascular complications (n= 91), 45.1% had non-proliferative retinopathy, 41.8% had pre-proliferative retinopathy, and 13.2% had proliferative retinopathy. Among patients with diabetic neuropathy (n= 75), 82.7% had chronic polyneuropathy, 20% had autonomic neuropathy, and 13.3% had focal or multifocal mononeuropathy. Among patients with macroangiopathy (n= 176), 80.7% had ischemic heart disease, 72.7% had peripheral vascular disease, and 10.2% had cerebral vascular disease. Conclusion: Among patients with DBT, kidney involvement is not an independent complication; on the contrary, it frequently coexists with other chronic complications, such as retinopathy and neuropathy.