Early diagnosis of renal dysfunction in hypertensive patients with type 2 diabetes mellitus

Objective: to investigate intra-renal hemodynamic parameters and their relationship with the plasma level of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in patients with hypertension and type 2 diabetes mellitus. Materials and methods: 103 patients (45 men and 58 women) aged from 35 to 64 years (average age 55.5 +/- 3.4 years) were examined, of which 55 (24 men, 31 women, average age 55.9 +/- 3.5 years) were with stage II hypertension (AH) and type 2 diabetes mellitus (T2DM) of moderate severity, subcompensated (group 1) and 48 (21 men, 27 women, average age 55,4 +/- 3,3 years) were with stage II AH without concomitant T2DM (group 2). The control group included 25 apparently healthy individuals (average age 55.1 +/- 3.1 years). All patients underwent routine clinical examination, determination of parameters of carbohydrate metabolism and lipid profile; insulin resistance was assessed by the HOMA-IR index. Using kits for enzyme immunoassay the concentration of renal dysfunction markers, cystatin C and neutrophilic gelatinase-associated lipocalin (NGAL), was measured in blood serum. Renal hemodynamic states were analyzed using B-type ultrasound and Doppler of the renal arteries. Results: The serum level of cystatin C when compared with the control group significantly increased in both groups of examined patients, reaching the highest values in comorbidity AH and T2DM-. In patients with AH and T2DM compared with patients without T2DM, there were higher levels of NGAL in serum. In patients with AH in combination with T2DM, a significant decrease in the end-diastolic velocity of arterial blood flow (Ved) was observed in comparison with patients with AH without T2DM. A substantial increase in the resistance index (RI) was revealed in patients of both groups in comparison with the control group. In addition, RI significantly increased in the group of patients with AH and T2DM compared with the group of patients with AH without T2DM. Conclusion: Among hypertensive patients at the stage of normoalbuminuria with preserved GFR NGAL and cystatin C were higher in T2DM compared with non-T2DM. This corresponded to an increase in the resistance of the renal vascular bed in patients of both groups more pronounced in comorbidity with AH and T2DM.