Brain natriuretic peptide in different stages of diabetic nephropathy

Abstract EN

This study included forty patients with type 2 diabetes mellitus and 10 age and sex matched healthy control subjects.

The patients and control subjects were classified into five groups: Group I included 10 diabetic normotensive patients without micro or macro albuminuria and normal kidney functions.

Group II included 10 diabetic normotensive patients with micro albuminuria and normal kidney functions.

Group III included 10 diabetic hypertensive patients with macro albuminuria and renal impairment.

Group IV included 10 diabetic patients with end stage renal failure under regular hemodialysis and had hypertension.

Group V included 10 healthy non-diabetic subjects, of comparable age and sex was taken as a control group. All patients and control were subjected to history taking, clinical examination, resting ECG, abdominal ultrasound and the following laboratory investigations: Fasting and 2 hours postprandial plasma glucose, HbA1c, blood urea, serum creatinine, creatinine clearance, 24 hours urinary excretion of albumin and plasma brain natriuretic peptide (BNP).

Patients with history or clinical evidence of cardiac disease or heart failure, obstructive nephropathy or other diseases were excluded.

In all patients there was no correlation between plasma BNP and age, duration of DM, fasting plasma glucose, and HbA1c.

BNP was significantly higher in all diabetic groups than control.

Diabetic cases with micro-albuminuria (group II) had a higher level of BNP than diabetic only (group I) and then normal control (group V) while patients with macro albuminuria (group III) and diabetic cases with end stage renal disease (group IV) had a significantly higher level compared to diabetic only (group I), diabetic cases with micro albuminuria and normal control (group V) with highly significant difference in between. Although there was no correlation between plasma BNP and 24 hours urine albumin, group III patients with the highest urinary albumin excretion had also the highest BNP level. Conclusion: We might conclude that BNP level is increased in type 2 DM with significantly higher levels in diabetic nephropathy and it might have role in its pathogenesis and the progression of nephropathy.