The Performance of the Functions of the Kidneys in the Early Stages of Diabetic Nephropathy in Diabetes Mellitus 2

Goal. To study the characteristics of the functional state of kidneys in patients with early DN due to type 2 diabetes. Material and methods. We examined 132 people, including 102 patients with early stages of DN due to type 2 diabetes aged 42 to 64 years and 30 healthy individuals. disease Duration ranged from 3 months to 3 years. Patients were divided into 3 groups: I group -patients with type 2 normoalbuminuria, group II - patients with type 2 DM with microalbuminuria (MAU), III group - with MAU and normal high blood pressure (130/80-140/90 mm RT.CT.). Were studied indicators such as glomerular filtration rate (GFR) by radionuclide method; the average volume of kidney (SOP) ultrasonic method; microalbuminuria (MAU); the level of nitric oxide (NO) in daily urine parameters of renal hemodynamics - Doppler indices PI, RI, Vmax. Results. In group I patients was able to establish that until albuminuria stage is hyperfiltration (152, 0 (141,0-163,0), the increase in volume of the kidney (181,0 (169,-188,0), vnutrikletochnaya hypertension RI (0,5 (0,47 – 0,55), PI (to 0.72 (0.5 to 0.9), Vmax (0,95 (0,89-1,01) and a high NO level in daily urine (15,8 (15,2-16,8). That is, the absence in a patient of DM-2 UIA does not represent the absence of renal problems. In the algorithm of examination of such patients must necessarily be included the determination of radionuclide GFR. In group II patients found that with the advent of the MAU (33,0 (28,0 - 37,0) GFR decreases and reaches a normal level (134,0 (122,0 - 143,0). However, simultaneously there is a decrease in renal blood flow RI (0,6 (0,57-0,68), PI (1,36 (1,1-1,6), Vmax (0,77 (0,73-0,83) with increased peripheral resistance of vessels, and reduction of NO in the urine (15,6 (15,1-15,9), characterizes endothelial dysfunction. In group III patients found that normally an increased level of blood pressure in patients with type 2 diabetes negatively affects renal function, evidence of which is the reduction in GFR (89,0 (81,0-96,0) with the exacerbation of vasospastic reactions renal blood flow, with elements of endothelial damage (decrease in the level of nitric oxide in the urine (13,7 (13,3-14,3). Apparently, even a slight increase in blood pressure in DM 2 leads to depletion of NO, resulting in blood vessels become rigid to the effects of hemodynamic factors. So the balance of nutrients that support the adequate blood flow in the vessels toward vasoconstrictors. Analysis of the obtained data in the study suggests that in diabetes 2 kidneys are involved in the pathological process in the early stages of the disease. The appearance of MAU or normal BP in a patient of DM-2 indicate already far advanced pathological process in the kidneys from the point of view of the possibility of its return development. Changes in the functional state of kidneys occur before albuminuric stage of development of DN, and that this stage should be a "springboard" to conduct an aggressive impact on the hyperfiltration, renomegaly, endothelial dysfunction. This is the only approach to renal problems in diabetes 2, in our opinion, will allow to stop the epidemic days in the world today, the only way to reduce economic costs, which have budgets of developed countries, unsuccessfully trying to treat patients with advanced stages of DN.