Diyabet Hastalarında Hematüri Sıklığı ve Albüminüri ile İlişkisi

Abstract

Amaç: Bu çalışmanın amacı diyabetik hastalarda hematüri sıklığını belirlemek ve bunun mevcut klinik ve laboratuvar değişkenleriyle özellikle de albüminüri ile olan ilişkisini değerlendirmektir. Yöntem: Çalışmaya aynı başvuruda tam idrar tahlili ve idrar albümin/kreatinin oranı istenen 302 diyabet hastası dahil edilmiştir. Hastalar hematürisi olan ve hematürisi olmayan hastalar şeklinde iki gruba ayrılmıştır. Hastalara ait hemogram sonuçları, spot idrar albümin ve kreatinin düzeyleri, serum glukoz, total kolesterol, LDL kolesterol, trigliserid, BUN, kreatinin, albumin, sodyum ve potasyum sonuçlarıyla ALT ve AST enzim aktiviteleri, tam idrar tahlili, serum CRP düzeyleri, HbA1c düzeyleri ve tahmini glomerüler filtrasyon hızı (eGFR) düzeyleri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 54±13 yıl bulunmuştur. Hastaların %23.5 (n=71)’inde hematüri saptanmıştır. Çalışmaya dahil edilen 229 (%75.8) hastanın normoalbüminürik, 52 (%17.2) hastanın mikroalbüminürik, 21 (%7) hastanın ise makroalbuminürik olduğu görülmüştür. Hematürisi olan diyabetik hastaların idrar albüminüri değerleri hematürisi olmayanlara göre istatistiksel olarak anlamlı şekilde yüksek saptandı (14.23 mg/g vs 1.96 mg/g, p<0.001). Makroalbüminüri görülme oranı hematürisi olan hastalarda olmayanlara göre istatistiksel olarak anlamlı şekilde yüksek bulunmuştur. Hematürisi olan hastaların ortalama eGFR değerleri hematürisi olmayan hastalar ile karşılaştırıldığında daha düşük bulunmuştur. Ancak istatiksel anlamlılığa ulaşmamıştır (p=0.055). Sonuç: Diyabetik hastalarda hematüri sık görülmektedir ve hematüri diyabetik böbrek hastalığının bir bulgusu olarak karşımıza çıkabilir. Hematürisi olan hastalarda albüminüri değerleri daha yüksek ve eGFR değerleri daha düşük bulunmuştur.

Keywords

• diyabet
• hematüri
• albüminüri

Frequency of Haematuria in Diabetic Patients and Relationship with Albuminuria

Abstract

Objective: The aim of this study was to determine the frequency of hematuria in diabetic patients and to evaluate its relationship with current clinical and laboratory variables, especially albuminuria. Methods: Three hundred and two diabetic patients were included in the study. The patients were divided into two groups as those with and without hematuria. Hemogram, spot urine albumin and creatinine, serum glucose, total cholesterol, LDL cholesterol, triglyceride, BUN, creatinine, albumin, sodium, potassium results, ALT and AST enzyme activities, complete urinalysis, serum CRP levels, HbA1c levels and estimated glomerular filtration rate (eGFR) levels of patients were evaluated retrospectively. Results: The mean age of the patients was 54±13 years. Hematuria was found in 23.5% (n=71) of the patients. It was observed that 229 (75.8%) patients included in the study were normoalbuminuric, 52 (17.2%) patients were microalbuminuric, and 21 (7%) patients were macroalbuminuric. The urinary albuminuria values of diabetic patients with hematuria were found to be statistically significantly higher than those without hematuria (14.23 mg/d vs 1.96 mg/d, p<0.001). The incidence of macroalbuminuria was found to be statistically significantly higher in patients with hematuria than in patients without hematuria. The mean eGFR values of patients with hematuria were found to be lower compared to patients without hematuria. However, it did not reach statistical significance (p=0.055). Conclusion: Hematuria is common in diabetic patients and hematuria may be a manifestation of diabetic kidney disease. In patients with hematuria, albuminuria values were higher and eGFR values were lower.

Keywords

• diabetes
• albuminuria
• haematuria

References

1. 1. Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. JURO. 2012; 188:2473–81. https://doi.org/10.1016/j.juro.2012.09.078.
2. 2. Orlandi PF, Fujii N, Roy J, Chen HY, Lee Hamm L, Sondheimer JH, et al. Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Nephrol. 2018 26;19(1):150. doi: 10.1186/s12882-018-0951-0.
3. 3. Moreno JA, Martin-Cleary C, Gutierrez E, Rubio-Navarro A, Ortiz A, Praga M, et al. Haematuria: the forgotten CKD factor? Nephrol Dial Transplant. 2012;27(1):28-34. doi: 10.1093/ndt/gfr749
4. 4. Yuste C, Gutierrez E, Sevillano AM, Rubio-Navarro A, Amaro-Villalobos JM, Ortiz A, et al. Pathogenesis of glomerular haematuria. WJN. 2015;4(2):185–12. doi: 10.5527/wjn.v4.i2.185.
5. 5. Heyman SN, Brezis M. Acute renal failure in glomerular bleeding: a puzzling phenomenon. Nephrol Dial Transplant. 1995;10(5):591–3.
6. 6. Shen FC, Lee CT, Sun CK, Chung MS, Lee JJ, Chang HW, et al. Prevalence of haematuria positively associated with urine albumin excretion in Type 2 diabetes. Diabet Med. 2012;29(9):1178-83. doi: 10.1111/j.1464-5491.2012.03608.x
7. 7. TEMD Diabetes Mellitus ve Komplikasyonlarinin Tanı, Tedavi ve İzlem Kılavuzu 2020, 174-178.
8. 8. Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, Steffes MW; American Diabetes Association. Nephropathy in diabetes. Diabetes Care. 2004 Jan;27 Suppl 1:S79-83. doi: 10.2337/diacare.27.2007.s79.

9. 9. KDOQI. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):12-154. doi: 10.1053/j.ajkd.2006.12.005. 10. Schulman G, Berl T, Beck GJ, Remuzzi G , Ritz E, Shimizu M, et al. Randomized placebo-controlled EPPIC trials of AST-120 in CKD. J Am Soc Nephrol. 2015;26(7):1732–46. https://doi.org/10.1681/ASN.2014010042.
10. 11. You-Hsien Lin H, Yen CY, Lim LM, Hwang DY, Tsai JC, Hwang SJ, et al. Microscopic Haematuria and clinical outcomes in patients with stage 3–5 nondiabetic chronic kidney disease. Sci Rep. 2015;16;5:15242. doi: 10.1038/srep15242.
11. 12. Yoshida N, Hanai K, Murata H, Uchigata Y, Babazono T. Cross-sectional and longitudinal associations between dipstick hematuria and chronic kidney disease in patients with type 2 diabetes. Diabetes Res Clin Pract. 2021 Feb;172:108519. doi: 10.1016/j.diabres.2020.108519.
12. 13. Mashitani T, Hayashino Y, Okamura S, Kitatani M, Furuya M, Iburi T, et al. Diabetes Distress and Care Registry at Tenri Study Group. Association between dipstick hematuria and decline in estimated glomerular filtration rate among Japanese patients with type 2 diabetes: A prospective cohort study [Diabetes Distress and Care Registry at Tenri (DDCRT 14)]. J Diabetes Complications. 2017;31(7):1079-1084. doi: 10.1016/j.jdiacomp.2017.04.016.
13. 14. Liang S, Zhang XG, Cai GY, Zhu HY, Zhou JH, Wu J, et al. Identifying parameters to distinguish non-diabetic renal diseases from diabetic nephropathy in patients with type 2 diabetes mellitus: a meta-analysis. PLoS One. 2013;8:e64184, http://dx.doi.org/10.1371/journal.pone.0064184.
14. 15. Okada T, Nagao T, Matsumoto H, Nagaoka Y, Wada T, Nakao T. Clinical significance of microscopic haematuria in diabetic nephropathy in type 2 diabetes patients with overt proteinuria. Nephrology (Carlton). 2013;18:563-8, http://dx.doi.org/10.1111/nep.12104.
15. 16. Sheen YJ, Sheu WH. Risks of rapid decline renal function in patients with type 2 diabetes. World J Diabetes. 2014;5:835-46, http://dx.doi.org/10.4239/wjd.v5.i6.835.
16. 17. Okada S, Samejima KI, Matsui M, Morimoto K, Furuyama R, Tanabe K, et al. Microscopic hematuria is a risk factor for end-stage kidney disease in patients with biopsy-proven diabetic nephropathy. BMJ Open Diabetes Res Care. 2020;8(2):e001863. doi: 10.1136/bmjdrc-2020-001863.
17. 18. Vivante A, Afek A, Frenkel-Nir Y, Tzur D, Farfel A, Golan E, et al. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA. 2011;17;306(7):729-36. doi: 10.1001/jama.2011.1141.