RENAL FUNCTIONAL RESERVE IN PATIENTS WITH TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE

THE AIM: to study kidneys functional state in patients with diabetes mellitus 2 type with determination of renal functional reserve (RFR). PATIENTS AND METHODS. The research involved 39 patients, 15 male (38 %) and 24 female (62 %) aged from 38 to 78 years, which determined НВА1с level, microalbuminuria, urinary sediment persistent changes and serum creatinine concentration, glomerular filtration rate (GFR) with determination of RFR after water-salt loading with 0.5% NaCl. RESULTS. Diabetic nephropathy was set in all patients with passing to chronic kidney disease (CKD), at that, an urinary syndrome was observed in 14 patients (35 %), however the miсroalbuminuria at most of examinees within 3 months didn’t exceed 0.02 g \l, the hypercreatinaemia from 98 to 133 mmol \l was observed in 10 patients (26%). Kidney changes according to ultrasonography were observed in 15 patients (39%). HbA1c level was within 5.3% - 15.2%. GFRc varied from 39.1 to 140.2 ml\m, GFR60 after carrying out water-salt loading was from 53 to 543 ml \min. RFR was ranging from - 60 to + 402% in all patients, in most patients RFR was preserved and only in 6 patients (15% of the cases) no kidney reserve was observed with GFRp more than 90 ml \min in 5 of the 6 cases. RFR was kept in 6 patients with GFRp less than 60ml \min after carrying out water-salt loading, moreover, in 5 patients it made over 100% (maximum to 478%). RFR was also kept and varied from 26% to 468% in 9 of 10 cases in patients with hypercreatinemia. INCLUSION. It has been established that in patients with diabetic nephropathy RFR decrease is not always proportional to CKD stage and it has no direct dependence on extent of GFR decrease. The RFR index allows to differentiate GFR decrease mechanism because of both convertible nephron damage and their death, and also to reveal hidden violations on the stage of clinical and laboratory wellbeing.

glomerular filtration rate, renal functional reserve, chronic kidney disease, microalbuminuria, glycated hemoglobin HbA1c, diabetes mellitus 2 type

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