الفهرس 
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Abstract
The work aimed to study the changes in kidney function in obese non – diabetic adults and their relation to the presence of metabolic syndrome.
The total sample size collected in the study was 100 patients who are obese non diabetic adults who attending the outpatient clinic of internal medicine departments at Assiut university hospital.
The patients subdivided into two groups according to the presence of metabolic syndrome as follow :-
1- 54 Obese without metabolic syndrome as a group 1
2- 46 Obese with metabolic syndrome as a group 2
In addition The control group included 40 participants are normal weight adults and healthy individuals age and sex matched with the patients.
Inclusion criteria:
Patients were obese, non-diabetic adults.
Exclusion criteria:-
DM type 1
DM type 2
Elderly
Method
Detailed history and clinical examination.
• Personal history (name, age, sex, education) and history of chronic illness (hypertension, diabetic, hyperlipidemia)
Clinical examination.
• Measurement weight (Kg), height (m), and waist circumference (WC) (cm).
• and body mass index (BMI) was calculated as weight (kg) divided by height squared (m2) and classified into 5 categories.
1. Normal weight 18.5–24.9 kg/m2
2. Overweight 25–29.9 kg/m2
3. Obesity (Class 1) 30–34.9 kg/m2
4. Obesity (Class 2) 35–39.9 kg/m2
5. Extreme obesity (Class 3) >= 40 kg/m2
• Blood pressure was assessed by using mercury sphygmomanometer.
C- The following investigations were performed for all patients and control
1- Fasting plasma glucose (mg\dL)
2 - 2-hour postprandial glucose test (mg\dL)
3- Fasting Lipid profile:-
- Total cholesterol (mg /dL)
- Triglycerides (mg /dL)
- High-density lipoprotein (HDL) (mg /dL)
- Calculated low-density lipoprotein (LDL) (IU /L)
4- Diagnosis of chronic kidney disease by
• Serum creatinine levels (mg /dL)
• Then Estimated - glomerular filtration rate (eGFR) was calculated using the variable Modification of Diet in Renal Disease (MDRD).
• Microalbuminurea was measured by urinary albumin: creatinine ratio (ACR) (mg/mmol)
5- Diagnosis of metabolic syndrome
We used the modified National Cholesterol Education Program
Adult Treatment Panel III (NCEP ATP III) criteria.
The diagnosis of Mets was made when three or more of the following criteria were present:-
1) Central obesity with waist circumference of at least 88 cm in females and at least 102 cm in males;
2) Triglyceride level of at least 150 mg/dl or specific treatment for this lipid abnormality;
3) High-density lipoprotein (HDL) cholesterol level below 40 mg/dl (1.03 mmol/L) in males, below 50 mg/dl (1.29 mmol/L) in females, or specific treatment for this lipid abnormality;
4) Systolic blood pressure of at least 130 mm Hg or diastolic blood pressure of at least 85 mm Hg, or treatment of previously diagnosed hypertension.
5) Increased fasting glucose >100 mg/dl (5.6 mmol/L).
6 -Measurement of the insulin resistance
* The homeostasis model assessment (HOMA) was used to Evaluate insulin resistance. the values for a patient can be calculated from the fasting concentrations of insulin and glucose using the formula: fasting serum insulin (_U/ml) x fasting plasma glucose (mmol/liter)/ 22.5.
The results of this study showed that:-
This study included 100 obese and non diabetic adults : 49 males (49%) and 51 females (51%), Their age ranged from (21-60) with the mean ± SD 47.34±13.89. The GFR ranged from (14.9-120 ml\ min/1.73m2) with Mean±SD 79.6±24.2. The number of patients who had a GFR level <60 ml/min/1.73m2 were 18 patients (18%) , Creatinine ranged from (0.28 – 3.6 mg /dl) with Mean±SD (0.69 ± 0.29) and Microalbuminuria ranged from (10 – 38) Mean±SD( 23.4±7.33) and the number of patients who were found to have microalbuminuria were 18 patients.
The control groups included 40 normal weighted participants and healthy adults : 18 males (45%) and 22 females (55%). The GFR ranged from( 75-125 )Mean±SD( 106.2±11.4), creatinine ranged from ( 0.34 - 0.99 ) Mean±SD (0.67 ± 0.18) and microalbuminuria ranged from (11 – 25) Mean±SD (12.1±4.82).
According to changes in kidney functions : the study found that there was a significant decrease in GFR levels and an increase in( serum Creatinine levels and microalbuminuria )with Mean±SD (22.6±12.2, 2.1 ± 0.29, 35.4±7.3) in patients compared to control with Mean±SD (106.2±11.4, 0.67 ± 0.18, 19.1±4.8) and P. value, 0.001** 0.003, 0.001** Respectively.
In this study, we found that 45 patients were suffering from metabolic syndrome : 15 males (32.61 %) and 31 females (67.39%). GFR levels ranged from( 21.7 – 120) with Mean±SD 71.8±24.6 , the study found that the number of patients who had a decrease in GFR levels were 14 patients (30.43%) ,the microalbuminuria ranged from (12 - 38) with Mean±SD 26±7.0 and the number of patients who had increased in microalbuminuria were 12 patients (26.09%).
On the other hand the patients who appeared without the metabolic metabolic syndrome were 54 patients (34 males (62.96%) and 20 females (37.04%).
The number of patients who had a decrease in GFR levels were 4 patients (7.41%) and 7 patients (13%) who had increased in microalbuminuria .
The study observed that the metabolic syndrome presence was significantly higher in females more than males with value 0.002.
As regards the changes in kidney functions , we observed that there were a significant decrease in GFR , an increase in serum creatinine level and a significant increase in microalbuminuria in patients with metabolic syndrome with Mean ± SD{(22.8±12.6, 2.3±0.6, 35±2.0)} when compared to patients without metabolic syndrome with Mean ± SD{(44.2±18, 1.4±0.43, 32±5.1)} with p. Value of 0.003,0.026, 0.007 resepectively.
The study revealed that There was a significant decrease in GFR as regards increased in metabolic syndrome scores in SCORE 3 {Mean±SD 90.1±15.6}, score 4 {Mean±SD 70.9±26.7} score 5 {Mean+SD 67. 4+19.5}. Also There was significant increase in creatinine in SCORE 3 {Mean+SD 0.7±0.4}, score 4{Mean+SD 1+49.3} score 5{Mean±SD 32 ±3.0} and There was a significant increase in microalbminuria in Score 3 {Mean±SD 25±6.1}, Score 4 {Mean±SD 27±6.0.7}, Score5 {Mean±SD 32 ±3.0}
The study found that There was a significant decrease in GFR and an increase in (creatinine and microalbuminuria) in positive HOMA IR with Mean ± SD{ 72.3±24.2, (1.1±0.3, 30±7.1)} compered to negative HOMA IR Mean ±SD{ 86.8±22.1, Mean ± SD (0.41±0.23, 15± 8.2)} Respectively with P.value 0.002,0.00,0.00.
The study showed that a highly significant positive correlation between GFR and the following {age, blood pressure (systolic, diastolic, total cholestrole)} with P.value 0.000, 0.000, 0.000, 0.033). However, GFR no correlate with {F. plasma glucose, TG, HDL, LDL}
The study found that there was a significant positive correlation between serum creatinine and age with P.value 0.036. but there were no correlations with other parameters.
The study revealed that there were a significantly positive correlations between microalbuminuria and the following {(systolic ,diastolic) blood pressure, Total cholesterol, WC} with P.value (0.0031, 0.048), 0.035, 0.025. However, there were no correlated with ( F. plasma glucose, age, TG, HDL, LDL, HOMA IR).