الفهرس 
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Abstract
Diabetes mellitus is a syndrome of chronic hyperglycemia due to relative or absolute deficiency in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
Diabetes is the leading cause of chronic kidney disease (CKD) in developed countries. Diabetic kidney disease accounts for 40% of prevalent CKD and 50% of incident end-stage renal disease, and it has increased in direct proportion to the increasing prevalence of diabetes.
cystatin C is a small 13-Kda protein that is a member of the cystatine proteinase inhibitor family that is produced at a constant rate by all nucleated cells . Due to its small size it is freely filtered at the glomerulus. After filtration, cystatin C is reabsorbed and catabolized by the tubular epithelial cells, with only small amounts excreted in the urine. Cystatin C levels are therefore measured not in the urine, but in the blood stream.
Early identification of impairment in renal function is crucial in diabetic patients. Serum cystatin C may be the most sensitive indicator of glomerular filtration rate (GFR) in the clinical setting.
It was assumed that the high rate of sugar is one of the main reasons for the increase in kidney disease in diabetes mellitus therefore the aim of this work was to study the activity of some chemical parameters such as creatinine, urea,GFR and particularly the role of cystatin C as a marker for the early detection of kidney diseases in diabetes mellitus.
The present study comprised 50 patients with diabetes. 25 patients with diabetes mellitus and 25 suffering from diabetes with renal insufficiency. In addition, 30 health subjects were selected as control group.
The following investigations were done for the studied groups:
• Serum glucose level.
• Kidney functions ( creatinine and urea).
• Glomerular filtration rate.
• Serum cystatin C.
The present study showed that serum levels of urea and creatinine were more statically significantly higher in diabetes with renal insufficiency than in diabetes without any complication.
Serum creatinine and urea are a non-specific markers to know the renal status in patients of diabetes mellitus. This is based on the fact that their serum levels increase in long standing diabetes only. Their serum values do not increase significantly in early stages of diabetes mellitus but show increase after there is substantial renal damage.
In our study serum cystatin C level shows higher increment above control than serum creatinine in early stage of kidney affection.
A substational degree of renal dysfunction may develop unnoticed as creatinine may remain in the normal range despite amajor decline in GFR in diabetic syndrome and the use of serum creatinine may in accurately estimate GFR due to dietary intake, tubular secretion of creatinine, and variation in the patient muscle mass.
In the present study cystatin C shows more significant correlation than serum creatinine with GFR and also, cystatin C shows high sensitivity, accuracy and specificity than creatinine in detection reduced GFR in diabetes.
These data indicate that serum cystatin C is a promising new marker of early renal dysfunction as it is more accurate than current measures for GFR estimation in diabetes mellitus.