Trace elements level in type 2 Diabetic Nephropathy

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Trace elements are essential nutrients with numerous biological functions resulting from their action as major components of enzymes throughout metabolism. The trace elements (Cu, Zn, Se & Cr) for this study play a key role in the pathogenesis of diabetes and its complications. Decreased levels of these trace elements have been found to be associated with DN type 2 because they are excreted by the kidney through the urine, thus hyperzincuria is a cause of low plasma zinc in diabetics. The basic aim of the study is to determine whether Zn, Cu, Se and Cr are involved in the development of DN in Ghanaian type 2 diabetic patients. Blood samples of 5-10 mL were aseptically collected from the median antecubital or cephalic veins of the study subjects, after an overnight (12 hr) fast. The blood was then dispensed into labelled plain BD vacutainer®, tubes, and fluoride oxalate coated tubes (to prevent glycolysis) for fasting blood glucose. Samples for blood glucose assay were immediately analysed. After clotting, blood sample in the plain tubes were centrifuged at 3000 g for 3 min and the serum stored at -20°C until ready for analysis of kidney function test and trace element respectively. The trace elements (Zn, Cu, Se & Cr) analysis was performed at Ghana Atomic Energy Commission using the International neutron activation analysis (lNAA) which is a sensitive, non-destructive method for determining the elemental composition of the sample. An early morning urine sample was collected in a sterile wide mouth container and screw capped for urine protein which was immediately analyzed. A total of 80 diabetics and 48 non-diabetics were involved in this case-control study. The mean age of the diabetics was 51.70 ± 6.23 years with 51.2% being the majority between the ages of 50-59 years whereas the mean age of the non-diabetics was 49.50 ± 6.17 years with majority between the ages of 40-49 years. Blood pressure and BMI showed no significant differences between the two groups. However, 17.5% and 2.5% of the diabetics had grade 1 and 2 hypertension respectively. Also, 30.0% were found to be obese with 8.8% morbid obese respectively. On the other hand, 16.7% and 14.6% of the non-diabetics had grade 1 and 2 hypertension respectively. A percentage of 37.5 were found to be obese with 10.4 being morbid obese respectively. There was a significant difference (p<0.0001) in the blood glucose levels among the diabetics and non-diabetics. The levels of Zn (p=0.001) and Cu (p=0.002) showed a significant difference in the diabetics compared to the non-diabetics whereas that of Se and Cr were not significantly different. Renal function among the patients with diabetes shows significantly increased urea and potassium with decreased creatinine levels on comparison with the non-diabetic patients. Significant differences (p=0.0001) was also observed when proteinuria was compared between the two groups with 48.8% and 4.2% of the diabetics and non-diabetics respectively having increased urine protein.
A thesis submitted in fulfillment of the requirements for the degree of Master of Philosophy (Chemical Pathology) In the Department of Molecular Medicine School of Medical Sciences College of Health Sciences,