| BackgroundDiabetes mellitus (T2DM) is one of the non-infectious chronic epidemic diseases, under the condition of elevated living standard and diet and living stylel alteration, as well as different environmental factors, DM patients are on the rise. Take America as a sample, morbility of DM was 3 percent in 1976, increased to be 5.8 percent in 1987 and 7.9 percent recently. There was higher morbility in Asia, amount of DM patients in India is on the first place all over the world, China is on the second place, there are about 50 million DM patients in China now a days, more than American patients. The number of DM patients continue to increase.333 million DM patients are estimated all over the world in 2025. DM has been a common and frequently encountered disease, which can cause to serious complications, diabetic nephropathy will occur if renal is involved. Typer 2 diabetic nephropathy (T2DN) has been one of the critical reasons for end stage renal disease (ESRD) living on sustained dialysis. According to data In America, almost 45 percent of patients with ESRD are caused by DM, about one half of new diagnosed ESRD patients suffered from DN. In England, DN accounted for 30 percent in patients with ESRD, and 41.3 percent out of 13920 cases of patients who accepted first dialysis were caused by DN in Japan in 2004. According to Chinese statistical data in a part of cities in the year of 2000, DN accounted for 15 percent among ESRD patients. Now a days,20,000 million yuan expended on DM every year in our country, accounted for 4.38% out of total medical expenditure, it is estimated that total medical expenditure on DM will arrive 366 million dollars all over the world in the year of 2025. Morbility of DM are on the rise, diabetic complications are serious, DM can not only give rise to extreme suffering, but also leading to serious social and economic burden, as well as tremendous medical resource waste. In this regard, DM as the public health problem should be conquered as soon as possible.DM is a kind of multiple sysmetic disease, which is used to involve micro and macro blood vessels and cause to heart, renal and nervous system damage, including hypertension, coronary artery disease, DN and diabetic peripheral neuropathy and so on. However, cardiovascular involvement is common in patients with T2DN, cardiovascular event is the major factor for death In T2DN patients. When micro blood vessel complications take place, nephropathy clinical syndrome often present accordingly, symptoms of nephropathy clinical syndrome include different degree of proteinuria, decreased GFR, metabolic disorder, hypertension, micro and macro blood vessel complications. Epidemiological investigation showed that there is crosstalk between heart and renal in patients suffered from both heart and renal disease, and aggravate each other, and give rise to vicious circle. Early discovery and aggressive treatment can postpone and ameliorate both heart and ranal damage, avoid cardiovascular events and renal failure, at last reduce mortality and raise survival rate.There are various risk factors for micro and macro blood vessel complications in patients with DM, including high bloog glucose level, hyperlipidemia, obesity and hypertension. Obesity is not only risk factor for insuling resistence (IR), but also for T2DM, in addition to IR and T2DM, T2DM patients are oftern associated with obesity, obesity can cause to not only metabolic disturbance, but relative reduced glomeruli amount, which can also promote glomerular hypertransferation and hyperfiltration so that to result in podocyte damage and detachment, then cause to different level of proteinuria and renal damage aggravation. In addition, concomitant severe lipid metoblic disturbace and hypertension in patients with obesity are also aggravating factors for renal damage.It is well known that Obesity often correlate with DM and DM often correlate with cardiovascular disease, however, the relationship between heart structural alteration and renal pathological characteristic is not yet elucidated, meanwhile, relationship between BMI alteration and clinical and pathological characteristic in T2DN is also not yet known.Our research based on renal bipsy, echocardiaographic parameters, clinical and renal histological data, firstly, to probe relative influential factors on echocardiographic parameters and the relation with renal clinical and histological changes, so as to discover the relationship between heart hypertrophy and dysfunction and renal histological alteration. secondly, to probe renal clinical and pathological characteristic according to different BMI in T2DN, in order to present proof on prevention and treatment on diabetic target organ complications on the earlier stage and mortality reduction in T2DM.ObjectiveBy the way of echocardiography, biochemistry, urinary detect and renal biopy, to analyze the influential factors on cardiac structural and functional alteration of patients with T2DN and the relationship with clinical and pathologic kidney lesion, then to probe the relationship between left ventricular hypertrophy and renal pathological lesions.Methodlogy:1,Using Two dimensional echocardiography to detect 254 cases diagnosed with T2DN patients, echocardiographic data were collected..then, divided them into 3 groups including without left ventricular hypertrophy (LVH), concentric LVH (CLVH) and eccentric LVH (ELVH)2,Blood biochemistry (SCr, Hb, Alb, HbA1C, CHO, TG, LDL, HDL FBS, PBS, fasting insulin, C peptide) and urine data(proteinuria, NAG, RBP, urine osmolairty), as well as renal pathological data of 181 cases during the corresponding period were collected. Then 3 groups including microalbulmin-uria, overt proteinuria and renal insufficient were divided according to renal damage..3,The influential factors on heart remodeling and relation with clinical and pathological renal lesions were analyzed.Result1. Mean LAD in 254 cases was (35.71±5.64) mm, in renal insufficient group, Mean LAD was (36.57±5.53) mm,significantly higher than that in microalbuminuria group (34.51±6.6) mm (p<0.05),The incidence rate of left atrial diameter (LAD) enlargement was 70.86% and 77.3% in 254 cases and renal insufficient group, respectively, Mean left ventricular mass index (LVMI) was (121.3±36.9) g/m2 in 254 cases, LVMI was (134.7±38.6) mm, higher than the other 2 groups, LVH accounted for 42.51% in 254 cases and 56.2% in renal insufficient group, respectively, ELVH accounted for 69.7% in renal insufficient group. systolic and diastolic dysfunction accounted for 23.6% and 86.6%, respectively.2. Significant (all p<0.05) relations were found between LAD, LVMI, IVS and LVPW and blood arterial pressure, LAD was in correlation with body mass index (BMI), gender and age, then, LVMI was also related with gender, as well as postprandial blood glucose. With deterioration of renal function and anemia, the incidence rate of LAD enlargement and LVH increased, and presented the trend of ELVH.3. LAD,LVMI,IVS,LVPW positively correlated with serum creatinine (SCr) (all p<0.01), negatively with estimated glomerular filtration rate (eGFR) and Hb (all P<0.05). SCr, proteinuria, RBP and NAG elevated and urine osmolairty decreased significantly in patients with eccentric LVH (all P<0.05)4. Significant relation (r=0.243, p<0.01) was found between LAD and mesangial sclerosis, LVMI also correlated with tubular-interstitial lesion (r=0.314,p<0.01) and mesangial sclerosis (r=0.308,p<0.01), both IVS and LVPW were in relation with tubular-interstitial lesion (r=0.197, p=0.008; r=0.175, p=0.019, respectively)Conclusion1. Left ventricular diastolic disfunction, left atrial enlargement and LVH are common in T2DN patients, especially ELVH is more frequent, T2DN patients with ELVH are often associated with both left ventricular systolic and diastolic disfunctin.2. LAD is in correlation with age, sex and BMI positively, LVMI is also in correlation with sex. In addition, hypertension, renal dysfunction as well as renal anemia were critical factors for heart remodeling, especially renal dysfunction contributed to ELVH, LVMI correlate with postprandial blood glucose. So that high blood glucose level, hypertension, renal insufficiency and anemia all contribute to heart remodeling in T2DN patients.3. There is a relationship between echocardiographic parameters and both clinical (SCr, urinary markers) and pathological (mesangial sclerosis, tubular-interstitial lesions and so on) renal damage in patients with T2DN, to provide proof for us to evaluate prognosis and carry out strategy earlier to prevent cardiovascular complications in T2DN patients.Objectiveto analyze clinical, labolatry and pathologica data of 251 T2DN patients by the way of renal biopsy in Nanjin Jinling hospital, Then, to observe the relation between BMI and renal clinical and pathological characteristic, to probe the role of obesity on clinical and pathological alteration in T2DN, and provide proof to prevent disadvantage of obesity on renal damage in T2DM patients.Methodlogy251 cases of T2DN diagnosed by renal biopsy were enrolled, clinical and laboratory data as well as histological characters were analyzed. They were divided into 3 groups according to body mass index (BMI):normal weight group (18.5-<24kg/m2, n=82), over-weight group (24-<28kg/m2,n=109) obesity group (≥28 kg/m2, n=60). Then, compared clinical, laboratory and histological characteristics between obesity group and normal weight group.Result1,60 cases of obese patients accounted for 42.25%, ratio of male to femal was 1.3, the mean BMI was (30.29±1.9) kg/m2, mean waist circumstance was (101.8±7.8) cm, and mean waist to hip ratio was 0.96±0.06, central obesity account for 85%, especially in female patients, account for 75%.2,In obese group, incidence rate of high triglycerides is 64.4%, high dense lipoprotein account for 33.9%,, elevated C peptide and fasting insulin account for 26.7%and 35%, respectively, incidence rate of fatty liver is 43.33%, all of above data are higher than that in normal weight group, HOMA-IR as well (p<0.05)3,The course of diabetes mellitus in obese patients was shorter than that in normal weight group significantly (p<0.001),however, interval between diabetes and renal damage was significantly shorter (p<0.001), presented slight proteinuria(<1g/24h,21.7%), complications of diabetic eye ground and heart ischemia were lesser. Renal volume and eGFR in obese group was significantly higher than that in normal weight group (p<0.01), normal weight group presented more severe renal damage, and the incidence rate of retino and heart complications were higher. In addition to obesity, Multiple regression statistic analysis showed that diabetic course and hypertension are the independent risk factors for DN progession. 4,Renal histomorphology changes in obese group were with glomerular diameter and volume enlargement, hyaline degeneration of afferent and efferent arteriole of glomerulus were more common than normal weight patients (p<0.05).incidence ratio of renal dysfunction was higher in normal weight group, and renal pathological lesions prior to reflect advanced sclerosis changes.Conclusion1,Obese T2DN patients presented severe lipidemia disturbance and insulin resistence.2,Course of DM in obese T2DN patients was shorter significantly, but proteinuria occurred ealier. In this regard, we can see that obesity contributes to renal damage in T2DM.3,Histological data showed that renal damage was on the relatively earlier DN stage in obese group than normal weight group, however, glomerular hypertransfusion and hyperfiltration coexsisted in obese patients with T2DN.4,BMI was negatively related with course of DM, with the progression of DM, body mass decreased, but clinical renal damage and histological lesions were more severe in normal weight group.
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