| Objective To approach the influence factors correlated with renal dysfunction in elderly patients with type 2 diabetes mellitus(T2DM).Methods The data from that elderly patients with T2DM admitted in our hospital between 1997 and 2006 were reviewed.According to difference of glomerular filtration rate(GFR),they were divided into three groups,group A [GFR≥90 ml/min/1.73m~2],group B(60～90),group C(＜60).The clinical and biochemical indexes were compared and analysed.Result A total of 525 cases were studied.There were 159(30.3%) in group A,239(45.5%) in group B and 127(24.2%) in group C of renal dysfunction.History of hypertension,systolic blood pressure(SBP),diastolic blood pressure(DBP),postprandial blood glucose(PBG),cholesterol(TC) and blood uric acid(BUa) were independently associated influencing factors of renal dysfunction in aged T2DM,and hypertension contributed more than DM.Of this data,only 13.7%was diagnosed as diabetic nephropathy(DN),while 71.05%was hypertension.In group C of renal dysfunction,there were only 29.9%patients who were diagnosed as DN.With the prolongation of history of DM,the progression of hypertension and the increasing of urine Alb/Cr,GFR was declining and the incidence(IN) of renal dysfunction was increasing.Matched along with patients of BP＜130/80mmHg or of BP＞130/85mmHg,the IN was respectively 4.09%and 41.72%;when the history of DM was less than 5 years,5 to 10 years or more than 10 years,the IN of renal dysfunction was 18.64%, 26.09%or 28.90%;when the urine Alb/Cr was＜30,30～300 or≥300mg/g,the IN of renal dysfunction was 10.53%,40.38%or 75%.Conclusion There are multiple factors correlated with renal dysfunction of aged T2DM.And the history of hypertension,SBP,DBP,PBG,TC and BUa are independently associated impact factors.Hypertension contributed more than DM in renal dysfunction of aged T2DM.Favourable controlling of blood glucose and blood pressure is all the protecting factors,and available treatment aimed directly at the above impact factors could delay the progression of renal dysfunction. Objective To explore the reasons and influence factors of renal damage in elderly patients with type 2 diabetes mellitus(T2DM).Methods The clinical and pathological data from that elderly patients died and had autopsy in our hospital between October 1997 and August 2008 were reviewed.Based on these data,the reasons,charactor and influence factors of renal damage in elderly patients with T2DM were analyzed and explored. Pathological result based on the change of pathomorphology.According to the standard of K/DOQI,glomerular filtration rate(GFR)＜60ml/min/1.73m~2 is regarded as renal dysfunction.GFR is calculated from the formula of modification of diet in renal disease(MDRD).Result 1.A total of 513 elderly patients'cases that had pathologic results of abdominal autopsy were studied,including 454(88.5%) men and 59(11.5%) women.The detection of total renal damages were 53.6%.Of these renal damages, the detection of diabetic nephropathy(DN),hypertensive renal damage,primary glomerulopathy,other secondary glomerulopathy,nephric tubule and interstitial disease and some other renal disease which were not included in the above renal disease are respectively 9.75%,38.6%,2.14%,0.19%,8.77%and 3.51%.2.There were 161 elderly patients with DM who had abdominal autopsy,including a total of 3(1.86%)T1DM and 158(98.14%) T2DM.Of these patients,119(73.91%) affiliated with essential hypertension simultaneously.The pathological detection rate of DN,non-diabetic renal disease(NDRD),DN affiliating with NDRD are respectively 31.06%,62.73%,16.15%.And of NDRD,the pathological detection rate of hypertensive renal damage,nephric tubule and interstitial disease and some other renal disease are respectively 54.66%,7.45%,4.96%.Meanwhile,of DN affiliating with NDRD,the detection rate of DN affiliating with hypertensive renal damage,DN affiliating with renal tubule and interstitial disease are respectively 14.91%and 1.86%.3.(1) On the rate of pathological detection in elderly patients with T2DM,there were no difference in the gender and age.However,the detection of hypertensive renal damage of elderly patientds above 80 years old was higher than that of elderly patients below 80(respectively 61.26%,42.55%;P＜0.05).(2)In elderly patients with T2DM and(or) hypertension,the detection of renal disease rised up with the prolongation of history of T2DM and(or) hypertension.(3) In elderly patients with T2DM affiliating with hypertension,the detection of renal disease in group in which the hypertension appeared earlier than T2DM was the highest(67.65%).4.(1) The detection rate of renal disease in elderly patients who had renal dysfunction was 82.11%,while that of patients who hadn't had renal dysfunction.(2) Among cases of elderly patients with T2DM and renal dysfunction,the morbidity of renal disease was 82.54%, including morbidity of disease of DN,hypertension,renal tubule interstitial disease and some other renal disease respectively 31.75%,58.73%,6.35%,3.18%.Conclusion Renal damage in elderly patients with T2DM.was caused not only by DN but also by non-diabetic renal disease that including hypertensive renal damage,renal tubule interstitial disease and some other disease.And all of the above disease can cause renal dysfunction.DN and hypertension were the primary reasons of renal dysfunction in elderly patients with T2DM.And the morbidity of hypertensive renal damage even higher than that of DN.Therefore, based on controlling blood glucose,favourable controlling of blood pressure may contribute more to delay the progression of renal dysfunction.
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