Correlation Study Of25-dihydroxyvitamin D3and Urine Protein In Patients With Diabetic Nephropathy

Background＆ObjectiveDiabetes Mellitus (DM) is a metabolic disorder of glucose as the mainmanifestation of the clinical syndrome which causes by a variety of genetic andenvironmental factors. The patients who under sustained high glucose can be lead tomultiple organ dysfunction. Diabetic nephropathy (DN) is one of the most seriouschronic complications of DM which eventually lead to end-stage renal disease. Thisnot only decrease the quality of life of patients, but also increased the patients’mortality. Nowadays we lack effective prevention and treatment methods, it isnecessary to explore new treatments. Vitamin D is a classic of calcium andphosphorus metabolism regulator. In recent years, many studies have shown that thevitamin D has relationship with the occurrence and development of DN, which shownthe renal protective effect of vitamin D. This study analyzed the clinical datas ofpatients with type2DN, determination the25(OH) D and urinary albumin levels forearly diabetic nephropathy patients to reveal the correlation between renal functionand both of the25(OH) D and urinary albumin levels.To investigate the effect ofcombined therapy with Alfacalcidol and Telmisartan in patients with diabeticnephropathy. Mehtods120patients with diabetic nephropathy were randomly divided into three groups,40patients each. All of the patients are in line with the1999WHO diagnosticcriteria for diabetes, which referring Mogensen [1] staging. We selected early diabeticnephropathy (third stage of diabetic nephropathy, urinary albumin excretion rate(UAER) between20ug~200ug/min or microalbuminuria amount30mg-300mg/24h),all of them were given the insulin therapy and their blood glucose levels were wellcontrolled, whos fasting blood glucose (FBG)≤7.0mmol/L,2-hour postprandialblood glucose (2hPG)≤10.0mmol/L and serum creatinine (SCr) levels werenormal. Exclusion criteria: Exclude merger ketosis, a variety of acute and chronicinfections, cardiovascular and cerebrovascular disease, chronic or severe kidneydisease and taking drugs affect urinary protein excretion. Group A were treatedbyAlfacalcidol0.5μg per day, Group B were treated by telmisartan20-40mg per day,Group C were treated by Alfacalcidol0.5μg and telmisartan20～40mg per day.Wedetermined fasting blood glucose (FBG), glycated hemoglobin (HbA1C),24hurinary albumin quantification (MAU), blood pressure (BP),25(OH) D, blood ureanitrogen (BUN), serum creatinine (SCr), calcium (Ca2+) levels for both groupsbefore and after treatment. All statistical analysis was performed using SPSS14.0software. Measurement data were shown±s and analysis of variance. Count datawere used T-test. P <0.05between the comparison group indicated significantdifferences.ResultAll groups’25(OH) D levels were lower than normal value before treatment.The25(OH) D level of group A and C was elevated after treatment, while the Bgroup’s25(OH) D level was no significant change, the difference was statisticallysignificant (P <0.05). The urinary albumin excretion decreased in24h for threegroup, which had statistically significant (P <0.05)；24h urine protein in group Cwas significantly decreased (P<0.01).No statistical difference in other indicators (P>0.05). ConclusionThe25(OH) D in the early diabetic nephropathy lower than normal value, whichsuggested the lack of vitamin D. The25(OH) D in group A and C was improved byvitamin D treatment, and urinary albumin excretion decreased in24h. The deficiencyof Vitamin D can significantly increase the risk of diabetic nephropathy, The serum25(OH) D and urinary albumin quantitative negatively correlated, which suggeststhat vitamin D has a protective effect for the kidneys. But combination therapy ofAlfacalcidol and telmisartan has additive efficacy in reducing urine proteinexcretion.