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Islam SMJ, Yasmin S, Ahmed I, Haque WMM. Histopathologic and clinical features of diabetic nephropathy alone and with concomitant nondiabetic renal diseases. IMC JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.55010/imcjms.17.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective: Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM) and one of the leading causes of end-stage kidney disease. The aim of the present study was to evaluate the histomorphological and clinical profiles of DN and associated non-diabetic renal dieases (NDRD) in diabetic patients.
Materials and methods: The study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka, from July 2019 to December 2020. Renal biopsy samples from known diabetic patients were included in the study. The formalin-fixed tissues were stained with haematoxylene & eosin (H&E), Periodic acid Schiff (PAS), Masson Trichrome (MT) and Jones Methanamine Silver (JMS) stains. Tissues were stained for IgG, IgA, IgM, C3, C1q, kappa and lambda for direct immunofluorescence (DIF) study. DN was histologically classified according to Tervaert classification system. Interstitial fibrosis and tubular atrophy (IFTA) as well as arteriolar hyalinization scoring was also done. Clinical information was retrieved from the patient’s information sheet.
Results: Total 46 biopsy samples from DN cases were included in the study. The mean age of the cases was 46.76+10.63 years, including 36 males and 10 females. The most common clinical presentation was nephritic range proteinuria (n=32, 69.56%). Among all, 27 (58.69%) patients had haematuria. The mean serum creatinine level was 4.28+2.61 mg/dl, and 80.43% had serum creatinine levels >1.5 mg/dl. Histopathologic examinatiom revealed type III DN in 26 (56.5%) and type IV DN in 11 (23.9%) cases. IFTA score 1 (<25%) was seen in 20 (43.5%), score 2 (25-50%) in 19 (41.3%) and score 3 (>50%) in 7 (15.2%). Vascular hyalinization score-2 in 25 (54.3%), score-1 in 14 (30.4%) and score-0 in 7 (15.2%). DN class II, III and IV were associated with high urinary total protein (UTP) and serum creatinine levels. Among the histologic changes, percentage of glomerular sclerosis, the mean IFTA score and vascular hyalinization score were found to be highest in class IV DN, and all were significantly associated with histologic glomerular DN classes (p= <0.05). Of the total cases, 21 (45.65%) were found with nondiabetic renal diseases (NDRD), the most common feature was focal segmental glomerulosclerosis (FSGS) (26.57%), followed by IgA nephropathy and post-infectious glomerulonephritis (PIGN). Among 46 cases, one post-transplant biopsy was included, which revealed class II DN along with features of calcineurin inhibitor toxicity.
Conclusion: Tervaert’s histologic classification of our cases revealed class III DN lesions as the predominant one, and the classes had a significant association with age of the patient, serum creatinine level, mean IFTA, arteriolar hyalinization and NDRD. Among the NDRD, FSGS was the most common pathology.
IMC J Med Sci. 2023; 17(1): 003. DOI: https://doi.org/10.55010/imcjms.17.003
*Correspondence: Sk Md Jaynul Islam, Department of Histopathology, Armed Forces Institute of Pathology, Dhaka Cantonment, Dhaka, Bangladesh. Email: jaynul.islam@gmail.com
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Affiliation(s)
- Sk Md Jaynul Islam
- Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh
| | - Shamoli Yasmin
- Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh
| | - Ishtyiaque Ahmed
- Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh
| | - Wasim Md Mohosinul Haque
- Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
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Rahman MA, Halder HR, Kundu S, Sultana F, Islam SMS. Trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh: Evidence from population-based cross-sectional surveys. Diabetes Res Clin Pract 2022; 190:109873. [PMID: 35436546 DOI: 10.1016/j.diabres.2022.109873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/06/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
AIMS Diabetes is a major health problem in Bangladesh, but nationally representative studies on its trends and associated factors are scarce to guide policy formulation. Therefore, the study aims to determine trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh. METHODS The study included two population-based cross-sectional surveys from Bangladesh Demographic and Health Survey (n = 7,505 in 2011 and n = 11,959 in 2017-18). Chi-square association tests were performed to determine the associated factors. Logistic regression models (univariate and multivariable) were used to estimate unadjusted and adjusted relative risks of having diabetes, reported with odds ratios. Age-adjusted prevalence was also reported for both surveys. RESULTS The overall age-adjusted prevalence of prediabetes and diabetes decreased from 52.77% (95% CI: 52.61-52.92) and 10.43% (95% CI: 10.33-10.53) in 2011 to 34.10% (95% CI: 33.43-34.78) and 8.50% (95% CI: 8.11-8.90) in 2017-18. Compared to males, females had a higher odds of diabetes in 2011, but in 2017-18 a significant inverse result was observed. In both surveys, the odds of prediabetes and diabetes increased with advancing age, obesity, better wealth status, and hypertension. CONCLUSION The study shows that the prevalence of prediabetes and diabetes is high in Bangladesh despite decreasing trends. Therefore, the study recommends promoting healthy lifestyles and regular screening for non-communicable diseases.
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Affiliation(s)
- Md Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh.
| | - Henry Ratul Halder
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada; Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh.
| | - Satyajit Kundu
- School of Public Health, Southeast University, Nanjing 210009, China; Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Patuakhali 8602, Bangladesh.
| | - Farhana Sultana
- Telstra Health, 222 Lonsdale Street, Melbourne, Victoria 3000, Australia.
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Burwood, Victoria 3125, Australia.
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Factors Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312277. [PMID: 34886001 PMCID: PMC8657096 DOI: 10.3390/ijerph182312277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 12/25/2022]
Abstract
Diabetes and chronic kidney disease (CKD) are a major public health burden in low- and middle-income countries. This study aimed to explore factors associated with CKD in patients with type 2 diabetes (T2D) in Bangladesh. A cross-sectional study was conducted among 315 adults with T2D presenting at the outpatient department of Bangladesh Institute of Health Sciences (BIHS) hospital between July 2013 to December 2013. CKD was diagnosed based on the estimated glomerular filtration rate using the ‘Modification of Diet in Renal Disease’ equations and the presence of albuminuria estimated by the albumin-to-creatinine ratio. Multivariate logistic regression analysis was used to determine the factors associated with CKD. The overall prevalence of CKD among patients with T2D was 21.3%. In the unadjusted model, factors associated with CKD included age 40–49 years (OR: 5.7, 95% CI: 1.3–25.4), age 50–59 years (7.0, 1.6–39), age ≥60 years (7.6, 1.7–34), being female (2.2, 1.2–3.8), being hypertensive (1.9, 1.1–3.5), and household income between 10,001 and 20,000 Bangladeshi taka, BDT (2.9, 1.0–8.2) compared with income ≤10,000 BDT. However, after adjustment of other covariates, only the duration of hypertension and household income (10,001–20,000 BDT) remained statistically significant. There is a need to implement policies and programs for early detection and management of hypertension and CKD in T2D patients in Bangladesh.
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Zaman SB, Hossain N, Rahman AE, Islam SM. Can glycated hemoglobin act as a reliable glycemic indicator in patients with diabetic chronic kidney disease? evidence from the Northeast of Thailand. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i2.1995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Chronic kidney diseases (CKD) is a common microvascular complication in patients with diabetes mellitus (DM) which requires adequate glycemic control. Glycated hemoglobin (HbA1c) is a conventional biomarker to estimate glycemic status, but its role in diabetic CKD patients is unclear. Therefore, this study aimed to determine whether patients with high HbA1c are associated to develop diabetic CKD.Methods: Data were obtained from a clinical registry of diabetic patients who were treated in a district hospital in the Northeast of Thailand. CKD was defined according to the estimated glomerular filtration rate (eGFR<60mL/min/1.73m2). Anthropometric and biochemical measurements of the patient were taken by review of medical records. Multiple logistic regression analysis was used to determine the likelihood of the association between HbA1c and CKD.Results: Among 4,050 participants, 1,027 (25.3%) developed diabetic CKD. Older age (adjusted odds ratio (AOR): 4.88, 95% confidence interval (CI): 3.71–6.42, p<0.05), female (AOR: 1.38, 95% CI: 1.05–1.73, p<0.05), and hypertension (AOR: 1.52, 95% CI: 1.21–1.91, p<0.05) were found as the risk factors of diabetic CKD. However, patients with high HbA1c (>6.5%) were negatively associated with diabetic CKD (AOR: 0.66, 95% CI: 0.51–0.86, p<0.05).Conclusion: This study found patients with higher HbA1c level were not associated with diabetic CKD. Therefore, using the conventional cut-off values of HbA1c in diabetic CKD patients may be problematic in the clinical settings. Enhanced detection of glycemic status in patients with diabetic CKD is warranted to improve the outcome.
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Shariful Islam SM, Lechner A, Ferrari U, Laxy M, Seissler J, Brown J, Niessen LW, Holle R. Healthcare use and expenditure for diabetes in Bangladesh. BMJ Glob Health 2017; 2:e000033. [PMID: 28588991 PMCID: PMC5321382 DOI: 10.1136/bmjgh-2016-000033] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 02/06/2023] Open
Abstract
Background Diabetes imposes a huge social and economic impact on nations. However, information on the costs of treating and managing diabetes in developing countries is limited. The aim of this study was to estimate healthcare use and expenditure for diabetes in Bangladesh. Methods We conducted a matched case–control study between January and July 2014 among 591 adults with diagnosed diabetes mellitus (DMs) and 591 age-matched, sex-matched and residence-matched persons without diabetes mellitus (non-DMs). We recruited DMs from consecutive patients and non-DMs from accompanying persons in the Bangladesh Institute of Health Science (BIHS) hospital in Dhaka, Bangladesh. We estimated the impact of diabetes on healthcare use and expenditure by calculating ratios and differences between DMs and non-DMs for all expenses related to healthcare use and tested for statistical difference using Student's t-tests. Results DMs had two times more days of inpatient treatment, 1.3 times more outpatient visits, and 9.7 times more medications than non-DMs (all p<0.005). The total annual per capita expenditure on medical care was 6.1 times higher for DMs than non-DMs (US$635 vs US$104, respectively). Among DMs, 9.8% reported not taking any antidiabetic medications, 46.4% took metformin, 38.7% sulfonylurea, 40.8% insulin, 38.7% any antihypertensive medication, and 14.2% took anti-lipids over the preceding 3 months. Conclusions Diabetes significantly increases healthcare use and expenditure and is likely to impose a huge economic burden on the healthcare systems in Bangladesh. The study highlights the importance of prevention and optimum management of diabetes in Bangladesh and other developing countries, to gain a strong economic incentive through implementing multisectoral approach and cost-effective prevention strategies.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- NCD Unit, International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.,Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Munich, Germany.,Cardiovascular Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andreas Lechner
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany.,German Center for Diabetes Research (DZD), Germany
| | - Uta Ferrari
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany.,German Center for Diabetes Research (DZD), Germany
| | - Jochen Seissler
- Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jonathan Brown
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Louis W Niessen
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Munich, Germany.,German Center for Diabetes Research (DZD), Germany
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