الفهرس 
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Abstract
D
iabetes mellitus is the most common cause of chronic kidney disease in the world, leading to multiple complications including end-stage renal disease, cardiovascular disease and even death so, Screening is an important strategy to address the burden of CKD in diabetic population. International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes, using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion.
Our study is across sectional study of 200 type 2 diabetic patients who were screened in Alagouza Hospital for CKD by using urinary ACR and average eGFR. Patients with CKD were further investigated for extra renal diabetic complications as PVD and cardiovascular complications by using LL arterial duplex and Echocardiography.
Of our 200 type 2 diabetic patients, 55% were males and 45% were females. Duration of diabetes among the studied patients ranged from 2 months to 2years with median of 7 years most of the patients (71.5%) had diabetes for less than 10 years. 49.5% of the studied patients were under treatment with oral antidiabetics, while 44% were treated by Insulin and 6.5% were treated by combined therapy. Hypertension was found in 36% of the studied patients.
As regard diabetic complications observed in our population, Diabetic nephropathy came in the 1st rank with 106 patients (53%) presented with either average eGFR<60 ml/min/1.73m2, ACR >30 mg albumin/gm creatinine or both. That was followed by history of neuropathy which represented 44.5% of the studied patients. Retinopathy evidenced in fundus examination compromised about 34.5% out of our studied population. Patients with past history of stroke represented 17.5% of the studied population
Diabetic complications were more prevalent with longer duration of diabetes as diabetic retinopathy, nephropathy, history of stroke and neuropathy as reported by the patients are more prevalent in patients with diabetes duration more than 10 years rather than patients with diabetes duration less than 10 years.
Nephropathy was described as eGFR < 60 ml/minute/1.73 m2 or ACR >30 mg albumin/gm creatinine or both. In our study, 106 patients (53%) were found to have nephropathy, 21 patients (19.8%) had eGFR < 60 ml/minute/1.73 m2, 60 patients (56.6%) with ACR > 30 mg albumin/gm creatinine and 25 patients (23.5%) have both.
Diabetic retinopathy was most commonly associated with different stages of nephropathy (11 patients with declined GFR, 25 patients with albumiuria and 25 patients with albuminuria with declined GFR), in contrast to only 8 patients with retinopathy in non-nephropathic diabetic patients.
Stroke was more common among patients with nephropathy (4 patients with decline eGFR, 6 patients with albuminuria and 12 patients with albuminuria and declined eGFR), versus 13 patients with positive stroke history in non- nephropathic diabetic patients.
Peripheral neuropathy was more common in patients with nephropathy 69.7 % (n=62) (4 patients with decline eGFR, 36 patients with albuminuria and 22 patients with both), compared to only 30.3 % (n=27) non- nephropathic diabetic patients gave positive history of neuropathy.
Patients with nephropathy were further investigated for the presence of PVD and cardiovascular complications. Arterial LL duplex revealed PVD in 32.1% (34 patients) with 3 patients underwent amputation. As regard cardiovascular complications, 17.9 % (19 patients) were found to have abnormal findings in echocardiography examination including heart failure and ischemic changes.
Conclusion:
from our study, we showed the high burden of diabetic complications among the patients with type 2 diabetes especially renal diabetic complications. Therefore, screening of diabetic nephropathy in patients with type 2 diabetes mellitus can help in early treatment and avoid its more serious complications not only the progression to ESRD but also development of other extra-renal diabetic complications.