DIFFERENCES OF ASYMMETRIC DIMETHYL ARGININE LEVEL IN PATIENTS WITH DIABETIC NEPHROPATHY AND NON-DIABETIC NEPHROPATHY
DOI:
https://doi.org/10.24293/ijcpml.v24i3.1420Keywords:
Asymmetric dimethylarginine, diabetic nephropathy, non-diabetic nephropathy, urinary albumin creatinine ratioAbstract
Endothelial dysfunction occurs early in Diabetic Nephropathy (DN), characterized by elevated Asymmetric Dimethylarginine (ADMA) levels. Increased ADMA levels may inhibit endothelial Nitric Oxide Synthase (eNOS) production which are required for Nitric Oxide (NO) formation. Decreased NO levels can increase peripheral resistance and exacerbate the endothelial dysfunction. By knowing the difference of ADMA levels in DN and non-DN patients can help the follow-up and management for the progression of endothelial dysfunction. The purpose of this research was to know the difference of ADMA levels in DN and non-DN by a cross-sectional observational analytical method in 53 diabetes mellitus patients at the Dr. Hasan Sadikin Hospital Bandung (December 2016-July 2017). Urine samples were examined to calculate urinary creatinine albumin ratio (uACR) and serum for ADMA levels. Asymetric dimethylarginin was examined by micro ELISA. Most of the subjects were males (60.38%) with the highest age in the range of 55-64 years (45.28%). Increased ADMA levels were found in 100% of DN and 18.5% of non-DN. Median ADMA levels were found in DN 1.01(0.73-2.25) µmol/L and non-DN 0.57(0.27-1.17) µmol/L, showing a significant difference of ADMA levels (p<0.001). High ADMA levels showed endothelial dysfunction in DN. Serum ADMA levels in DN patients were higher than in non-DN.
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References
Lim A. Diabetic nephropathy-complications and treatment. Inter Journal of Nephrology and Renovascular Dis. 2014; 7: 361-81.
Perkeni. Pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia. PB Perkeni, 2015; 6-68.
Vujićić B, Turk T, Crnćević-Orlić Z, ćorć‘ević G, Raćki S. Diabetic nephropathy. In: Vujićić B, editor. Pathophysiology and complications of diabetes mellitus. Croatia, InTech, 2012; 71-96.
Collins R, Armitage J, Parish S, Sleigh P, Peto R, Group HPSC. Heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: A randomised placebo-controlled trial. Lancet. 2003; 361(9374): 2005-16.
Handayani. Modifikasi gaya hidup dan intervensi farmakologis dini untuk pencegahan penyakit diabetes melitus tipe 2. Media Gizi Masyarakat Indonesia 2012; 1(2): 65-70.
Assal HS, Younes K, Alsayed A, Hasan N, Ali AR. Asymmetric dimethylarginine (ADMA) and progression of nephropathy in patients with type 2 diabetes. Kidney International. 2009; 18: 247-51.
Prastuti B, Sunarti. Pengendalian Superoxide Dismutase (SOD) dan Nitric Oxide (NO) pada penderita DMT2 dengan emping garut (Maranta arundinacea Linn) sebagai makanan selingan. Jurnal Gizi Klinik Indonesia. 2012; 8(3): 118-25.
Trocha M, Merwid-Lad A, Szuba A, Sozanski T, Magdalan J, Szelag A. Asymmetric dimethylarginine synthesis and degradation under physcological and pathological condition. Adv Clin Exp Med. 2010; 19(2): 233-43.
Tse-Min Lua, Yu-A Dinga, Shing-Jong Lina, Wen-Shin Leea, Tai H-C. Plasma levels of asymmetrical dimethylarginine and adverse cardiovascular events after percutaneous coronary intervention. jehj. 2003; 24: 1912–9.
Hanai K, Babazono T, Nyumura I, Toya K, Tanaka N, et al. Asymmetric dimethylarginine is closely associated with the development and progression of nephropathy in patients with type 2 diabetes. Nephrol Dial Transplant. 2009; 24: 1884–888.
Woolson RF, editor. Statistical methods for the analysis of biomedical data. New York, John Wiley and Sons Inc, 1987; 151-154.
ADMA (Asymmetric Dimethylarginine) ELISA kit. Elabscience. 2017.
MALB. Microalbumin flex reagent cartridge. Siemens-Dimension Insert Kit. 2015.
CRE2. Creatinine flex reagen cartridge. Siemens-Dimension. 2016.
Jayachandran I, Sundararajan S, Paramasivam P, Venkatesan B, Subramanian SC, Balasubramanyam M, et al. Association of circulatory asymmetric dimethylarginine (ADMA) with diabetic nephropathy in Asian Indians and its causative role in renal cell injury. J Clin Biochem. 2017; 26(5): 1-8.
Badan Penelitian dan Pengembangan Kesehatan. Riset kesehatan dasar. Jakarta, Kementerian Kesehatan Republik Indonesia, 2013; 90-2.
Kelly DM, Jones TH. Testosterone: A metabolic hormone in health and disease. J Endocrinol. 2013; 217(3): 25-45.
Jawalekar SL KA, Bhutey A. Risk of cardiovascular diseases in diabetes mellitus and serum concentration of asymmetrical dimethylarginine. Biochemistry Research International. 2013; 20: 1-6.
Tarnow L, Hovind P, Teerlink T, Stehouwer CD, Parving H. Elevated plasma asymmetric dimethylarginine as a marker of cardiovascular morbidity in early diabetics nephropathy in type 1 diabetes. Diabetes Care, 2004; 27(3): 765-9.
Sitar ME. Asymmetric dimethylarginine and its relation as a biomarker in nephrologic diseases. Biomarker Insights. 2016; 11: 131–37.
Krzyzanowska K, Mittermayer F, Shnawa N, Hofer M, Schnabler J, et al. Asymmetrical dimethylarginine is related to renal function, chronic inflammation and macroangiopathy in patients with Type 2 diabetes and albuminuria. Diabetic Med. 2007; 24: 81-6.
Anderssohn M, Schwedhelm E, Lüneburg N, Vasan RS, Böger RH. Asymmetric dimethylarginine as a mediator of vascular dysfunction and a marker of cardiovascular disease and mortality: An intriguing interaction with diabetes mellitus. Diabetes and Vasc Dis Research. 2010; 7(2): 105-18.
Hariawan KN, Suastika K. Hubungan kendali glikemik dengan asimetrik dimetilarginin penderita diabetes melitus tipe 2 lanjut usia. J Peny Dalam. 2008; 9(3): 203-14.
Depkes RI. Pedoman praktis memantau status gizi orang dewasa. Jakarta, Depkes RI, 2011; 1-10.[diunduh 26 September 2017]. Tersedia dari: http://gizi.depkes.go.id.
Ozdogan O, Cekic B. Is there a correlation between plasma levels of Asymmetric Dimethylarginine (ADMA) levels and Atherosclerosis in type 2 diabetes patients in Turkey. Medical Bulletin of Sisli Etfal Hosp. 2016; 51(1): 63-70.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ. 1998; 317(7160): 703-13.
