Study of Association between Hyperuricemia and Albuminuria in Patients with Type 2 Diabetes Mellitus

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production. Hyperuricemia is defined as serum uric acid level ≥ 7 mg/dl (in men) or ≥ 6.0 mg/dl (in women). Uric acid is an end product of purine metabolism and approximately, one-third of it is degraded in the gut, and two-thirds is excreted by the kidneys. Elevated uric acid levels can result from increased generation or decreased elimination. Increased generation, in turn, can be caused by ingesting a purine-rich diet or alcohol, by certain genetic disorders (such as the Lesch- Nyhan syndrome), and by increased turnover of cells (such as in myeloproliferative diseases or tumor lysis syndrome). Method: This is a Hospital Based, cross-sectional study conducted in the Department of General Medicine. Age, Body weight, Height, BMI, serum uric acid, urinary albumin to creatine ratio (ACR), Fasting Blood Glucose (FBG), HbA1C, lipid profile, serum creatinine. Total number of cases were 100 (hundred) including both male and female and evaluated to calculate a correlation coefficient between albuminuria as measured by urinary ACR & serum uric acid level. Complete blood count, Serum uric acid, Urine RE/ ME & C/S, Urinary Albumin to Creatinine Ratio (ACR), Fasting Blood Glucose (FBG), HbA1C, Lipid profile, Serum Urea & Creatinine, USG whole abdomen, ECG in all leads. Results: In people with Hyperuricemia 50%(n=22) have microalbuminuria ; 36.4%(n=16) have macroalbuminuria & 13.6%(n=6) have normoalbuminuria. In people with Normouricemia, 17.9% (n=10) have microalbuminuria; 5.4%(n=3) have macroalbuminuria & 76.8%(n=43) have normoalbuminuria. So Albuminuria is significantly associated with Hyperuricemia. In people with Normoalbuminuria 87.8%(n=43) have Normouricemia and 12.2%(n=6) have Hyperuricemia. In people with Microalbuminuria 31.2%(n=10) have Normouricemia and  68.8%(n=22) have Hyperuricemia. In people with Macroalbuminuria 15.8%(n=3) have Normouricemia and 84.2%(n=16) have Hyperuricemia. In female population with Normoalbuminuria 79.2% (n=19) have  Normouricemia & 20.8% (n=5) have Hyperuricemia. In female population with Microalbuminuria 40%(n=8) have Normouricemia & 60%(n=12) have Hyperuricemia. Conclusion: Hyperuricemia correlated positively with FBG, HbA1C, serum creatinine, LDL & Triglycerides in patients with T2DM. No significant correlation found between Hyperuricemia and Age, Sex, Weight, Height, BMI, Hypertension & HDL. Urinary ACR correlated positively with FBG, HbA1C, serum creatinine, LDL & Triglycerides in patients with T2DM. patients with T2DM serum Uric Acid level correlated negatively with GFR. In patients with T2DM serum uric acid level correlated positively with urinary albumin creatinine ratio. This study showed that Hyperuricemia was associated with a greater probability of Albuminuria in patients with type 2 diabetes mellitus. Serum uric acid is an independent correlate of urinary ACR in patients with type 2 diabetes mellitus.