Comparative Study of Renal Function Tests and Liver Function Tests in Type2 Diabetes Mellitus Dr

Research Article Volume 10 Issue No.5

Comparative Study of Renal Function Tests and Liver function Tests in Type2 Diabetes Mellitus Dr. Gulab Kanwar1, Dr. Neeraj Saxena2 Senior Professor & Head1, Senior Resident2 Department of Biochemistry Government Medical College, Kota, India

Abstract: Introduction: diabetes is a metabolic disorder characterized by increased levels of blood glucose due to impairment in insulin action and/or insulin secretion. Liver is more susceptible to diseases as Liver plays a major role in the regulation of carbohydrate metabolism. Materials and methods: the study comprises of 100 subjects, out of whom 50 were diabetic cases and 50 non-diabetic control subjects. The subjects were those attending outdoor and indoor in New Medical College Hospital Kota, Rajasthan, India. Renal function test and Liver function test were estimated by various methods mentioned above on fully automatic analyzer. Quantitative data was summarized in the form of mean ± sd and differences in means of both the groups were analyzed by unpaired student‘t’ test using graph pad prism. P-value less than 0.05 were considered significant. Results: The mean activity of serum bilirubin, serum AST, serum ALT and serum ALP of diabetic patients shows significant difference from that of normal subjects. While Renal function of diabetic patients were at upper limit that of non-diabetic controls. Conclusion: the outcome of the present study shows that both liver and renal functions have altered level in diabetic patients than controls. In contrast to renal function, liver function shows visible disturbance. Thus screening for liver dysfunction along with renal function test in diabetics and subsequent workup may lead to early detection of co-morbidities and better management of diabetes.

Keywords: Renal Function; Liver function; LFT; RFT; AST; ALT; alkaline phosphatase; Urea; Creatinine; Diabetes Mellitus; NMCH; Kota.

I. INTRODUCTION incidence of liver function test abnormalities than individuals who do not have diabetes. Mild chronic elevations of Diabetes mellitus (DM) is a metabolic disorder of chronic transaminases often reflect underlying insulin resistance. high glucose level either due to insulin insufficiency or resistance. It proceeds with long–term damage dysfunction II. AIMS AND OBJECTIVES and failure of various organs, especially the kidneys, liver, heart, nerves, eyes and blood vessels1. The liver plays a main We aimed meta-analysis of data to role of the regulation of carbohydrate metabolism, as it has the 1) To study the derangements of liver function test (LFT) and capability to uses glucose as a fuel and store as glycogen and Renal function test (RFT) in Diabetes cases also synthesizes glucose from non-carbohydrate sources. This 2) To compare the differences in LFT and RFT in diabetic makes the liver more susceptible to diseases. Liver function cases and non-diabetics controls. tests (LFTs) include the serum aminotransferases, bilirubin, 3) To find out relation in LFT and RFT in diabetic cases and alkaline phosphatase and albumin. non-diabetics controls.

Aminotransferases such as Aspartate aminotransferase (AST) III. MATERIALS AND METHODS and Alanine aminotransferase (ALT) are measure the concentration of intracellular hepatocellular enzyme that have This study was carried out in the New Medical College leaked into the circulation and serve as amarker of Hospital Kota, Rajasthan, India. Fifty patients with known hepatocellular injury2. In United States,Erbeyet al.3were history of diabetes for past 2 years were included in study as studied the increased level of ALT enzyme among type 2 cases, another fifty age matched non-diabetic healthy included diabetes was about 7.8% compared with 3.8% in those as controls. Patients of known case of alcoholism, HIV without diabetes. The metabolic disease has been seen with infection, patients having chronic liver disease or using many diseases such as endothelial dysfunction, kidney disease hepatotoxic drugs, cor-pumonale or congestive cardiac failure and oxidative stress4. patients having proteinuria and pregnant women were excluded from study. Sample taken from all of the subjects. Plasma ceratinine and urea are established markers of Serum separated after centrifuge and analyzed for LFT Glomerular filtration rate (GFR), While the lower serum including AST, ALT, Bilirubin total and direct; and serum creatinine is associated with high risk of type2 diabetes, which renal function tests (Urea and creatinine) levels. All samples might reflect a lower volume of skeletal muscle5.Skeletal were analyzed for LFT and RFT on ERBA EM-360 auto muscle is a major target tissue of insulin and a lower volume analyzer based on wet chemistry principle. of it would mean fewer target sites for insulin which causes elevated in insulin resistance and leads to the progression of Statistical analysis: Quantitative data was summarized in the type2 diabetes6. Individuals with type 2 diabetes have a higher form of MEAN ± SD and differences in means of both the

IJESC, May 2020 26084 http:// ijesc.org/ groups were analyzed by unpaired student‘t’ test using graph pad prism. P-value less than 0.05 were considered Significant.

IV. OBSERVATION AND RESULT

Table.1. The Comparison between levels of LFT and RFT GLU BIL T BIL D PRO T ALB UREA CREA AGE SGOT SGPT ALP (mg/dl (mg/dl (mg/dl (Gm/dl (Gm/d (mg/dl T. (Yrs) (U/L) (U/L) (U/L) ) ) ) ) l) ) (mg/dl) CASE 52.54 151.32 1.74 0.474 49.38 62.56 134.32 6.18 3.37 35.46 0.9 CONTRO L 51.66 97.46 0.4 0.134 24.46 24.2 79.12 6.398 3.75 20.26 0.802

p-value 0.735 0.0001 0.0001 0.0001 0.0001 0.0003 0.0001 0.1174 0.0002 0.001 0.031

The result shows that liver functions are elevated in diabetic urea level because hyperglycemia is one of the major cause of cases (except albumin & protein). The levels of urea and progressive renal damage and an increase in urea level is seen creatinine in diabetes were also at higher side, which indicate when there is damage in the kidney or the kidney is not that there is strong relationship between blood sugar level and functioning properly7.

Table.2. The Comparative levels of LFT and RFT in form of ratios. BIL T/ UREA/ CREATININE ALB BIL T UREA ALB/CREAT CREAT CREAT (mg/dl) (Gm/dl) (mg/dl) (mg/dl) RATIO RATIO RATIO CASE 0.9 3.37 1.74 35.46 3.744 1.933 39.4 CONTROL 0.802 3.75 0.4 20.26 4.6875 0.5 25.325

Table.3. serum AST, ALT and AST/ALT ratio PARAMETER AST ALT AST/ALT RATIO CASE 49.38 62.56 0.789322251 CONTROL 24.46 24.2 1.010743802

160 140 120 100 80 60 CASE 40 20 CONTROL 0

Figure.1. The Comparison between levels of LFT and RFT

3 CASE CONTROL 2

0 ALBUMIN CREATININE ALB/ CREATININE RATIO

Figure.2. Serum albumin, creatinine, and albumin/cretinine ratio

IJESC, May 2020 26085 http:// ijesc.org/ As shown above when comparing albumin or creatinine alone between diabetic cases and non-diabetic controls. The similar it doesn’t give clear idea of comparison but in findings we observed when applied the idea of ratio albumin/creatinine ratio it is grossly visible the difference presentation in bilirubin vs. creatinine, urea vs. creatinine.

1.5

CASE 1 CONTROL 0.5

0 BILIRUBINE CREATININE BIL T/ CREATININE RATIO

Figure.3. serum bilirubin total, creatinine and bilirubine total/creatinine ratio

40 35 30 25 CASE 20 CONTROL 15 10 5 0 UREA CREATININE UREA/ CREATININE RATIO

Figure.4. Serum urea, creatinine and urea/creatinine ratio

40 CASE CONTROL 30

0 AST ALT AST/ALT RATIO

Figure.5. Serum AST, ALT and AST/ALT ratio

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3 CASE 2 CONTROL 1

0 ALB/ CRET RATIO BIL T/ CRET RATIO AST/ALT RATIO

Figure.6. Serum albumin/creatinine bilirubine/creatinine and AST/ALT ratio

As shown in above figure our findings in study stat that necessary facilities. Though urine albumin/creatinine ratio is albumin/creatinine ratio and AST/ALT ratio is lower in being used for microalbuminuria; author also recommend diabetic case in compare to non-diabetic controls; whereas serum albumin/creatinine ratio to discriminate risk of diabetic bilirubine total/creatinine ratio is higher in diabetics. complications.

V. DISCUSSION & CONCLUSION VII. REFERENCES

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The higher levels of bilirubin and ALT and lower AST/ALT [8]. Mamta, C.; Surendra, K.; Yogtt, Ghanshyam, G. and ratio are independent additive risk factors of T2DM. The Rachit, S.2011. comparative study of liver function test in serum bilirubin/creatinine ratio and urea/creatinine ratio are type 1 in type 2 diabetes mellitus. J. Indian .Sci. Res. independent markers for T2DM. The individuals with diabetes 5(2):143-147. mellitus have higher incidence abnormalities for renal and liver function than individuals who do not have diabetes. [9].Eshraq, M. andBushra, F.2015. The effect obesity and Although there are currently no consensus guidelines or insulin resistance on liver enzymes in type 2 diabetesmellitus. recommendations regarding LFT screening in patients with J.BaghdadSci. 12(3): 536-545. type 2 diabetes mellitus, these findings lend support to the practice of routine liver function monitoring in subjects with [10]. Johnston, D.G. and Alberti, K.G. 1976. Carbohydrate type 2 diabetes mellitus. Therefore, if LFT screening is to be metabolism in liver disease. J.Clin. Endoc. 5: 675. adopted, it would be incumbent on the physician to ensure that abnormal findings are appropriately investigated, or that the [11]. Elizabeth, H. and Harris, MD. 2005. Elevated liver patient be timorously referred to a tertiary institution with the Function test in type 2 diabetes.J. Clin. Diabet. 23(3):115-119.

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