Mohammad Rizwan Khaliq, Shabnam Farooqui.
Diabetic Nephropathy and its association with cardiac autonomic dysfunction.
Ann Abbasi Shaheed Hosp Karachi Med Dent Coll Jan ;8(1):41-7.

Diabetic nephropathy is one of the fore runners of almost all complications of diabetes. This is a preventable disease. It can lead to sudden deaths due to arrhythmias in nephropathic patients, which can be due to cardiac autonomic dysfunctions Objective: To establish an association of diabetic nephropathy with cardiac autonomic dysfunction by crosses sectional study. Materials and Methods: Study was conducted in the Diabetic Clinic of JPMC Ward - 7 from January 1993 to January 1994. Fifty (N= 50) diabetic patients were included in the study with a history of diabetes for more than five years. Thirty six (N = 36) were diabetic proteinuric patients while fourteen (N=14) were non proteinuric diabetes. Patients with severe ischemic heart disease patients and infections anywhere in the body were excluded. Patients were divided(a-e) in to five groups according to severity of protein excretion in 24 hours. They were than assessed for cardiovascular autonomic neuropathy. Four tests for autonomic dysfunctions for selected. 1. Valsalva manoeuvre 2. Systolic blood pressure change to standing 3. Heart rate variation to breathe tests. 4. Heart rate variation to standing Group A was non-nephropathic diabetics while from B to E, were uric diabetics in increasing severity. Results: All autonomic tests showed increased abnormalities with degree of protein excretion. The tests were least abnormal in Group A while mostly abnormal in-group E, group B, C, D showed mostly borderline and abnormal responses. Conclusion: Autonomic abnormalities are increasingly seen with severe diabetic nephropathy, while least observed in non-nephropathic diabetes. This is of immense importance as cardiac arrhythmias and sudden death are encountered more frequently in cardiac autonomic disturbed patients.

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