الفهرس 
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Abstract
DM is a complex metabolic syndrome characterized by chronic hyperglycemia resulting in complications affecting the peripheral nerves, kidneys, eyes, and micro- and macrovascular structures. The prevalence of all types of diagnosed diabetes in most western societies is 3–7%. Preventing vascular complications and monitoring of DM are the need of the hour as the prevalence of DM and its vascular burdens are increasing day by day. Type 2 DM is characterized mainly by impaired insulin secretion and increased tissue insulin resistance. Sustained hyperglycemia leads to a series of interrelated alterations that can cause evident endothelial dysfunction and vascular lesions in diabetic complications. Formation of advanced glycation end products, activation of protein kinase C and disturbances in polyol pathways are the possible mechanisms by which increased glucose induces vascular abnormalities. The risk of progression of diabetic nephropathy has improved over the last several decades, largely due to vigorous glycemic control, more blood pressure reduction and the use of angiotensin converting enzyme inhibitors. The general objective of the present study was to reduce chronic kidney disease progression as a complication of type 2 diabetes mellitus to prevent end stage renal failure. This was achieved through determination of the prevalence of renal disease progression (diabetic nephropathy) in type 2 diabetic patients and study its risk factors amongstudied group.
The aim of this study to evaluate the early detection of diabetic nephropathy by urinary albumin to creatinine ratio which can be used as a valuable non-expensive and non- invasive diagnostic marker. The present study included 89 type 2 diabetic patients persons (48) males and (41)females ranged between 27---66 years old selected from internal medicine department in Boolak Eldakrory hospital from 2014to 2015. The selected patients were compared to( 20)normal control persons (11) males and ( 9) females ranged between 28---66 years old. Excluded patients who had:- 1- Hypertension. 2- Other causes of nephropathy. 3- Acute or chronic inflammation . 4- Any cardiovascular disease. 5- Any organ failure. 6- Urinary tract infection. All patients were subjected to:- Questioner of Medical history included: Age Duration of diabetes. Hypertension Smoking Oral contraceptive intake Family history Diabetic micro –macro vascular complications Physical examination and Laboratory evaluation included (ACR, HbA1Cserum creatinine). Results of this study revealed that: As regard sex: There was no a significant difference between studied groups. As regard age: There was no a significant difference between control and case groups. There was highly significant difference between control and case groups as regard FBG, 2HPPG, HbA1c. There was a significant difference between control and case groups regarding to urinary albumin creatinine ratio. Cases group divided on the basis of urinary albumin creatinine ratio as markers of diabetic nephropathy to normoalbuminuric diabetic patients 59(66.35%), microalbuminuric patients 23(25.8%) and macroalbuminuric patients 7(7.9%). There were statistically significant relationships between nephrogenic diabetes and duration of diabetes, glycemic control, obesity. This study shows that duration of diabetes and HbA1c are independent risk factors for diabetic nephropathy. The high proportion of patients who present with albuminuria within the two year of diagnosis probably indicates longer duration of prior undiagnosed diabetes or poor glycemic control.