THE RELATIONSHIP BETWEEN HYPERTENSION AND INCIDENT
OF PROTEINURIA IN PATIENTS WITH THE TYPE 2 DIABETES
MELLITUS AT IBNU SINA HOSPITAL MAKASSAR
DzulRizka Razak, Prema Hapsari Hidayati, Rezky Putri Indarwati A, Dahliah, Andi
Faculty of Medicine,Universitas Muslim Indonesia
ABSTRACT
Background: About 30-40% of people with type 2
diabetes mellitus could experience renal damage
that will eventually lead to terminal renal failure and
require hemodialysis. Some people with type 2
diabetes mellitus also experience hypertension.
High blood pressure can affect kidney function by
stimulate the kidneys to work harder and induce
renal cell damage which is characterized by
proteinuria. Aim: The purpose of our study is to
determine the relationship between hypertension and
proteinuria in type 2 diabetes mellitus patients in
Ibnu Sina Hospital Makassar. Methods: A cross
sectional study of Diabetic patients at Ibnu Sina
Teaching Hospital that examined for their urine and
blood pressure at one time. Results: There were 32
diabetic patients included in this study at March to
June 2019. Among these samples there were
81,25% with hypertension and 8,75% without
hypertension. Our study revealed that out of 32
diabetic patients 8 (25%) had proteinuria and 24
(75.0%) didn’t have proteinuria. After we analyzed
with Chi Squared Test, we obtained p value is 0,296.
In prehypertension group, we found 1 patient with
proteinuria (+), and 1 patient with proteinuria (++). In
stage 1 hypertension group, there were 3 patients
with proteinuria (+). And in stage 2 hypertension , we
found 2 patients with proteinuria (+++) and 1 patient
with proteinuria (++++). It seems the more severe
degree hypertension would induce more severe
proteinuria, although statiscally not significant.
Conclusion: There is no relationship between
hypertension and proteinuria in patients diabetes
mellitus type 2.
 
Keywords: Type 2 Diabetes Mellitus;
Hypertension; Proteinuria  who accompanied hypertension could detected
BACKGROUND
Diabetes mellitus is a clinical syndrome
associated with insulin deficiency, inefficiency or
both. The IDF estimates that over 382 million people
worldwide are presenting with diabetes with the
number possibly rising to 592 million in the year of
2035. Indonesian on 7th rank out of 10 countries that
presenting the people with type 2 Diabetes Mellitus.
One of the complications of type 2 diabetes
mellitus (T2DM) is nephropathy characterized by
increased excretion of protein in the urine which is
presently the leading attributable cause of chronic
kidney disease. This condition sometimes eventually
become worsen and require hemodialysis. Persistent
proteinuria in T2 DM patient indicated the beginning
of damage of kidney function.
Some studies found that hypertension is one
of risk factor that contribute to development
proteinuria in T2DM.
Research on the relationship of hypertension
to the incidence of proteinuria in patients with type 2
diabetes mellitus in Indonesia is still rare to be found
the incidents of the type 2 Diabetes Mellitus is
increase year by year. There for, the authors are
interested in conducting research on this matter.
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METHOD AND MATERIALS
This study uses a cross-sectional study design
with consecutive random sampling technique, the
sample is patient with type 2 Diabetes Mellitus and
hypertension that examined for their urine and blood
pressure at the same time. The sample that having
urinary tract infection at kidney abnormalities will be
exclude.
Patients who have the criteria then continued to
measuring the blood pressure and urine test. The
result of this study are performed in univariat and
bivariat. That analyzed by using SPSS program. The
statistic test that used is chi-square test.
RESULTS
Of the 32 diabetes mellitus patients that fulfill
the inclusion and exclusion criteria, where found 26
patients that are having hypertension and
normotension as many as 6 patients while the
patients with proteinuria are 8 patients and negative
proteinuria are 24 patients. In the bivariate analysis
that using the chi-square test, twhere found non
significant p value which is p = 0.296.  sensitivity to the action of insulin in the muscles and
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DISCUSSION
The incident of women whom suffering from
diabetes mellitus are more than compared to the
number of men. This is because the level of
liver. Estrogen is a hormone that belongs to women.
Increased and decreased levels of the hormone
estrogen which is can be increased and decreased
by blood glucose levels. When estrogen levels
increased, the body will be resistant to insulin
The relationship of hypertension with the
incidence of proteinuria in patients with diabetes
melitustype 2 also showed that patients who detected
proteinuria were positive as many as 8 people
(30.8%) and negative 24 people (69.2%). This also
showed that not all patients with diabetes mellitus
proteinuria because proteinuria is usually found in
patients with diabetes melitustype 2 who have long
suffered from hypertension, usually the length of time
needed to cause proteinuria about 10 years more
due to kidney atherosclerosis and benign
nephrosclerosis.
Research conducted by Saaito T, et al in 2013
of 216 people found that metabolic syndromes
including hypertension and diabetes mellitus were
predictors of the development of chronic kidney
disease characterized by pathological proteinuria.
Higher blood pressure in hypertension results in
damage to renal nephrons, decreases in nephron
mass causing an increase in plasma nephron flow
and hyperfiltration in the remaining nephrons.
Hyperfiltration increases glomerular capillary
permeability, so that the protein passes through the
glomerular capillary membrane and proteinuria
occurs.
CONCLUSION
In this study there was no significant
relationship between hypertension and incidence of
proteinuria in patients with type 2 diabetes mellitus
at Ibnu Sina Hospital Makassar.