International Journal of Medical Science and Public Health Research
73
https://ijmsphr.com/index.php/ijmsphr
TYPE
Original Research
PAGE NO.
73-77
DOI
10.37547/ijmsphr/Volume06Issue05-05
OPEN ACCESS
SUBMITED
23 March 2025
ACCEPTED
19 April 2025
PUBLISHED
21 May 2025
VOLUME
Vol.06 Issue05 2025
CITATION
Saitov Dilshod Narzulloevic. (2025). Clinical and Pathogenetic Relationship
Between Nephropathy and Diabetic Foot Syndrome. International Journal
of Medical Science and Public Health Research, 6(05), 73
–
77.
https://doi.org/10.37547/ijmsphr/Volume06Issue05-05
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Clinical and Pathogenetic
Relationship Between
Nephropathy and Diabetic
Foot Syndrome
Saitov Dilshod Narzulloevich
PhD, Assistant of the Department of General and Pediatric Surgery No1,
Tashkent State Medical University, Tashkent, Uzbekistan
Abstract:
Diabetic nephropathy and diabetic foot
syndrome are among the most severe and disabling
complications of diabetes mellitus, determining the
severity of systemic disorders and an unfavorable
prognosis. Modern research indicates the presence of a
common pathogenetic basis for these conditions,
including
chronic
inflammation,
endothelial
dysfunction, microcirculation disorders and activation
of fibrotic processes. In this work, data on 32 patients
with various degrees of diabetic foot syndrome
according to the Wagner classification, who
simultaneously showed signs of diabetic nephropathy,
are considered. The analysis showed that more severe
forms of foot syndrome are associated with a
pronounced decrease in the glomerular filtration rate
and a high degree of albuminuria, which indicates
progressive kidney damage in this category of patients.
The data obtained emphasize the need for a
comprehensive assessment of target organ damage in
patients with diabetes mellitus, which is important both
for the prognosis and for the choice of management
tactics. Particular attention is paid to the role of chronic
renal failure as a factor in the deterioration of reparative
processes and a predisposition to purulent-necrotic
complications of the lower extremities.
Keywords:
Diabetes mellitus, diabetic nephropathy,
diabetic foot syndrome, chronic renal failure, severity of
complications.
Introduction:
Diabetes mellitus is a chronic multi-organ
disease accompanied by vascular, metabolic and
inflammatory disorders, which over time lead to the
development of severe complications. The most
significant among them are diabetic nephropathy and
diabetic foot syndrome, which significantly reduce the
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quality of life, aggravate the course of the underlying
disease and increase the risk of disability. Diabetic
nephropathy remains the leading cause of end-stage
renal disease, especially in patients with long-term
type 2 diabetes mellitus, and is accompanied by
persistent changes in the glomerular apparatus, the
development of proteinuria, a decrease in the
glomerular filtration rate, and the formation of fibrosis
[1, 2].
Diabetic foot syndrome is formed against the
background of a combination of peripheral
neuropathy, micro- and macroangiopathy and
infection, and is the leading cause of non-traumatic
amputations of the lower extremities worldwide [3, 4].
The course of this complication is exacerbated in
patients with concomitant renal dysfunction, since
chronic uremia, anemia, and decreased immune
reactivity contribute to the progression of ulcerative-
necrotic changes and a slowdown in reparative
processes [5]. Current studies indicate that the
presence of diabetic nephropathy increases the risk of
purulent complications and amputations in patients
with diabetic foot syndrome, while the severity of renal
damage correlates with the severity of foot damage
and the prognosis [6, 7].
Despite the obvious clinical conjugation of these
conditions, many aspects of their pathogenetic
relationship are not fully understood, and the issue of
risk stratification in patients with combined
complications remains a subject of discussion. Given
the high prevalence of combined foot and kidney
damage in patients with long-term diabetes, it seems
relevant to study the clinical and functional
relationships between these conditions.
The purpose of this work is to analyze the severity of
diabetic nephropathy in patients with diabetic foot
syndrome of varying severity and to discuss the
pathogenetic mechanisms of their mutual burden.
METHODS
This study is based on the analysis of data from 32
patients diagnosed with type 2 diabetes mellitus
hospitalized in the surgical department of the
multidisciplinary clinic of Tashkent State Medical
University between January 2022 and December 2024
for complicated forms of diabetic foot syndrome. All
patients at the time of inclusion in the analysis had
signs of diabetic nephropathy of varying severity,
which made it possible to study the clinical and
functional relationship between the severity of renal
damage and the degree of foot syndrome.
Among the examined patients, there were 19 men
(59.4%) and 13 women (40.6%) aged 48 to 72 years, the
mean age was 61.2±6.4 years. The average duration of
diabetes mellitus at the time of inclusion was 11.7±3.2
years. The diagnosis of diabetic foot syndrome was
established on the basis of clinical examination,
instrumental examination, assessment of ulcerative-
necrotic changes, palpation data of peripheral arteries
and ankle-brachial pressure index. Classification of
severity was used according to the Wagner system:
stage I was diagnosed in 6 patients (18.8%), stage II - in
10 patients (31.3%), stage III - in 9 patients (28.1%),
stage IV - in 7 patients (21.8%).
Diabetic nephropathy was confirmed on the basis of two
criteria: the presence of persistent albuminuria (≥ 30
mg/day) and a decrease in the glomerular filtration rate
according to the CKD-EPI formula. Depending on the
degree of renal failure, the patients were divided into
three subgroups: 12 patients (37.5 %) with preserved
renal function (glomerular filtration rate ≥ 60
ml/min/1.73 m²), 13 patients (40.6 %) with moderate
decrease (glomerular filtration rate 30
–
59 ml/min/1.73
m²) and 7 patients (21.9 %) with a pronounced decrease
in filtration capacity (glomerular filtration rate < 30
ml/min/1.73 m²).
Laboratory studies included serum creatinine,
glomerular filtration rate, daily proteinuria, glycosylated
hemoglobin (HbA1c), C-reactive protein levels, and
leukocyte count. To assess the relationship between the
severity of diabetic nephropathy and the stage of
diabetic foot syndrome, Spearman's correlation
coefficient was used. To assess the statistical
significance of the differences between the subgroups,
the Mann
–
Whitney U-test for quantitative traits and the
Pearson χ² test for qualitative traits were used. The
significance level was assumed to be p <0.05.
Data processing and visualization were carried out using
the Statistica v.12.5 and SPSS v.25.0 packages. All data
were previously anonymized, the study was performed
without interference in the treatment process and did
not require the approval of the ethics committee.
RESULTS
The analysis of the distribution of patients by the
severity of diabetic foot syndrome depending on the
level of decrease in the glomerular filtration rate
revealed a clear clinical and functional relationship
between the severity of renal damage and the stage of
local destructive changes in the foot area. In the group
with preserved renal function (glomerular filtration rate
≥ 60 ml/min/1.73 m²), patients with grade I
-II diabetic
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foot syndrome predominated, while in patients with
moderate to severe decline, grade III-IV glomerular
filtration rate according to the Wagner classification was
more common.
Table. Distribution of patients by degree of diabetic foot syndrome and glomerular filtration rate (n = 32)
The degree of diabetic syndrome стопы
(Wagner)
glomerular filtration rate (
ml/min
)
≥ 60
30–59
< 30
TOTAL
I degree
5 (41,7 %) 1 (7,7 %)
0 (0 %)
6 (18,8 %)
II degree
5 (41,7 %) 4 (30,8 %)
1
(14,3 %)
10
(31,3 %)
III degree
2 (16,6 %) 5 (38,5 %)
2
(28,6 %)
9 (28,1 %)
IV degree
0 (0 %)
3 (23,0 %)
4
(57,1 %)
7 (21,8 %)
TOTAL
12
(100 %)
13
(100 %)
7 (100 %) 32 (100 %)
Based on the data obtained, it was found that severe
forms of diabetic foot syndrome (III-IV degree)
prevailed in patients with a glomerular filtration rate of
<30 ml/min/1.73 m², which indicates an adverse effect
of pronounced nephropathy on the course of local
purulent-necrotic processes. In this category of
patients, deeper ulcerative defects, slow granulation
dynamics and frequent involvement of bone structures
in the process were recorded, which increased the
need for surgical interventions, including amputations.
Correlation analysis showed the presence of a
statistically significant inverse relationship between
the level of glomerular filtration rate and the degree of
diabetic foot syndrome (r=-0.67, p <0.01), which
confirms the clinical and pathogenetic relationship
between progressive nephropathy and aggravation of
local lesions of the extremities. There is also a
tendency to increase the level of C-reactive protein
and neutrophilia in patients with stage III-IV diabetic
foot syndrome and severe renal failure, which reflects
the systemic inflammatory load.
DISCUSSION
Diabetic nephropathy is one of the most serious
microvascular complications of diabetes mellitus,
leading to chronic kidney disease and end-stage renal
disease. According to various studies, up to 40% of
patients with diabetes mellitus develop diabetic
nephropathy during their lifetime [1].
The pathogenesis of diabetic nephropathy involves a
complex interplay of metabolic and hemodynamic
factors. Chronic hyperglycemia leads to activation of the
polyol pathway, increased formation of advanced
glycation end products (AGEs), and activation of protein
kinase C, which contributes to inflammation and fibrosis
of renal tissue [2]. In addition, activation of the renin-
angiotensin-aldosterone system (RAAS) increases
intraglomerular
pressure,
contributing
to
the
progression of nephropathy [3].
Clinically, diabetic nephropathy is manifested by
proteinuria, a decrease in the glomerular filtration rate,
and an increase in blood pressure. Early diagnosis and
control of risk factors such as hyperglycemia and
hypertension are key in slowing the progression of the
disease [4].
Diabetic foot syndrome is a complex multifactorial
complication of diabetes mellitus, characterized by the
development of ulcers, infections and, in severe cases,
gangrene of the lower extremities. According to the
World Health Organization, up to 15% of patients with
diabetes face foot ulcers during their lifetime [5].
The pathogenesis of diabetic foot syndrome includes
peripheral neuropathy, ischemia due to peripheral
arterial disease, and immune dysfunction. Neuropathy
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International Journal of Medical Science and Public Health Research
leads to a loss of sensation, which contributes to
invisible injuries and the subsequent development of
ulcers. Ischemia exacerbates wound healing, and
immune dysfunction increases the risk of infections [6].
Clinical management of diabetic foot syndrome
requires a multidisciplinary approach, including
glycemic control, wound care, antibiotic therapy, and,
if necessary, surgery. Early diagnosis and prevention
are key in reducing the risk of amputations [7].
There is strong evidence of a strong relationship
between diabetic nephropathy and diabetic foot
syndrome. According to studies, a decrease in the
glomerular filtration rate and the presence of
proteinuria are associated with an increased risk of
foot ulcers and amputations [8].
The mechanisms of this relationship include worsening
of microcirculation, increased inflammation and
reduced immune defense in patients with advanced
nephropathy. These factors contribute to poor wound
healing and increase the risk of infections in the foot
area [9].
Thus, the presence of diabetic nephropathy in patients
with diabetic foot syndrome requires special attention
from clinicians. A comprehensive approach to
treatment, including control of glycemia, blood
pressure, and renal function, as well as timely
intervention for foot lesions, is key in improving the
prognosis for this category of patients [10].
CONCLUSION
The data obtained confirm the existence of a
pronounced clinical and pathogenetic relationship
between diabetic nephropathy and diabetic foot
syndrome. It has been established that a progressive
decrease in renal function, especially with a decrease
in the glomerular filtration rate less than 60
ml/min/1.73 m², is associated with an aggravation of
the course of diabetic foot syndrome and an increase
in the incidence of III-IV degrees according to the
Wagner classification. This confirms the thesis about
the systemic nature of vascular and inflammatory
damage to target organs in diabetes mellitus.
The pathogenetic proximity of these complications is
explained by common links in the form of chronic
inflammation, endothelial dysfunction, dysregulation
of angiogenesis and a decrease in the immune
response. In patients with nephropathy, there is a
deterioration in reparative processes, a tendency to
infections, and pronounced ischemia of the distal parts
of the extremities, which leads to a complicated course
of ulcerative-necrotic processes and increases the risk of
surgical interventions. A particularly severe course is
noted with a combination of albuminuria, a reduced
level of glomerular filtration rate and a neuroischemic
form of foot syndrome.
Thus, when managing patients with diabetic foot
syndrome, it is imperative to take into account the state
of renal function, including a dynamic assessment of
glomerular filtration rate and albuminuria. The inclusion
of nephrological assessment in the risk stratification
algorithm allows not only to predict the severity of the
course, but also to apply nephroprotective measures in
a timely manner, thereby improving outcomes and
reducing the frequency of amputations. The presented
results emphasize the importance of an interdisciplinary
approach and the need for early diagnosis of
concomitant complications of diabetes mellitus.
Ethics Statement:
This study was carried out on the basis of a retrospective
analysis of anonymized clinical data obtained as part of
standard diagnostics and treatment. Experiments and
interventions outside of clinical protocols were not
carried out. The study complies with the Declaration of
Helsinki of the World Medical Association and did not
require separate approval from the ethics committee.
Financing:
The authors did not receive funding from public, private
or international organizations in the performance of this
work.
Conflict of interest:
The author declares that there is no conflict of interest
that could affect the interpretation of the data
presented or the scientific objectivity of the conclusions.
Author's contribution:
Saitov D.N. - development of the research concept, data
collection and analysis, preparation of the text of the
article, editing and final approval of the manuscript.
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