Abstract
ObjectivesNeutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid binding protein (L-FABP) are emerging as excellent biomarkers in the urine and plasma for the early prediction of acute and chronic kidney injury. The aims of this prospective study were to determine the role of albuminuria, and that of serum and urine levels of NGAL and L-FABP as predictors of a decline in the glomerular filtration rate (GFR) in patients with type 2 diabetes.MethodsA longitudinal cohort study with one hundred forty type 2 diabetic patients was conducted. Serum and urine levels of NGAL and L-FABP, and the urine albumin excretion rate were determined. The correlation between the kidney injury biomarkers and rate of GFR decline was analyzed.ResultsThe eGFR of study subjects decreased significantly as the study progressed (86.4±31.1 vs. 74.4±27.3 ml/min/1.73 m2, P<0.001), and the urine albumin excretion rate increased significantly (264.9±1060.3 vs. 557.7±2092.5 mg/day, P = 0.009). The baseline urine albumin excretion rate and serum L-FABP level were significantly correlated with baseline eGFR (P<0.05). The results of regression analysis for the correlations between the rate of eGFR change and the baseline levels of NGAL and L-FABP, and the urine albumin excretion rate showed that only the urine albumin excretion rate was significantly correlated with the rate of eGFR change (standardized coefficients: −0.378; t: −4.298; P<0.001).ConclusionsTubular markers, such as NGAL and L-FABP, may not be predictive factors associated with GFR decline in type 2 diabetic patients.
Highlights
Diabetes mellitus is the leading cause of chronic kidney disease (CKD) [1]
Microalbuminuria is an early clinical marker for diabetic nephropathy, which is associated with disease progression to end-stage renal disease and cardiovascular events [6,7,8,9]
The results showed that baseline urine albumin excretion rate, urine Neutrophil gelatinase-associated lipocalin (NGAL), and serum/urine liver-type fatty acid binding protein (L-FABP) levels were significantly correlated with baseline eGFR (P,0.05) (Table 5)
Summary
Diabetes mellitus is the leading cause of chronic kidney disease (CKD) [1]. The kidney injury is often irreversible when the diabetic nephropathy enters the macroalbuminuria or CKD stages [2]. Pathologic abnormalities are noted in patients with long-standing diabetes mellitus before the onset of microalbuminuria [3]. Microalbuminuria is an early clinical marker for diabetic nephropathy, which is associated with disease progression to end-stage renal disease and cardiovascular events [6,7,8,9]. Albuminuria is widely used and is considered the best clinical marker for renal damage in diabetic patients, several studies have suggested that significant kidney damage can appear before microalbuminuria occurs [10,11,12]
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