Correlation between Neutrophil to Lymphocyte Ratio and Urine Albumin to Creatinine Ratio in Diabetic Nephropathy Patients: A Cross-sectional Study

Abstract

Introduction: One of the microvascular complications of diabetes is known as Diabetic Nephropathy (DN). The clinical manifestation of DN is an increase in the amount of albumin excreted in the urine. Albuminuria is the inflammatory process that occurs before end-stage renal failure and is a diagnostic marker. The total White Blood Cell (WBC) count is a crude but sensitive measure of inflammation. It is examined as an inflammatory marker in various cardiac and non cardiac disorders, such as acute Myocardial Infarction (MI), stroke, and heart failure. Aim: To find a correlation between Neutrophil to Lymphocyte Ratio (NLR) and Urine Albumin to Creatinine Ratio (UACR) in DN patients. Materials and Methods: This was an analytical cross-sectional study done over a period of 18 months from January 2018 to June 2019 at Vydehi Institute of Medical Sciences and Research Centre in Bengaluru, Karnataka, India. on 104 subjects diagnosed with type 2 Diabetes Mellitus (DM) registered in present study. Spot albuminuria was tested by immune turbidimetry method. Urine creatinine was tested using Jaffe’s kinetic method, from which spot UACR was calculated. The patients with albuminuria and without albuminuria were grouped into cases and controls, respectively. NLR was calculated using complete blood count and correlated with UACR. The estimated Glomerulus Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation and correlated with UACR. Cases were further subgrouped into moderately increased albuminuria and severely increased albuminuria groups. Mean and standard deviation, independent sample t-test, Chi-square test, Odds Ratio (OR) were applied to find significance. A p-value of <0.05 was considered statistically significant, and an OR more than one suggests a positive association. Results: A total of 104 diabetic subjects were registered, with 52 subjects having DN and 52 having normal urine albumin. The mean age was 56±11.3 years and 50.6±11.8 years in the case and control groups, respectively. Among the 52 subjects in the case group, 12 (23.1%) were female and 40 (76.9%) were male. In the 52 control group, 30.8% (n=16) were female, and 69.2% (n=36) were male. The mean urine albumin was 75.5±121.2 mg/dL and 1.2±1.2 mg/dL in the case and control groups, respectively (p<0.001). A correlation was calculated between UACR and NLR, with a cut-off value for NLR of 2.92. The cutoff value for NLR was calculated using the Receivers Operating Curve (ROC). The Chi-square test was applied, showing statistical significance (p<0.001), with an OR calculated at 4.34 (OR >1). Conclusion: The present study showed a significant positive correlation between NLR and UACR. Therefore, NLR may be considered a novel surrogate marker of DN, as an alternative to UACR, which is expensive and requires special equipment.