Abstract
Objectives Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol (p=0.018) and serum cystatin C (p < 0.001) was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p=0.022), duration of T2DM (r = 0.326, p=0.021), and UACR (r = 0.528, p < 0.001) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p < 0.001). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.
Highlights
Diabetes mellitus (DM) has reached an epidemic state; globally, 1 in 11 adults have DM (90% have type 2 diabetes mellitus (T2DM)) [1]. is has led to an increase in microvascular and macrovascular complications [2, 3]
Up to 40% of DM patients are said to be affected by diabetic nephropathy (DN), and the diagnosis is usually made based on the presence of albuminuria (increased urinary albumin excretion (UAE)) and/or reduced estimated glomerular filtration rate in the absence of other renal diseases [4,5,6]
Based on the urinary albumin creatinine ratio (UACR) values, patients were divided into three groups: normoalbuminuria, microalbuminuria, and macroalbuminuria
Summary
Diabetes mellitus (DM) has reached an epidemic state; globally, 1 in 11 adults have DM (90% have type 2 diabetes mellitus (T2DM)) [1]. is has led to an increase in microvascular (nephropathy, retinopathy, and neuropathy) and macrovascular (coronary artery disease, peripheral arterial disease, and stroke) complications [2, 3]. Up to 40% of DM patients are said to be affected by diabetic nephropathy (DN), and the diagnosis is usually made based on the presence of albuminuria (increased urinary albumin excretion (UAE)) and/or reduced estimated glomerular filtration rate (eGFR) in the absence of other renal diseases [4,5,6]. Detection of abnormal renal function is essential to slow down the progression to nephropathy stage and further to end-stage renal disease (ESRD). Many markers such as cystatin C, alpha 1-microglobulin, immunoglobulin G or M, angiotensinogen, livertype fatty acid-binding protein, urinary transferrin, serum osteopontin, urinary retinol-binding protein, and interleukin-18 have been screened as early indicators of DN [6, 9,10,11,12,13]
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