Is Urinary NGAL Determination Useful for Monitoring Kidney Function and Assessment of Cardiovascular Disease? A 12-Month Observation of Patients with Type 2 Diabetes.

Agnieszka Żyłka,Krzysztof Gil,Agnieszka Gala-Błądzińska,Paulina Dumnicka,Marek Kuźniewski,Beata Kuśnierz-Cabala,Rafał Olszanecki,Piotr Ceranowicz

doi:10.1155/2016/8489543

Agnieszka Żyłka, Krzysztof Gil + Show 6 more

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https://doi.org/10.1155/2016/8489543

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Journal: Disease markers	Publication Date: Jan 1, 2016
Citations: 15	License type: CC BY 4.0

Affiliation: Jagiellonian University

Abstract

Background. Diabetic kidney disease (DKD) may start as glomerular or tubular damage. We assessed kidney function during one-year-long observation of patients with type 2 diabetes mellitus (T2DM) after initiation of nephroprotective treatment, with emphasis on the changes in urinary neutrophil gelatinase-associated lipocalin (uNGAL), and evaluated the association between tubular damage and cardiovascular complications of T2DM. Materials and Methods. Adult T2DM patients (55) were assessed initially and 30 patients after 1 year. Albumin and uNGAL and creatinine were measured in first morning urine. Albumin/creatinine (uACR) and uNGAL/creatinine (uNCR) ratios were calculated. Results. In logistic regression, both uACR above 30 mg/g and uNCR the median (21.3 μg/g) were associated with cardiovascular complications, independently of classical risk factors and diabetes duration. One year after initiation of treatment, a significant reduction in HbA1c was observed. BMI and lipid profiles did not change. Increase in serum creatinine and reduction in eGFR occurred, along with decrease in uNGAL and uNCR. Increasing uNCR and uACR were associated with higher control HbA1c. The increase in uNCR was more frequent in patients with hypertension. Conclusions. Better glycemic control in T2DM patients results in improved tubular function, as reflected by reduced uNCR and uNGAL. First morning urine uNGAL and uNCR may be useful to assess renal function and cardiovascular risk, along with albuminuria and eGFR.

Highlights

The prevalence of diabetes worldwide is over 9 percent, and it is gradually increasing [1]
Promising preliminary results were obtained in our studies: namely, we found that uNCR exceeding 21.3 μg/g may be useful for early prediction of renal tubular damage in the course of Diabetic kidney disease (DKD) [18]
Patients with cardiovascular complications were characterized with older age, higher albuminuria and urine. Albumin/creatinine (uACR) values, and higher uNCR values (Table 1)

Summary

Introduction

The prevalence of diabetes worldwide is over 9 percent, and it is gradually increasing [1]. We assessed kidney function during oneyear-long observation of patients with type 2 diabetes mellitus (T2DM) after initiation of nephroprotective treatment, with emphasis on the changes in urinary neutrophil gelatinase-associated lipocalin (uNGAL), and evaluated the association between tubular damage and cardiovascular complications of T2DM. In logistic regression, both uACR above 30 mg/g and uNCR the median (21.3 μg/g) were associated with cardiovascular complications, independently of classical risk factors and diabetes duration. Increase in serum creatinine and reduction in eGFR occurred, along with decrease in uNGAL and uNCR. Better glycemic control in T2DM patients results in improved tubular function, as reflected by reduced uNCR and uNGAL. First morning urine uNGAL and uNCR may be useful to assess renal function and cardiovascular risk, along with albuminuria and eGFR

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Conclusion