Abstract
Diabetic kidney disease develops in half of genetically predisposed patients with type 2 diabetes (T2DM). Early diagnosis of kidney damage and nephroprotective treatment are the ways of preventing the disease progression. Our aim was to evaluate selected laboratory markers of glomerular and tubular damage in T2DM patients with early stages of chronic kidney disease (G1/G2, A1/A2) for their associations with A2 albuminuria and early decline in the estimated glomerular filtration rate (eGFR). Among 80 T2DM patients with median eGFR of 92.4 ml/min/1.73 m2 and median urinary albumin to creatinine ratio (uACR) of 4.69 mg/g, 19 had uACR > 30 mg/g (A2). Higher serum cystatin C, serum and urine neutrophil gelatinase associated lipocalin (NGAL), urine kidney injury molecule 1 (KIM-1), detectable urine transferrin and IgG, and lower serum uromodulin significantly predicted A2 albuminuria, urine KIM-1/creatinine ratio, and IgG being the best predictors. Albuminuria, urine NGAL/creatinine, and IgG correlated with diabetes duration. Albuminuria, urine NGAL, transferrin, IgG, and uromodulin correlated with diabetes control. In a subgroup of 29 patients, retrospective data were available on changes in eGFR and uACR over one year. Decline in eGFR was observed in 17 patients and increase in uACR in 10 patients. Serum and urine NGAL correlated with eGFR changes. Higher urine NGAL, KIM-1/creatinine ratio, and detectable IgG were significantly associated with the increase in uACR. Widely available markers, serum cystatin C, urine IgG, transferrin, and NGAL, may help in early assessment of kidney disease in T2DM patients; however, large prospective studies are needed to confirm the conclusion.
Highlights
Diabetes is the most prevalent metabolic disease worldwide, and its complications are among the most important public health issues [1]
Based on the guidelines issued by Kidney Disease Outcomes Quality Initiative (KDOQI) in 2007 [4], the Mediators of Inflammation repeated assessment of urine albumin/creatinine ratio in two to three samples of morning urine together with the estimation of glomerular filtration rate has been recognized as the best standard screening for diabetic kidney disease (DKD)
Based on KDOQI definitions [4, 10], DKD diagnosis is based on increased albuminuria and decreased estimation of glomerular filtration rate (eGFR)
Summary
Diabetes is the most prevalent metabolic disease worldwide, and its complications are among the most important public health issues [1]. Diagnosis and early initiation of nephroprotective therapy have the potential to prevent the progression of DKD toward end-stage renal disease and to improve patients’ prognosis. Based on the guidelines issued by Kidney Disease Outcomes Quality Initiative (KDOQI) in 2007 [4], the Mediators of Inflammation repeated assessment of urine albumin/creatinine ratio (uACR) in two to three samples of morning urine together with the estimation of glomerular filtration rate (eGFR) has been recognized as the best standard screening for DKD. It is well known that kidney damage in course of type 2 diabetes mellitus (T2DM) may occur without increased albuminuria [5]. Decrease in eGFR is not an early indicator of diabetic renal damage. There is a need to seek new biomarkers of early renal damage in patients with T2DM
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