Serum neutrophil gelatinase-associated lipocalin as a potential biomarker of diabetic kidney disease in patients with childhood-onset type 1 diabetes

Abstract

Diabetic kidney disease (DKD) is a major complication in patients with type 1 diabetes (T1D). The aim of this study was to evaluate the role of serum neutrophil gelatinase-associated lipocalin (sNGAL) in the early detection of DKD in childhood-onset T1D patients. A total of 116 patients (mean age, 22.3±6.9 years) with estimated glomerular filtration rate (eGFR)≥60mL/min/1.73m2 were enrolled in this prospective cross-sectional study. Persistent albuminuria (PA) was defined as a urine albumin-to-creatinine ratio≥30mg/g for at least two consecutive years; non-albuminuria (NA) was defined otherwise. The patients were divided into the adult (Ad) (≥18 years, n=91) and pediatric (Ped) (<18 years, n=25) groups and further into the Ad-PA (n=8), Ad-NA (n=83), Ped-PA (n=2), and Ad-NA (n=23) subgroups. In all groups, the sNGAL level was determined. The mean diabetes duration was 14.2±6.1 years, and 8.6% patients had PA. There was no significant difference in sNGAL levels between the PA and NA groups; notably, in adults, the sNGAL level was significantly higher in the Ad-PA than Ad-NA subgroups (P=0.039). The sNGAL level was negatively correlated with the eGFR in adults (rho -0.41, P<0.001). Multiple linear regression models showed that higher sNGAL levels in the adult group were independent and significant determinants of a lower eGFR (P<0.001). An elevated sNGAL was significantly correlated with a decreased eGFR even in the range of normal to mildly decreased renal function. Thus, it is a potential biomarker of early deterioration of DKD in childhood-onset T1D.