Early Marker Of Diabetic Nephropathy Research Articles

FRI626 Association Between Fasting Serum C-peptide Values And The Presence Of Chronic Kidney Disease In Patients With Type 2 Diabetes Mellitus

Abstract Disclosure: L. Leyva Figueroa: None. F.J. Gomez-Perez: None. F. Gonzalez-Valdivia: None. D. Cuevas-Ramos: None. Background: High C-peptide levels have been associated with microvascular complications, although there is controversial evidence in patients with T2DM. Objective: To correlate fasting serum C-peptide values in patients with T2DM with diabetic nephropathy. Hypothesis: In patients with type 2 diabetes mellitus there is a positive correlation of minimum r=0.3 between fasting C-peptide, albumin/creatinine ratio (ACR) and glomerular filtration rate (eGFR). Research Question: Is there a significant and independent correlation between fasting C-peptide values, ACR, and eGFR in patients with type 2 diabetes mellitus? Methods: Retrospective, cross-sectional, observational, real-world study, in 551 type 2 diabetic patients. Data was collected from the electronic clinical records. Microalbuminuria was defined as an ACR equal or greater than 30, and eGFR was calculated by CKD-EPI 2021. Fasting C-peptide was measured by immunochemiluminescence. Continuous variables were expressed as means +/− standard deviation, while categorical variables will be expressed as percentages. We used one-way ANOVA to compare continuous variables between groups, and Chi-square test to compare categorical variables. Multivariate logistic regression analysis was used to analyze the independent relationship between C-peptide quartiles, eGFR, and ACR, adjusted for weight, insulin, and disease duration. Results: 551 patients were evaluated (63% were women), with mean age of 62 ±11 years old, and a HbA1c of 8.4%. Median (interquartile range) of disease duration was 20 years (12-25), with a C-peptide median level of 1.6 (0.9-2.4 ng/ml), with no significant difference by gender. A statistically significant direct relationship was found between a higher C-peptide quartile and higher ACR (F=9.8, p= 0.03). A significant correlation was also found between C-peptide and ACR (r=0.16, p<0.001), and also with eGFR (r=−0.11, p=0.01). Using a multivariate regression analysis we identified an independent association between C-peptide and ACR (beta=44.7, CI95%, 16-73, p=0.002), and also with eGFR (beta −2.7, CI95% −4.7 to −0.6, p=0.01). Conclusions: A significant and independent association was found between C-peptide levels and kidney function and albuminuria. Future studies may confirm that C-peptide can stand as an early marker for diabetic nephropathy. Presentation: Friday, June 16, 2023

Choroidal structural changes in patients with early diabetic nephropathy

PurposeTo determine alterations of the choroidal thickness (CT) and the choroidal vascularity index (CVI) in patients with glomerular hyperfiltration, a marker of early diabetic nephropathy (DN). MethodsTwenty-two patients with type 2 diabetes (T2D) with glomerular hyperfiltration (early DN group) and 28 patients with T2D without DN (NDN group) were included in the study. Patients with diabetic retinopathy were excluded. Parameters including subfoveal CT, the subfoveal choroidal vascularity index (CVI), and total CVI were measured using spectral-domain enhanced depth imaging optical coherence tomography method. ResultsThe early DN group included 22 patients and the NDN group comprised 28 patients. The groups were similar in terms of age and sex (p>0.05). The CT values were statistically significantly lower in the early DN group than in the NDN group (p < 0.001). There was no significant difference between the early DN group and the NDN group in terms of total and subfoveal CVI (p>0.05). ConclusionThe choroidal thickness decreased in patients with T2D with glomerular hyperfiltration, but there were no differences in CVI when they were compared with patients with T2D without DN.

Effects of Ramadan Fasting on Diabetic Nephropathy in Type 2 Diabetic Patients

Abstract Background Type 2 diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients, as well as on the health care system. Diabetic nephropathy is one of the major complications of diabetes, characterized by proteinuria and renal insufficiency. The development of microalbuminuria is an early marker for diabetic nephropathy, which is potentially modifiable through lifestyle changes and pharmacological interventions targeting blood glucose and blood pressure, specifically through the renin angiotensin system. Aim of the Work The aim of this work is to study the effect of Ramadan fasting on diabetic nephropathy in type 2 diabetic patients. Patients and Methods Our study conducted on 90 type 2 diabetic patients, their age between 40-60 years; all of them are welling to fast the whole month of Ramadan, selected from the outpatient clinic of endocrinology, Ain Shams University Hospitals. Results There was a highly statistically significant increase in Creatinine (p &amp;lt; 0.001) as well as a highly statistically significant increase in urea after Ramdan in all studied group (P &amp;lt; 0.001). The Percentage change in GFR was significantly higher in macroalbuminuria. The Percentage change in A/C ratio in micro and macroalbuminuria were significantly lower when compared to normoalbuminuria, as well as in macroalbuminuria when compared to microalbuminuria groups. (P = 0.001). There were no significant differences found regarding, body mass index;, systolic blood pressure, diastolic blood pressure fasting blood glucose, postprandial blood glucose, HbA1c before and after Ramadan. Conclusion Ramadan fasting has no harmful impact on albuminuria among patients with T2DM. However, fasting leads to a significant decline in renal function parameters among diabetic patients with albuminuria. This decline is more prominent in patients with macroalbuminuria than patients with microalbuminuria. Thus, fasting should be avoided in patients with a severe decline in renal functions. Patients should be advised regarding adequate hydration and dietary modification during Pre-Ramadan health care education. On the other hand, Ramadan fasting has no negative impacts on glycemic control and other metabolic parameters. Nevertheless, further trials that assess the role of fasting in at-risk patients are still needed.

Analysis of Urinary Fibronectin Levels in Patients with Type 2 Diabetes Mellitus and Non-Diabetes Mellitus

Diabetic nephropathy is a microvascular complication associated with high glucose levels in individuals with diabetes mellitus (DM). Fibronectin, an early marker of diabetic nephropathy, can indicate the occurrence and progression of renal damage. This cross-sectional study aimed to compare urinary fibronectin levels in patients with type 2 diabetes mellitus and non-diabetes mellitus. A sample of 50 DM patients was divided into two groups: the DM group and the non-DM group. Urinary fibronectin levels were measured using the ELISA method, while albuminuria levels were determined by the albumin-to-creatinine ratio (ACR). Statistical analysis was performed to assess the relationship between urinary fibronectin levels and urine albumin. Results: The average urinary fibronectin level in DM patients was 2.07 ± 3.04 ng/mL, which was slightly higher than the level observed in non-DM patients (1.09 ± 0.56 ng/mL). However, this difference was not statistically significant (p 0.05). Additionally, there was no significant relationship found between urinary fibronectin levels and urine albumin (p = 0.001). Conclusion: The findings of this study indicate that urinary fibronectin levels in individuals with DM were slightly higher than those without DM. However, this difference did not reach statistical significance. The lack of a significant relationship between urinary fibronectin levels and urine albumin suggests that fibronectin may provide additional information about renal damage in DM patients, independent of albuminuria. Further research is necessary to explore the clinical significance of urinary fibronectin as a potential biomarker for diabetic nephropathy.

Urinary N-Acetyl-β-D glucosaminidase (uNAG) levels as an early marker for diabetic nephropathy in children with type 1 diabetes

BackgroundDiabetic nephropathy is considered a major complication among patients with type 1 diabetes. In the present study, we aimed to evaluate urinary N-acetyl-beta-D-glucosaminidase levels (uNAG) in patients with type 1 diabetes mellitus (DM).MethodsThis cross-sectional study of 60 patients with type 1 DM, was categorized into two groups (normoalbuminuria and microalbuminuria) and 30 healthy controls. uNAG was measured in all cases and controls.ResultsPatients with type 1 DM showed increased mean uNAG values compared to controls. Interestingly, increased NAG levels were found in diabetic patients without early signs of glomerular damage (normoalbuminuric). The severity of renal disease, poor glycemic control, and duration of diabetes were all proportional to uNAG increased levels.ConclusionsNAG measurement is a useful, noninvasive tool for assessing renal involvement in children with diabetes and for early diagnosis of developing nephropathy.

A study of serum cystatin C as a marker of diabetic nephropathy among patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Clinically type 2 diabetes mellitus (T2DM) without serum creatinine microalbuminuria, macroalbuminuria lacks predictors for diabetic nephropathy (DN). We utilized a meta-analysis technique to review the literature to evaluate whether serum cystatin C may be used as an early marker of diabetic nephropathy in light of the differing opinions regarding the utility of serum cystatin C as such. PubMed, Google Scholar, Web of Science, EMBASE, and Scopus Database were searched using various key search terms. Studies involving T2DM patients and containing serum cystatin C levels and the estimated glomerular filtration rate (eGFR) data were included. Pooled sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The pooled sensitivity and specificity of serum cystatin C for predicting DN were 0.87 (95% CI 0.84 - 0.91) and 0.84 (95% CI 0.83 - 0.88) respectively. The pooled positive and negative predictive values of serum cystatin C for predicting DN were 7.035 (95 % CI 4.30 – 11.43) and 0.15 (95% CI 0.09 - 0.21) respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.9548 and the diagnostic odds ratio was 67.10 (95% CI 28.12 - 156.84). Serum cystatin C is a significant biomarker of DN among patients with T2DM. It can also positively monitor kidney function progression and prediction of adverse outcomes among T2DM patients.

Serum α-KL, a potential early marker of diabetes complications in youth with T1D, is regulated by miRNA 192.

Despite the wealth of information on biomarkers of diabetes complications in adults with type 1 diabetes, data in the pediatric population is limited. Diabetic nephropathy (DN), the leading cause of mortality in type 1 diabetes T1D), could be potentially missed in youth, as albuminuria, the current “gold” standard, may be transient and may not reflect permanent renal impairment. Soluble alpha KL has emerged as a potential marker of early diabetic nephropathy. Seventy-nine pediatric patients with type 1 diabetes meeting ISPAD criteria for nephropathy screening were consecutively recruited (90% Caucasian, 51% male, mean age 16.1 ± 3.1 years, duration of T1D 7.2 ± 3.9 years, 2-year average HbA1c 8.0 ± 1.3%, and serum and urine samples were collected for analysis. Serum Klotho (KL) and circulating miRNA levels of select miRNA involved in the pathogenesis of DN were estimated. KL had a strong inverse correlation with diabetes duration and HbA1c, two important risk factors in the development of diabetes complications. Serum miR-192 were negatively associated with KL among children with prolonged duration of diabetes (≥12 years) after adjustment for age and sex. In cell culture, overexpression of miR-192 significantly downregulated KL mRNA and protein levels, and reduced KL levels in the media. miR-192 mimic reduced luciferase activity in a reporter containing the KL 3’ UTR (60% compared to controls, p<0.01), and the inhibitor rescued it. Deletion of a potential binding site for miR-192 in the KL 3’UTR completely abolished the effect of miR-192 in the reporter assay, suggesting that KL is a direct target gene of miR-192. Overexpression of miR-192 significantly increased oxidative stress (MDA) and expression of inflammatory and senescence markers IL-6 and p16. Inhibition of miR-192 significantly reduced levels of MDA, IL-6 and p16. In summary, we demonstrate an increase in miR-192 and a decrease in KL levels in children with prolonged duration of T1D. We demonstrate a novel role for miR-192 in directly regulating KL levels, and through that, senescence and oxidative stress, key pathological processes in the development of DN. miR-192 and/or KL levels are altered with severity and duration of diabetes and could serve as early biomarkers for DN.

Urinary Neutrophil Gelatinase-associated Lipocalin: As an Early Marker for Diabetic Nephropathy

Background: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diagnostic marker to detect diabetic nephropathy at early stage is important as early intervention can slow the loss of kidney function and reduce adverse outcomes. Neutrophil gelatinase-associated lipocalin (NGAL) is a small (25-kd) protein that belongs to the lipocalin protein family. Urinary NGAL (u-NGAL) levels have been demonstrated to be a very promising marker especially in acute kidney disease. Objective: To measure urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker for diagnosis of diabetic nephropathy in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: The study was conducted on 84 subjects, from (18- 80 years old), 45 (53.5%) were males and 39 (46.4%) were females, with mean age (58.18 ± 13.98). They were collected from Endocrinology and Nephrology Clinic after a written consent was taken from the patients at Zagazig University Hospital. Results: Urinary NGAL is higher in diabetic patients compared with non-diabetic controls with high significant difference (p < 0.0001). In our result we found a positive correlation between NGAL and the duration of DM (r =0.279, p=0.027). There was a positive correlation between NGAL level and HbA1C, with significant difference (r =0.778, p =0.000) in patients groups. Our results showed a positive correlation between NGAL and FPG (r= 0.562) (p < 0.001) and 2hPPPG (r=0.687) (p < 0.001). There was a positive correlation between NGAL level and albumin-creatinine ratio (Alb/Cr) with significant difference (r =0.888, p < 0.001) in patients groups. Conclusion: There was a high significant difference in the level of urinary NGAL in diabetic patients than control subjects. Urine NGAL had a positive correlation with albumin-creatinine ratio, duration of DM, HbA1c.

Urinary cystatin C as a biomarker of early renal dysfunction in type 2 diabetic patients

AimsWe aimed to evaluate urinary CysC (cystanin c) as an early marker of diabetic nephropathy in patients with type 2 diabetes and investigate the correlation of urinary CysC with albuminuria and GFR. MethodologyThis case-controlled study was conducted on 66 type 2 diabetic patients who were classified according to albuminuria into 3 groups and consisting of 20 healthy subjects as the control group. We assessed urinary CysC, urinary albumin excretion rate (UACR). ResultsUrinary CysC levels were significantly higher in normoalbuminuric diabetic compared with healthy control and there was a progressive linear increase in urinary CysC levels with increasing albuminuria in the diabetic patients. Despite insignificant deference in creatinine between participants groups, we observed significant differences between these groups as regard eGFR, urinary CysC, and UACR. Urinary CysC did not have significant correlations with any clinical or biochemical parameters. Moreover, urinary CysC had a statistically significant association with albuminuria and eGFR. ConclusionUrinary CysC levels correlated with UACR and GFR. It is linked to subclinical tubular injury and can be an earlier marker of kidney involvement, even before albuminuria and it is less influenced by non-renal factors. Therefore, Urinary CysC is useful biomarker for early diagnosis of diabetic nephropathy.

Microalbuminuria and its associations with clinical profile and complications of type 2 Diabetes Mellitus

Background and Aims: Microalbuminuria is an early marker of diabetic nephropathy, which accounts for a significant reduction in life expectancy of diabetic patients. Timely detection of microalbuminuria facilitates appropriate preventive and therapeutic approaches to minimize risks. The aim of this study is to determine the prevalence and association of microalbuminuria with clinical profile and complications of type 2 diabetes mellitus.&#x0D; Methods: This study was a descriptive, cross sectional study involving 100 diabetic subjects between July 2018 to January 2019 at Bir Hospital. Microalbuminuria (mg/dl) was defined as spot urine albumin to creatinine ratio of 30-300 mg/g (Kidney Disease Improving Global Outcomes guidelines) in a single spot urine sample. Statistical analysis was done using Statistical package for the social sciences version 20.&#x0D; Results: Microalbuminuria was found in 35% of the sample and the rate was significantly higher among males (P =0.027). Microalbuminuria was significantly related to Body mass index (P = 0.018), duration of diabetes (P =0.000), retinopathy (P = 0.000) and stroke (P = 0.043). No statistically significant relation was found between microalbuminuria and age (P = 0.366), hypertension (P = 0.208), HbA1c (P = 0.098), dyslipidemia (P = 0.171) and ischemic heart disease (P = 0.651).&#x0D; Conclusions: This study shows high prevalence of microalbuminuria in Nepalese Type 2 diabetes mellitus. Screening for microalbuminuria should be done for all the type 2 diabetes mellitus patients for early detection and management of complications of diabetes mellitus.

Prevalence and Correlates of Microalbuminuria among Type 2 Diabetes Patients at Muhimbili National Hospital, Dar es Salaam, Tanzania

Background&#x0D; Regular screening for microalbuminuria among type 2 diabetes patients is less common in most low-income countries while it is an early marker of diabetic nephropathy and cardiovascular complications.&#x0D; Objective&#x0D; This study aims to assess the need for regular screening for microalbuminuria among type 2 diabetes patients.&#x0D; Methodology&#x0D; with cross-sectional approach, 124 diabetic patients were recruited at Muhimbili National Hospital, in Tanzania; their age, gender, body mass index, fasting blood sugar levels (by Accu Chek Active Glucometer), random urine albumin levels (by Microalbumin 2-1 Combo Test Strips), and the duration of diabetes were recorded.&#x0D; Results&#x0D; The study indicated that 62.1% of the participants were microalbuminuric while 2.4% were macroalbuminuric. The risk of microalbuminuria was 4.55 higher in patients aged 60-69 years (95% CI: 1.32-16.51), and 17.4 times higher in patients aged 70 and above (95% CI: 1.49-202.86) compared to individuals aged below 50 years. Patients with high blood sugar level had a risk of 8.09 times higher compared to those with normal blood sugar (CI: 2.53-25.86). Also, the odds were 7.89 higher in patients who lived with diabetes for 10-14 years compared to those lived with the disease less than 5 years (95% CI:1.33-45.59).&#x0D; Conclusion&#x0D; The odds of microalbuminuria increased significantly as the patient gets older, with high blood sugar, and the duration of diabetes. Health policies need to establish programs that enhance care at the diabetic clinic through regular screening for microalbuminuria to reduce the risk of developing kidney and cardiovascular complications.&#x0D; Rwanda J Med Health Sci 2021;4(1):84-97

Study of significance of Serum Cystatin-C and Vascular Endothelial Growth Factor as an early marker of diabetic nephropathy in type 2 diabetes patients

Aim: To determine the usefulness of serum cystatin-C along with vascular endothelial growth factor (VEGF) as an early marker of diabetic nephropathy. Method: The study includes diabetic patients visiting the Medicine OPD and was divided into groups according to duration of diabetes. Group 1 with diabetes between 5-10 years, group 2 with diabetes between 10-15 years, group 3 with diabetes more than 15 years and control group. Results: Serum cystatin-C and VEGF level raised significantly in group 2 patients (10-15 years duration) and increases further with the progression of disease. Conclusion: Both cystatin-C and vascular endothelial growth factor can be useful marker of early diabetic nephropathy in patients with type 2 diabetes.

Relationship between Serum Sialic Acid Concentration and Diabetic Nephropathy in Egyptian Patients with Type 2 Diabetes Mellitus

Aim: Diabetic nephropathy is a major microvascular complication of diabetes mellitus (DM), and it is the most common cause of end-stage renal disease worldwide. Sialic acid is considered as an acute-phase reactant. Serum sialic acid level was found to be increased in diabetic nephropathy patients. We aimed to measure the serum sialic acid concentration in patients with type 2 DM and to assess if it could be used as an early marker of diabetic nephropathy. Subjects and Methods: This was a cross-sectional study that was carried out on 40 patients subdivided into 3 groups, first group involved 25 patients with diabetic nephropathy, second group involved 15 patients without diabetic nephropathy and the third group involved 10 patients serving as control group. All patients were selected from those attending the outpatient diabetic clinic at Benha University Hospital between July 2017 and July 2018. Mean and standard deviation (±SD) were used for quantitative data, and t test, Fisher extract test, and regression analysis were used for statistical analysis. A P value &lt;0.05 was considered statistically significant, whereas &gt;0.05 statistically insignificant. Results: On comparing patients with diabetic nephropathy with the control group patients we found that serum sialic level is increased and this was statistically significant and also in diabetic patients with nephropathy when compared to diabetic patients without nephropathy. The age of the onset of the discovery of diabetes and the duration of diabetes had no impact on serum sialic acid level. Conclusion: This study showed that serum sialic acid level is significantly increased in patients with diabetic nephropathy, and it is positively correlated with the glycemic control parameters and negatively correlated with estimated glomerular filtration rate, and it could be used as an early predictor of albuminuria and decrease of creatinine clearance.

Does N-Carboxymethyl Lysine Serve as a Prognostic Biomarker of Diabetic Nephropathy?

Introduction: The occurrence and progression of diabetic nephropathy to end stage disease mandates an early detection of kidney damage. Glycation and oxidation injury form an essential element in the evolution of diabetic complications both microvascular and macrovascular. Aim: To study the trends in the N-Carboxymethyl lysine levels in various stages of diabetic nephropathy and assess its efficacy as a prognostic marker for diabetic nephropathy. Materials and Methods: The study included 125 Type 2 diabetic individuals- 45 patients with normoalbuminuria, 40 patients having microalbuminuria and 40 with macroalbuminuria {based on the Albumin-Creatinine Ratio (ACR)}. Forty five non-diabetic healthy individuals were included as a control group. Serum N-carboxymethyl lysine quantification was done for all the study participants and compared and correlated with other parameters across various groups. Results: The fasting and postprandial sugar, glycosylated haemoglobin, triglycerides, duration of diabetes, systolic and diastolic blood pressure, Body Mass Index (BMI), all were strong risk factors for Diabetic Kidney Disease (DKD) progression which significantly correlated positively with microalbumin and urine ACR (uACR) and negatively with Glomerular Filtration Rate (GFR). The serum N-carboxymethyl lysine was observed to be significantly increased as the ACR increased and in comparison to the controls, respectively (p-value &lt;0.001). The GFR showed significant negative correlation with levels of serum N-carboxymethyl lysine whereas positively correlated with fasting and postprandial sugar, glycosylated haemoglobin, triglyceride levels, duration of diabetes, systolic and diastolic blood pressure, BMI, microalbumin and uACR. Conclusion: N-carboxymethyl lysine in serum can serve as an early marker for diabetic nephropathy and its progression and severity.

A retrospective study of microalbuminuria in patients of diabetes and hypertension

A retrospective study of microalbuminuria in patients of diabetes and hypertension - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2018.0089, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Study of The Podocalyxin as An Early Marker for Diabetic Nephropathy and Its Correlation with Stages of Diabetic Nephropathy in A Sample of Egyptian Patients with T2DM

Background: Nephropathy is a major complication of diabetes, and is the main cause of end-stage kidney disease. Early recognition of nephropathy in diabetic patients is critical because it creates an opportunity to prevent the occurrence of diabetic nephropathy and/or even slow down the process of end-stage kidney disease attributable to diabetes. Human cells; podocytes (pods) have been shown to be functionally and structurally affected in the natural history of diabetic nephropathy. Objective: Study of the podocalyxin as an early marker for diabetic nephropathy and its correlation with stages of diabetic nephropathy in a sample of Egyptian patients with type 2 diabetes mellitus (T2DM). Patients and Methods:This study was a cross sectional study conducted on 80 subjects divided into four groups: Group 1: 20 diabetic patients with normalbuminuria. Group 2: 20 diabetic patients with nephropathy and microalbuminuria stages. Group 3: 20 diabetic patients with nephropathy and macroalbuminuria stages, Group 4:20 apparently healthy volunteers were included as a control group. Results: Urinary podocalyxin (PCX) was significantly higher in patients group compared to control group. Urinary PCX was significantly higher in macroalbuminuric group followed by microalbuminuric group then normoalbuminuric group. There was a positive significant correlation between urinary PCX and glycemic profile [Fasting blood sugar (FBS), 2hrPP, Glycosylated Hemoglobin (HbA1C)], serum creatinine and albumin creatinine ratio (ACR). Conclusion: Urinary podocalyxin is a beneficial as an early marker for early stages of diabetic nephropathy in type 2 DM patients.

Urinary Netrin-1 as an Early Marker for Diabetic Nephropathy

Background: Netrin-1, a laminin-related secreted protein, is a proximal tubular injury urinary marker. It is released in the urine of both humans and mice and highly stimulated after acute and chronic renal diseases. Objective: The current study aimed to assess the value of urinary netrin-1 level as an early marker for diabetic nephropathy. Patients and Methods: A total of 60 diabetic patients and 20 healthy controls were enrolled in this case-control study. Diabetic patients were subdivided into normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary netrin-1 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Results: Urinary netrin-1 excretion was significantly higher in the diabetic group (1418.3±733.6 pg/mg creatinine) compared to the control group (477.4±283.6 pg/mg creatinine) with the highest value in the macroalbuminuria group (1919.4±573.4 pg/mg creatinine) and the lowest value in normoalbuminuria group (833.7±595.3 pg/mg creatinine). ROC curve analysis showed that urinary netrin 1/creatinine at a cutoff point of >630.75 pg/mg with AUC of 0.899 had 83.3% sensitivity and 85% specificity for prediction of diabetic nephropathy (P<0.001). Conclusion: Our study is suggesting that urinary netrin-1 may be a useful biomarker for early detection of diabetic nephropathy

Study of The Podocalyxin as An Early Marker for Diabetic Nephropathy and Its Correlation with Stages of Diabetic Nephropathy in A Sample of Egyptian Patients with T2DM

Background: Nephropathy is a major complication of diabetes, and is the main cause of end-stage kidney disease. Early recognition of nephropathy in diabetic patients is critical because it creates an opportunity to prevent the occurrence of diabetic nephropathy and/or even slow down the process of end-stage kidney disease attributable to diabetes. Human cells; podocytes (pods) have been shown to be functionally and structurally affected in the natural history of diabetic nephropathy. Objective: Study of the podocalyxin as an early marker for diabetic nephropathy and its correlation with stages of diabetic nephropathy in a sample of Egyptian patients with type 2 diabetes mellitus (T2DM). Patients and Methods:This study was a cross sectional study conducted on 80 subjects divided into four groups: Group 1: 20 diabetic patients with normalbuminuria. Group 2: 20 diabetic patients with nephropathy and microalbuminuria stages. Group 3: 20 diabetic patients with nephropathy and macroalbuminuria stages, Group 4:20 apparently healthy volunteers were included as a control group. Results: Urinary podocalyxin (PCX) was significantly higher in patients group compared to control group. Urinary PCX was significantly higher in macroalbuminuric group followed by microalbuminuric group then normoalbuminuric group. There was a positive significant correlation between urinary PCX and glycemic profile [Fasting blood sugar (FBS), 2hrPP, Glycosylated Hemoglobin (HbA1C)], serum creatinine and albumin creatinine ratio (ACR). Conclusion: Urinary podocalyxin is a beneficial as an early marker for early stages of diabetic nephropathy in type 2 DM patients.

The Peripheral Blood Expression of Lipoic Acid Synthetase Gene as an Early Marker for Diabetic Nephropathy

Introduction: Diabetic nephropathy (DN) is one of the diabetic complications, which leads to end-stage renal disease. This study aimed to assess the expression of the lipoic acid synthetase (LIAS) gene in type 2 diabetic patients and DN patients. Subjects and Methods: A case-control study conducted on 60 patients who had type 2 diabetes, 60 patients who had DN, and 60 healthy matched individuals. The peripheral blood expression of the LIAS gene was assessed by real-time qRT-PCR. Results: In diabetic and DN patients, the expressions of LIAS were significantly lower than controls (p < 0.001). The LIAS expression showed a reducing trend with the progress of DN (p < 0.001). The LIAS expression showed a sensitivity of 95 % and specificity of 88.3% in the differentiating between diabetic and DN patients and it can detect early DN with a sensitivity of 93.5 % and specificity of 90%. LIAS expression in DN patients had significant negative correlations with disease duration and albuminuria. LIAS gene expression can protect significantly from the DN. It had an odds ratio of 0.01 [95% confidence interval (CI): 0.001-0.03] (p < 0.001). LIAS gene expression can significantly predict disease severity. Conclusion: Peripheral blood expression of the LIAS gene was significantly lower in diabetic and DN patients in comparison to controls. The LIAS expression negatively correlated with the progress of DN. LIAS gene expression seems to be a promising marker for prediction and early detection of DN in type 2 diabetic patients.

The Peripheral Blood Expression of Lipoic Acid Synthetase Gene as an Early Marker for Diabetic Nephropathy

Introduction: Diabetic nephropathy (DN) is one of the diabetic complications, which leads to end-stage renal disease. This study aimed to assess the expression of the lipoic acid synthetase (LIAS) gene in type 2 diabetic patients and DN patients. Subjects and Methods: A case-control study conducted on 60 patients who had type 2 diabetes, 60 patients who had DN, and 60 healthy matched individuals. The peripheral blood expression of the LIAS gene was assessed by real-time qRT-PCR. Results: In diabetic and DN patients, the expressions of LIAS were significantly lower than controls (p < 0.001). The LIAS expression showed a reducing trend with the progress of DN (p < 0.001). The LIAS expression showed a sensitivity of 95 % and specificity of 88.3% in the differentiating between diabetic and DN patients and it can detect early DN with a sensitivity of 93.5 % and specificity of 90%. LIAS expression in DN patients had significant negative correlations with disease duration and albuminuria. LIAS gene expression can protect significantly from the DN. It had an odds ratio of 0.01 [95% confidence interval (CI): 0.001-0.03] (p < 0.001). LIAS gene expression can significantly predict disease severity. Conclusion: Peripheral blood expression of the LIAS gene was significantly lower in diabetic and DN patients in comparison to controls. The LIAS expression negatively correlated with the progress of DN. LIAS gene expression seems to be a promising marker for prediction and early detection of DN in type 2 diabetic patients.