Normoalbuminuria Group Research Articles

Relation between Serum Leptin, Lipid Profiles and other biomarkers levels in patients with type 2 diabetic nephropathy

Background: In advanced diabetes mellitus, serum levels of the most hormones are altered due to several interplaying mechanisms. Objective: To assess the relation of serum leptin and lipid profile in type 2 diabetic nephropathy. Patients and Method: Serum leptin levels and its relation to lipid profile were estimated in 62 patients with type 2 diabetic nephropathy attending the National Diabetes Center in Al- Mustansiriya University, and (26) healthy individuals considered as control group. The diabetic patients were classified into three groups, (24) pathients with normoalbuminuria (21) patients with microalbuminuria and (17) patients with macroalbuminuria. Fasting plasma glucose, serum creatinine, Hb A1c %, lipid profile (Total cholesterol, LDL- Cholesterol, HDL- Cholesterol and Triglyceride) and urinary albumin, were measured to establish the possibility of using these biomarkers as a supplementary to serum leptin to be a diagnostic test for type 2 diabetic nephropathy. Results: Serum leptin levels showed a significant elevation in microalbuminuria (20.08± 4.50 ng/ml) and macroalbuminuria groups (22.35± 6.89 ng/ml) as compared to nondiabetic normal control group (10.64 ± 3.17 ng/ml). There was no significant differences observed in serum leptin levels between the normoalbuminuria group (13.96 ± 5.73 ng/ml) and healthy controls, but a significant positive differences were noticed in the levels of fasting plasma glucose, serum creatinine, Hb A1c% and lipid profile in the three patient groups in comparison with the control group. While no significant correlation was observed between these biomarkers levels and serum leptin values. Conclusion: It might be concluded that serum leptin levels were elevated in type 2 diabetic patients with microalbuminuria and macroalbuminuria, suggesting that renal leptin degradation is impaired in early stage of kidney damage and this impairment increase with the progression of this disease. Leptin hormone may consider according to these results as a risk factor for progression of kidney disease in diabetic patients.

8626 Associations Between Low Serum Bilirubin Levels and the Progression of Diabetic Kidney Disease in Individuals with Type 2 Diabetes, Including Those in a Normoalbuminuric State

Abstract Disclosure: E. Kim: None. Y. Cho: None. O. Hong: None. K. Jo: None. J. Han: None. S. Moon: None. Objective: This study aimed to investigate the potential correlation between serum bilirubin levels and the progression of diabetic nephropathy, assessing whether low serum bilirubin levels are associated with a decline in renal function, while considering the baseline albumin excretion status. Methods: The longitudinal observation, spanning 11 years, involved 1167 Korean subjects aged 20 years or older, diagnosed with type 2 diabetes mellitus (T2DM), and having a baseline estimated glomerular filtration rate (eGFR) greater than 60 ml/min per 1.73 m2. Albuminuria was assessed by the 24-hour urinary albumin to creatinine excretion rate (ACR) and categorized into normoalbuminuria (ACR <30 mg/g), micro- or macroalbuminuria (ACR >300/g). Cox regression analysis was employed to explore connections between serum bilirubin levels and eGFR decline ≥40%, with adjustments for potential confounding variables. Results: Over a median follow-up of 8.2 years, 128 individuals experienced a decline in eGFR >40%. The hazard ratio (HR) of incident GFR decline was 1.72 (95% CI: 1.04-2.85, P=0.036) in the lowest total bilirubin (TB) tertile compared to the highest TB tertile after multivariable adjustment. When stratified by baseline albuminuria status, low bilirubin levels were significantly associated with eGFR decline, even in the normoalbuminuria group (HR: 2.21, 95% CI: 1.26-3.90, P=0.006), with a gradually increasing risk according to the absence of low TB levels and albuminuria (HR: 2.92, 95% CI: 1.65-5.19, P<0.001), and low TB levels and albuminuria (HR: 3.01, 95% CI: 1.65-5.46, P<0.001). Conclusion: Low serum TB levels are associated with an increased risk of rapid GFR decline in Korean patients with T2DM. Serum bilirubin levels may serve as a prognostic marker for the development and progression of diabetic kidney disease. Presentation: 6/1/2024

Evaluation of Early Renal Changes in Type 2 Diabetes Mellitus Using Multiparametric MR Imaging.

To evaluate the clinical value of early renal changes in type 2 diabetes mellitus (T2DM) using multiparameter MRI. The study included 41 diabetics (normoalbuminuria: n = 23; microalbuminuria: n = 18) and 30 healthy controls. All subjects underwent intravoxel incoherent motion diffusion-weighted imaging (IVIM), blood oxygen level dependent (BOLD) and arterial spin labeling (ASL) examinations. One-way analysis of variance was used to compare MRI parameters among the three groups. Pearson correlation analysis was used to evaluate the relationship between MRI parameters and estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). Receiver operating characteristic analysis was performed to assess the diagnostic performance. There were statistical differences in cortical D, D*, f, renal blood flow (RBF) and medulla D, D*, f, R2* among the three groups (P < 0.05). The cortical or medullary D, cortical f, and RBF were significantly positively correlated with eGFR (all P < 0.01). The cortical or medullary D, D*, f, cortical RBF were negatively correlated with ACR (all P < 0.05).To evaluate early kidney changes and degree of diabetes, cortical combined D and RBF (AUC [area under the curve] = 0.796 and 0.947, respectively) was better than single D or RBF (all P > 0.05); medullary combined D and R2* (AUC = 0.899 and 0.923, respectively) was better than single D or R2* (all P > 0.05), except single D (P = 0.005) in differentiating normoalbuminuria group from control group. The early changes of renal diffusion and perfusion, oxygenation level, and blood flow in T2DM could be evaluated noninvasively and quantitatively using IVIM, BOLD and ASL. Renal medullary combined IVIM-derived D and BOLD-derived R2* and cortical combined IVIM-derived D and ASL-derived RBF were better for evaluating early renal changes in T2DM.

Association of different obesity indexes with diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study

The objective of this study is to investigate the association between diabetic kidney disease (DKD) and various adiposity indexes, including the visceral adiposity index (VAI), lipid accumulation product index (LAPI), visceral fat area (VFA), and subcutaneous fat area (SFA) in type 2 diabetes mellitus (T2DM) patients. 1176 T2DM patients was stratified into normoalbuminuria (NO), microalbuminuria (MI), and macroalbuminuria (MA) groups based on their urinary albumin-creatinine ratio (UACR) levels. To analyse the correlation between DKD and VAI, LAPI, VFA, and SFA. Multiple linear, restricted cubic spline (RCS), subgroup analyses, and multinomial logistic regression were employed. After adjusting for confounding variables, UACR levels were positively associated with VAI, LAPI, and VFA. RCS curves demonstrated a J-shaped dose-response relationship between VAI and LAPI levels with UACR levels, while a linear correlation was observed between UACR levels and VFA. Using the NO and MI as reference groups, the MA group was analysed as the observational group. DKD severity was positively associated with VAI, LAPI and VFA. When evaluating DKD prognostic risk, with the low-risk and medium-risk groups serving as reference categories, a significant positive correlation was identified with prognostic risk and VAI, LAPI, and VFA in the high-risk or very high-risk groups. In patients with T2DM, DKD severity and prognostic risk were positively correlated with VAI, LAPI, and VFA levels.

Proteomic Analysis Identifies Dysregulated Proteins in Albuminuria: A South African Pilot Study.

Albuminuria may precede decreases in the glomerular filtration rate (GFR) and both tests are insensitive predictors of early stages of kidney disease. Our aim was to characterise the urinary proteome in black African individuals with albuminuria and well-preserved GFR from South Africa. This case-controlled study compared the urinary proteomes of 52 normoalbuminuric (urine albumin: creatinine ratio (uACR) < 3 mg/mmol) and 56 albuminuric (uACR ≥ 3 mg/mmol) adults of black African ethnicity. Urine proteins were precipitated, reduced, alkylated, digested, and analysed using an Evosep One LC (Evosep Biosystems, Odense, Denmark) coupled to a Sciex 5600 Triple-TOF (Sciex, Framingham, MA, USA) in data-independent acquisition mode. The data were searched on SpectronautTM 15. Differentially abundant proteins (DAPs) were filtered to include those with a ≥2.25-fold change and a false discovery rate ≤ 1%. Receiver-operating characteristic curves were used to assess the discriminating abilities of proteins of interest. Pathway analysis was performed using Enrichr software. As expected, the albuminuric group had higher uACR (7.9 vs. 0.55 mg/mmol, p < 0.001). The median eGFR (mL/min/1.73 m2) showed no difference between the groups (111 vs. 114, p = 0.707). We identified 80 DAPs in the albuminuria group compared to the normoalbuminuria group, of which 59 proteins were increased while 21 proteins were decreased in abundance. We found 12 urinary proteins with an AUC > 0.8 and a p < 0.001 in the multivariate analysis. Furthermore, an 80-protein model was developed that showed a high AUC ˃ 0.907 and a predictive accuracy of 91.3% between the two groups. Pathway analysis found that the DAPs were involved in insulin growth factor (IGF) functions, innate immunity, platelet degranulation, and extracellular matrix organization. In albuminuric individuals with a well-preserved eGFR, pathways involved in preventing the release and uptake of IGF by insulin growth factor binding protein were significantly enriched. These proteins are indicative of a homeostatic imbalance in a variety of cellular processes underlying renal dysfunction and are implicated in chronic kidney disease.

Longitudinal albuminuria patterns predict coronary artery calcification progression: Findings from the Coronary Artery Risk Development in Young Adults study

Background and aimsAlbuminuria is an established risk factor for adverse cardiovascular outcomes. However, few studies have characterized longitudinal albuminuria patterns based on long-term measurement of urine albumin-to-creatinine ratio (UACR) levels. We aimed to evaluate the association between longitudinal albuminuria patterns in midlife adults and subsequent CAC progression. MethodsWe included 1919 participants with CAC assessment by computed tomography from CARDIA (Coronary Artery Risk Development in Young Adults) study. CAC progression was determined for each individual as the difference of logarithmic CAC scores at follow-up and baseline. Albuminuria patterns across a 10-year span were estimated by longitudinal UACR levels. Multivariable general linear models were used to evaluate the association of long-term albuminuria patterns with CAC progression. ResultsOf the 1919 included participants, 583 (30.4 %) participants experienced CAC progression, and the mean (SD) age was 50.4 (3.5) years at year 25. A total of four dynamic albuminuria patterns were identified. After multivariable adjustment, there were significant differences in CAC progression by albuminuria patterns as demonstrated as percent change in CAC with 36.0 % (SE, 1.5) progression for mid- and late-life normoalbuminuria group, 46.0 % (SE, 7.6) for midlife normoalbuminuria and late-life high albuminuria group, 52.4 % (SE, 7.1) for midlife high albuminuria and late-life normoalbuminuria group, and 54.5 % (SE, 8.7) for mid- and late-life high albuminuria group (p = 0.019). Similar findings were also observed in CAC volume score changes. ConclusionsLongitudinal albuminuria patterns across a 10-year span were associated with worse CAC progression independent of baseline CAC level and albuminuria changes, suggesting that it may provide early identification of high-risk individuals with dynamic rises in albuminuria who may benefit from aggressive risk factor modification.

Role of Beta Trace Protein and Cystatin C as a Potential Biomarker for Early Detection of Type 2 Diabetic Nephropathy

Background: One of the most well-known diabetic microvascular consequences is diabetic nephropathy, which affects 40 percent of people with diabetes mellitus type 2. It develops into end stage renal disease, and diabetes biomarkers can be used as a predictor. Objectives: This study aimed to determine the concentration levels of serum Beta Trace Protein and serum Cystatin C in all stages of diabetic nephropathy disease. Subjects And Methods: A Case- control study included 120 Persons (30-persons appeared healthy as control and 90 patients proved with T2DM of both gender (64 males and 56 females), split into four groups by using urinary micro-albumin and albumin to creatinine ratio (UACR) as following: group-I: includes 30persons as a healthy control (UACR &lt; 30 mg/g creatinine). Group-II: includes 30patients with type2 DM normoalbuminuria (UACR &lt; 30 mg/g creatinine) as a positive control. Group-III: includes 30 patients with type 2 DM microalbuminuria (UACR 30 – 300 mg/g creatinine). Group-IV: includes 30 patientsا with type 2 DM macroalbuminuria (UACR˃ 300 mg/g creatinine), all groups with ages ranges between (40-69) years. in allا groups, Beta Trace Protein and Cystatin C quantitative enzyme immunoassay (double-antibody sandwich), calculated in serum and both biomarkers using the same methods. Results: Patients with diabetes have statistically substantially increased blood levels of Beta trace protein and Cystatin C. with macro-albuminuria groups in comparison to micro-albuminuria, normo-albuminuria and healthy control in addition, the mean for the micro-albuminuria group was greater than for the healthy control and normo-albuminuria groups. Conclusion: A rise in blood Beta trace protein and Cystatin C levels in the early nephropathy group microalbuminuria, which may be used as a predictor for early diagnosis of diabetic nephropathy.

Serum cell division cycle42 reflects the development and progression of diabetic nephropathy in patients with diabetes mellitus.

Cell division cycle 42 (CDC42) regulates podocyte apoptosis to take part in the development and progression of diabetic nephropathy (DN), but currently the clinical evidence is limited. The aim of the present study was to investigate the capability of serum CDC42 expression level to estimate the development and progression of DN in patients with diabetes mellitus (DM). Patients with type 2 DM (n=306) were enrolled and divided into normoalbuminuria (n=185), microalbuminuria (n=72) and macroalbuminuria (n=49) groups based on the urinary albumin-to-creatinine ratio. Serum CDC42 was measured in all subjects using enzyme-linked immunosorbent assay. The median (interquartile range) CDC42 in patients with DM was 0.461 (0.314-0.690) ng/ml (range, 0.087-1.728 ng/ml). CDC42 was positively associated with the estimated glomerular filtration rate (P<0.001), but negatively correlated with body mass index, systolic blood pressure, hemoglobin A1c, serum creatine, serum uric acid and C reactive protein (all P<0.050). CDC42 levels were lowest in the macroalbuminuria group, followed by the microalbuminuria group, and were highest in the normoalbuminuria group (P<0.001). CDC42 indicated that it was a favorable estimator for the presence of albuminuria [area under the curve (AUC), 0.792; 95% confidence interval (CI), 0.736-0.848] and macroalbuminuria (AUC, 0.845; 95% CI, 0.775-0.915). By analyses in four different multivariate logistic regression models, increased CDC42 was independently associated with the presence of microalbuminuria (all P<0.001), macroalbuminuria (most P<0.001) and microalbuminuria + macroalbuminuria (all P<0.001). Serum CDC42 level negatively correlated with microalbuminuria and macroalbuminuria in patients with DM, suggesting its ability for estimating the development and progression of DN.

Association between continuous glucose monitoring-derived glycemic control indices and urinary biomarkers of diabetic kidney disease: Hyogo Diabetes Hypoglycemia Cognition Complications study

AimsGlomerular damage and proximal tubular damage play an important role in the pathogenesis of diabetic kidney disease. This study aimed to investigate the relationship between the urinary markers of proximal tubular injury, including urinary liver-type fatty acid-binding protein-to-creatinine ratio (uL-FABP/Cr) and urinary N-acetyl-β-d-glucosaminidase-to-creatinine ratio (uNAG/Cr), and glycemic control status.MethodsThis cross-sectional study included 245 and 39 patients with type 2 diabetes mellitus (T2DM) and non-T2DM (NDM), respectively. The participants of this study were fitted with retrospective CGM, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated.ResultsThe results were presented as medians (interquartile ranges). The uL-FABP/Cr was significantly higher in the microalbuminuria than in the normo-albuminuria group [4.2 (2.7–7.1) and 2.2 (1.4–3.4) μg/gCr, respectively, P < 0.001], while the uNAG/Cr in the normo-albuminuria group [6.3 (4.5–10.1) U/gCr] was significantly higher than that in the NDM group [5.3 (3.8–6.3) U/gCr, P = 0.048] but significantly lower than that in the microalbuminuria group [9.2 (6.4–11.1) U/gCr, P = 0.004]. The multivariate logistic regression analysis indicated that CGM-derived TIR was significantly associated with the urinary albumin-to-creatinine ratio [uAlb/Cr, odds ratio (OR) 0.985, 95% confidence interval (CI) 0.971–0.998, P = 0.029] and uNAG/Cr (OR 0.973, 95% CI 0.957–0.989, P = 0.001) independent of renal function. GRI was similarly associated with uAlb/Cr and uNAG/Cr.ConclusionThe findings of this study indicated that uNAG/Cr was elevated before albuminuria development and was associated with CGM-derived TIR and GRI.

The Role of Podocyte Cells in Diabetic Nephropathy: A Narrative Literature Review

The main cells affected in diabetic nephropathy are podocytes and proximal tubular cells. One of the main functional proteins in the podocyte slit diaphragm is podocin which podocytes need to express together with several specific proteins in the correct way for their differentiation, as well as to maintain their complex anatomy. Podocytes are highly specialized epithelial cells. They line the urinary surface of the glomerular capillary bundles. Podocytes are part of the filtration barrier along with capillary endothelial cells and GBM. Podocytes ensure selective permeability of the glomerular capillary walls. Podocin is a membrane protein with a molecular weight of 42kD which is located in the foot processes, and also forms part of the SD with the nephrin protein. Urinary podocin levels more specifically indicate ongoing glomerular damage because they were significantly increased in the normoalbuminuria group compared with the control group.

Upregulation of the protein kinase Lyn is associated with renal injury in type 2 diabetes patients

Background The role of inflammation in the pathogenesis of type 2 diabetes mellitus (T2DM) is well established. Lyn, a member of the nonreceptor protein tyrosine kinase Src family, has been reported to modulate inflammatory signaling pathways. Methods Lyn expression was assessed in kidney biopsies of 11 patients with diabetic kidney disease (DKD) and in kidney tissues of streptozotocin (STZ)-induced DKD mice. 102 recruited T2DM patients were divided into three groups: normoalbuminuria, microalbuminuria and macroalbuminuria. Twenty-one healthy volunteers were recruited as a control group. Clinical data, blood and urine samples of all individuals were collected for analysis. Results Lyn expression was augmented in the kidneys of DKD patients and STZ-induced diabetic mice. Compared with control and normoalbuminuria groups, both mRNA and protein expression of Lyn in peripheral blood mononuclear cells (PBMCs) in the macroalbuminuria group were significantly increased (p < .05). Elevated Lyn levels were independently related to urine albumin/urine creatinine ratio and were positively associated with key inflammatory factors, namely interleukin-1β, monocyte chemoattractant protein-1, and tumor necrosis factor-α. Additionally, Lyn exhibited a noteworthy connection with renal tubular injury indicators, specifically urinary neutrophil gelatinase-associated lipocalin and urinary retinol binding protein. ROC curve analysis showed that Lyn could predict albuminuria in diabetic patients with an area under the curve of 0.844 (95% CI: 0.764–0.924). Conclusion Lyn levels in PBMCs exhibited a positive correlation with the severity of albuminuria, renal tubular damage, and inflammatory responses. Hence, Lyn may be a compelling candidate for predicting albuminuria levels in diabetes.

Is the serum uric acid (SUA) level and SUA/serum creatinine (Scr) ratio a predictive biomarker for microalbuminuria in patients with diabetes mellitus?

Background: The pathogenesis of diabetic nephropathy (DN) is very complex and is still not well understood. SUA has been associated with metabolic risk in a wide range of diseases. In this study, we aimed to investigate the effect of SUA and SUA/Scr ratio on renal function using glomerular filtration rate (GFR) and microalbuminuria.&#x0D; Methods: A total of 399 patients with diabetes alone, excluding other conditions that affect uric acid levels, were included in the study. Patients were divided into normoalbuminuria (n:247) and microalbuminuria (n:152) groups. SUA, SUA/Scr ratios were compared.&#x0D; Results: Female gender was 53.4% in the normoalbuminuria group and 57.9% in the microalbuminuria group. There was no significant difference in gender between the groups. In the microalbuminuria group, SUA (p=0.032), glucose (p

Association between serum 25- hydroxyvitamin D and albuminuiria in middle-aged and older Chinese patients with type 2 diabetes

ObjectiveThe objective was to analyze the relationship between serum 25-hydroxy-vitamin D (25(OH)D) level and albuminuiria in middle-aged and older patients with type 2 diabetes of Gansu Province.MethodsData pertaining to 380 in-patients with type 2 diabetes were collected. Subjects were classified groups based on gender,age,25(OH)D,BMI and UACR.Serum 25(OH)D and other clinical characteristics among various UACR groups were compared.The relationship between albuminuiria and 25(OH)D was analyzed.ResultsOut of the 380 subjects, 83.4%were classified as vitamin D deficiency, 14.5%were classified as vitamin D insufficiency, while 2.1% were classified as vitamin D sufficiency. Among the participants,41% had albuminuria (microalbuminuria,28.7%;macroalbuminuria,12.3%).The prevalence of 25(OH)D deficiency in the albuminuria group(84.6%) was significantly higher than that in the normoalbuminuria group(82.6%)(Mann–Whitney U test:Z = -3.86,P = 0.000); patients with macroalbuminuria had the highest prevalence of 25(OH)D deficiency (91.5%; P < 0.01 versus normoalbuminuria).A binary logistic analysis demonstrated that 25(OH)D were protective factors for albuminuria.ConclusionsThe prevalence of vitamin D deficiency in patients with albuminuria was overtly higher than that in patients without albuminuria among middle-aged and older adults with type 2 diabetes.

Serum JKAP reflects Th2 and Th17 cell levels, and diabetic nephropathy risk and severity in diabetes mellitus patients.

Objective: This studyaimed to explore the potency of serum JKAPfor estimating diabetic nephropathyrisk in diabetes mellitus (DM) patients. Methods: Serum JKAP was detected in 212 DM patients. According to urinary albumin-to-creatinine ratio, DM patients were divided into normoalbuminuria, microalbuminuriaand macroalbuminuria groups. Results: JKAP declined in themacroalbuminuria group versus normoalbuminuria group (p<0.001). In DM patients, JKAP inversely correlated with Th17 cells (p<0.001) but positively related to Th2 cells (p=0.003). After adjustment, JKAP independently estimated lower risks of albuminuria (microalbuminuria+macroalbuminuria; odds ratio=0.966, p<0.001) and macroalbuminuria (odds ratio=0.948; p=0.002). Conclusion: Serum JKAP reflects increased Th2 cells, decreased Th17 cells, andlower diabetic nephropathy risk and severity in DM patients.

Effects of Glycemic Variability on Regulatory T Cells in Patients with Type 2 Diabetes and Kidney Disease.

To investigate the pathogenesis of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM), we evaluated the effects of short-term glycemic variability (GV) on the profile of T cell subpopulations. A total of 47 T2DM patients with normoalbuminuria, 47 microalbuminuria, and 49 macroalbuminuria were enrolled. The continuous glucose monitoring (CGM) determined the GV of enrolled patients. Flow cytometry was used to determine the proportion of T cell subpopulations. The frequency of T helper (Th) 17 and Th1 cells significantly increased while regulatory T cells (Tregs) significantly decreased in the macroalbuminuria group compared to normoalbuminuria and microalbuminuria groups (P < 0.01). The suppressive function of Tregs was significantly lower in the macroalbuminuria group than the normoalbuminuria group (P < 0.05). Compared with the normoalbuminuria group, the mean amplitude of glucose excursions (MAGE) of the macroalbuminuria group was significantly higher (P<0.05). Furthermore, there were negative associations between the proportion of Tregs and MAGE. Increased GV could decrease the proportion of Tregs and may impair their function. This may lead to increases in Th1 and Th17 cells, and some inflammatory cytokines, which might contribute to the development and progression of DKD in T2DM.

Soluble TNFR1 Levels in Type 2 Diabetes and its Association with Stages of Proteinuria.

Early identification of at-risk individuals for diabetic nephropathy would help in preventing or delaying end-stage renal failure. We measured the levels of circulating soluble tumor necrosis factor receptor 1 (sTNFR1) in various stages of proteinuria (MAC) to determine the association of this marker with diabetic nephropathy. The study was performed on 160 subjects, and a case-control methodology was employed. Type 2 diabetic subjects were recruited based on albuminuria and were grouped as (1) normoalbuminuria (NA); (2) microalbuminuria (MIC); (3) MAC; (4) normal glucose tolerance (NGT) subjects who served as healthy controls. sTNFR1 levels were measured by quantitative enzyme-linked immunosorbent assay (ELISA). Soluble tumor necrosis factor receptor 1 (sTNFR1) levels were highest in the MAC group, followed by the microMAC group. The sTNFR1 levels were not statistically different between the NGT and NA groups. On regression models, sTNFR1 was associated with MIC [odds ratio (OR)- 6.491, 95% confidence interval (CI)-1.868-22.55] and MAC (OR per standard deviation-15.28; 95% CI-3.76-62.15; p &lt; 0.001) even after controlling for all the possible confounding factors. Receiver operator curve (ROC) analysis revealed sTNFR1 cut-point of 1832 pg/mL had a C-statistic of 0.685 to discriminate MI from NA with 52% sensitivity. Whereas the sTNFR1 cut-point of 2050 pg/mL with a C-statistic of 0.8177 had 77% sensitivity for identifying MAC. Soluble tumor necrosis factor receptor 1 (sTNFR1) is significantly associated with MIC and MAC group in type 2 diabetes, and this suggests a potential early diagnostic biomarker role of sTNFR1 for MAC among Asian Indians.

The correlation between visceral fat/subcutaneous fat area ratio and monocyte/high-density lipoprotein ratio in patients with type 2 diabetes mellitus and albuminuria

ObjectiveThis study aims to observe the correlation between the visceral fat/subcutaneous fat area ratio (VSR) and peripheral blood monocyte/high-density lipoprotein ratio (MHR) in patients with type 2 diabetes mellitus (T2DM) and albuminuria. MethodsBased on the urinary albumin/creatinine ratio (UACR), 89 T2DM patients were divided into normo-albuminuria group (n = 49, UACR <30 mg/g) and albuminuria group (n = 40, UACR ≥30 mg/g). Gender, age, body mass index (BMI), duration of T2DM, blood pressure, visceral fat area (VA), subcutaneous fat area (SA), biochemical indexes of blood serum and urinary were collected and compared between the two groups, and the relationship between VSR and MHR was analyzed in albuminuria group. ResultsNo significant differences existed in gender, age, BMI, duration of diabetes, blood pressure, serum lipids, and hemoglobin Alc between the two groups. The levels of VA, VSR, MHR, and UACR were higher in the albuminuria group (P < 0.05). VSR was positively correlated with MHR (r = 0.39, P < 0.01), whereas VA was not significantly correlated with MHR in the albuminuria group. ConclusionCompared with VA, VSR was significantly correlated with MHR, suggesting that VSR is more closely related to the occurrence of chronic inflammation in type 2 diabetics with albuminuria.

Evaluation of urinary haptoglobin level as a biomarker of diabetic nephropathy in children with type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is a common endocrine disease in children. Early recognition of complications of T1DM is important for preventing long-term morbidity and mortality. We aimed to investigate whether urinary haptoglobin level is a biomarker of diabetic nephropathy in children with T1DM. Ninety T1DM patients, aged between 2-18years, and 60 healthy age-matched children were included in the study. Glycosylated hemoglobin (HbA1c), spot urine creatinine, microalbumin, protein and haptoglobin levels of all cases were measured and compared. Correlations between HbA1c level, duration of diabetes, spot urine microalbumin/creatinine (uACR), protein/creatinine (uPCR), and haptoglobin/creatinine (uHCR) ratios in the T1DM group were evaluated. T1DM and control groups were homogeneous in terms of age, sex, and anthropometric measurements. uACR was higher in the T1DM group than in the control group (14mg/g vs. 6mg/g) while uHCR was not elevated in T1DM patients. Nevertheless, uHCR was higher in the microalbuminuria group when compared to the normoalbuminuria group. In the T1DM group, moderate positive correlations between uPCR with uACR and uHCR, and weak correlation between uACR and uHCR were found (r = 0.60, p < 0.001; r = 0.55, p < 0.001; r = 0.24, p = 0.03, respectively). No significant relationship was found between diabetes duration, HbA1c levels and uACR, uPCR, and uHCR. Although uHCR in the T1DM group was similar to the control group, uHCR was higher in the microalbuminuria group than in the normoalbuminuria group. These results show that the uHg level could be a biomarker of diabetic nephropathy, but not earlier than albuminuria in the disease course. A higher resolution version of the Graphical abstract is available as Supplementary information.

Comparations Of Glycated Albumin Among Type 2 Diabetes Mellitus Patient With Normoalbuminuria, Microalbuminuria And Macroalbuminuria

Diabetic nephropathy is the most often complication of diabetes mellitus (DM). Complications of diabetic nephropathy can occur through several pathways, one of which is the formation of Advanced Glycation End Products (AGEs) through the formation of Glycated Albumin (GA). Glycated albumin (GA) is a medium-term glycemic control (2-3 weeks), shorter duration than HbA1c (2-3 months). The aim of this study was to compare the levels of GA in T2DM patients with normoalbuminuria, microalbuminuria, and macroalbuminuria. This is a cross-sectional study with subjects were 105 outpatients who had been diagnosed with T2DM by clinicians at Hasan Sadikin Hospital’s Endocrinology Clinic. We examined urinary albumin per Creatinine (u-ACR) and blood GA Increased GA level was found in 75.24% subjects. Kruskal Wallis test in GA serum levels of patients with T2DM normoalbuminuria group, microalbuminuria and macroalbuminuria revealed statistically significant (p &lt;0.001), with median and range of GA in normoalbuminuria 15,9% (12,1-21,89)%; microalbuminuria 20,9% (12,9-47,2)%; dan macroalbuminuria 23,1% (13,6-46,1)%. Statistical analysis showed that the GA serum level was significantly different between T2DM patients with normoalbuminuria and macroalbuminuria, but not between those with microalbuminuria and macroalbuminuria (p=0.001 and p=0.137, respectively). The result showed that the extensive kidney damage at the subject, the higher result of Glycated Albumin level in serum.

Serum fatty acid-binding protein 4 as a biomarker for early detection of diabetic nephropathy in type 2 diabetes

BackgroundDiabetic nephropathy (DN) is one of the major causes of ESKD, and its complications are characterized by proteinuria, decreased glomerular filtration, and renal fibrosis resulting in the deterioration of renal functions, so early detection of nephropathy is essential to slow down and prevent the progression of the disease. Fatty acid-binding protein 4 (FABP4) is expressed in renal proximal tubule cells and released in response to hypoxia caused by decreased peritubular capillary blood flow, so serum FABP 4 is one of the promising biomarkers for early prediction of diabetic nephropathy in patients with type 2 diabetes.MethodsThis was a case–control study that included 120 patients with type-2 diabetes mellitus selected from Kasr Alainy Hospital, Cairo University Hospital, who were divided into 2 groups: the first group comprised 60 diabetic patients divided into 3 sub-groups according to their urinary albumin/creatinine ratio (normo-, micro-, and macroalbuminuria). The second group included 60 apparently healthy individuals. All patients were subjected to history, clinical examination, laboratory investigations, and serum FABP4 by ELISA.ResultsThere was a significant increase in serum FABP4 in the macroalbuminuria group, followed by the microalbuminuria group, then the normoalbuminuria group, in comparison to the normal control group. There was a significant positive correlation between serum FABP 4 level and the duration of diabetes and HBA1c. There was a significantly negative correlation between serum FABP4 and serum albumin in the macroalbuminuria group. Receiver operating characteristic curve analysis found that serum FABP 4 discriminate micro- and macroalbuminuric patients with diabetes from controls with 96.6% and 98.3% diagnostic specificity and 100% diagnostic sensitivity respectively.ConclusionSerum FABP 4 can be used as a biomarker for the early detection of diabetic nephropathy.