Predictor Of Diabetic Nephropathy Research Articles

Advanced Glycation End Products (AGEs) Webinar Meeting Report.

The advanced glycation end products (AGEs) Webinar was co-hosted by Diabetes Technology Society and Kitalys Institute on August 8, 2024, with the goal of reviewing progress made in the measurement and use of AGEs in clinical practice. Meeting topics included (1) AGEs as predictors of diabetic nephropathy (DKD), (2) hemoglobin glycation index (HGI) and the glycation gap (GG), (3) formation and structure of AGEs, (4) AGEs as a risk factor of cardiovascular disease (CVD), and (5) approaches to limit or prevent AGE formation.

Burden and Predictors of Diabetic Nephropathy in an Adult With Diabetes Mellitus Patients on Follow up at Ambo University Referral Hospital Central, Ethiopia

BACKGROUND: Despite the growing evidence of Diabetic Nephropathy in adult patients with long-standing diabetes in sub-Saharan Africa, data on its burden and correlates in adult African patients with diabetes are limited. We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy among adult population with diabetes in Hospital. OBJECTIVE: We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy among adult population with diabetes in Ambo University Referral Hospital Central, Ethiopia. METHODS: A Hospital-based cross-sectional study was conducted from June to August, 2023 and a systematic random sampling method used to recruit participants. A total of 4,300 were interviewed using structured questionnaires to gather data from the study subjects. For data entry and analysis, Epi Data version 3.1.1 and SPSS version 25 were used. Multivariable logistic regression analysis was done after descriptive statistics. 95% confidence intervals (CI) and crude and adjusted odds ratios were presented. RESULTS: Diabetic Nephropathy (DN) was documented in population was 24.9% from the 369 participants (95%; CI 23.37– 26.43) participants among the study). Male sex [AOR = 2.215; 95% CI: 1.34, 3.45, p = 0.002], physically inactive [AOR = 1.983; 95% CI: 1.05, 3.70), P = 0.034], dyslipidaemia [AOR: 1.98, CI: 1.009, 3.5), P = 0.024] and poor controlled glycemia [AOR= 2.70; 1.40, 5.2), P = 0.003] were significant determinants for the development of Diabetic Nephropathy. CONCLUSION: Among DM patients, sex, physical inactivity, dyslipidaemia, and poor glycemic control were discovered to be the predictors of diabetic nephropathy. By enhancing programs for health information, education, and promotion, diabetes management should be better equipped to achieve glycaemic control and prevent diabetic nephropathy.

Burden and Predictors of Diabetic Nephropathy in an Adult With Diabetes Mellitus Patients on Follow up at Ambo University Referral Hospital Central Ethiopia

BACKGROUND: Despite the growing evidence of Diabetic Nephropathy in adult patients with long-standing diabetes in sub-Saharan Africa, data on its burden and correlates in adult African patients with diabetes are limited. We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy n an adult population with diabetes in Hospital. OBJECTIVE: We, therefore, undertook this study to determine the burden and predictors of Diabetic Nephropathy n an adult population with diabetes in Hospital. METHODS: A Hospital-based cross-sectional study was conducted from June to August, 2023 and a systematic random sampling method used to recruit participants. A total of 4,300 diabetics are under observation. The interviewer used structured questionnaires to gather data from the study subjects. For data entry and analysis, Epi Data version 3.1.1 and SPSS version 25 were used. Multivariable logistic regression analysis was done after descriptive statistics. 95% confidence intervals (CI) and crude and adjusted odds ratios were presented. RESULTS: Diabetic Nephropathy (DN) was documented in population was 24.9% from the 369 participants (95%; CI 23.37– 26.43) participants among the study). Male sex [AOR = 2.215; 95% CI: 1.34, 3.45, p = 0.002], physically inactive [AOR = 1.983; 95% CI: 1.05, 3.70), P = 0.034], dyslipidaemia [AOR: 1.98, CI: 1.009, 3.5), P = 0.024] and poor controlled glycemia [AOR= 2.70; 1.40, 5.2), P = 0.003] were significant determinants for the development of Diabetic Nephropathy. Therefore, it is advised that healthcare professionals pay close attention to patients who have recognized related factors during follow-up in order to reduce the likelihood of DN. CONCLUSION: Among DM patients, sex, physical inactivity, dyslipidaemia, and poor glycemic control were discovered to be the predictors of diabetic nephropathy. By enhancing programs for health information, education, and promotion, diabetes management should be better equipped to achieve glycaemic control and prevent diabetic nephropathy. Male sex, sedentary lifestyles, dyslipidemia, and patients with poor glycemic control need to receive more attention.

Role of Tumor Necrosis Factor Alpha Gene Polymorphism (TNFα -308 G/A) and Prediction of Diabetic Nephropathy

Role of Tumor Necrosis Factor Alpha Gene Polymorphism (TNFα -308 G/A) and Prediction of Diabetic Nephropathy

Sympathetic skin response for early detection of type 2 diabetic peripheral neuropathy and nephropathy.

Diabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) are common complications of type 2 diabetes mellitus (T2DM). Although nerve conduction studies (NCS) and sympathetic skin response (SSR) can detect DPN, the more sensitive method for early diagnosis remains unclear. Furthermore, whether DPN can be used as a predictor for diabetic nephropathy needs clarification. We evaluated nerve conduction studies, sympathetic skin response, and the diabetic nephropathy indicator microalbuminuria (MAU) in 192 patients with type 2 diabetes mellitus and 50 healthy controls. Patients with type 2 diabetes mellitus showed a lower sensory nerve conduction velocity (SCV), sensory active nerve potential (SNAP), motor nerve conduction velocity (MCV), and compound motor action potential (CMAP) than the controls on NCS. Abnormal rates for nerve conduction studies and sympathetic skin response were 75.0% and 83.3%, respectively, in patients with type 2 diabetes mellitus. Interestingly, 54.2% of patients with normal nerve conduction studies had an abnormal sympathetic skin response. Moreover, we found a positive correlation between sympathetic skin response and microalbuminuria for the first time. The abnormal rate of microalbuminuria was 53.8%, lower than that of abnormal nerve conduction studies or sympathetic skin response patients. Sympathetic skin response is a more sensitive method than nerve conduction studies for the early diagnosis of diabetic peripheral neuropathy. Abnormal sympathetic skin response might serve as an indicator for early diabetic nephropathy. Additionally, diabetic peripheral neuropathy may occur earlier than diabetic nephropathy in the development of type 2 diabetes mellitus.

Neutrophil - Lymphocyte ratio as a predictive marker for Early Stage Diabetic Nephropathy

Background: Diabetic nephropathy is a diabetic microvascular complication. An increase in urine albumin excretion isthe clinical manifestation. Total white blood cell count is a basic but sensitive measure of inflammation that has beenevaluated as an inflammatory marker in a variety of cardiac and noncardiac ailments such as stroke, acute myocardialinfarction , and heart failure.Objective: To analyze Neutrophil-lymphocyte ratio as a predictive marker for early stage diabetic retinopathy.Methods: The research enrolled 230 individuals, with 115 of them having type 2 diabetes and 69 having Early Stage DN.The control group consisted of 115 healthy volunteers of similar age and gender. All of the patients’ samples was collectedand tested for HBA1c, CBC, FBS, PPBS, RFT, Urine microalbumin, and Urine albumin creatinine ratio. The Mogensen DNdiagnostic criteria and the American Diabetes Association was usedResults: This research had a total of 230 participants. Diabetic nephropathy patients and non-diabetic nephropathy patientswere divided into two groups. NLR was shown to have a substantial relationship with neutrophil and lymphocyte counts.In the DN group, mean neutrophil counts increased while mean lymphocyte levels decreased, resulting in a substantiallyhigher NLR value in the patient group than in the control group. The patient group’s mean NLR values were considerablyhigher than the control group’s (P 0001), and the NLR values of patients with early stage DN were significantly higherthan those of patients without early stage DN (P 0001). The results reveal that DN was associated with NLR, Creatinine,and Insulin Resistance.Conclusion: NLR might be used as a predictor and predictive risk factor for early-stage diabetic nephropathy. This testis affordable, routinely performed, and easy to compute. NLR can be a cost-effective alternative marker as a predictor ofDiabetic Nephropathy in a setting with constrained laboratory resources.

IDF21-0024 The non-invasively measured radial pulse and the renal outcomes of SGLT-2 inhibitors in patients with Type 2 diabetes

Background: Many studies had shown SGLT-2 inhibitors prevent diabetic nephropathy. The non-invasive spectrum analysis of radial pulse may be used as an indicator for renal function loss in patients with Type 2 diabetes. Aim: The purpose of this study was to examine if the third harmonic of radial pulse (C3) can be used as a risk marker of diabetic nephropathy for patients and if it is different with those treated with SGLT-2 inhibitors. Method: The study consists of two-year follow-up of 2,095 type 2 diabetes patients under the care of the Division of Endocrinology and Metabolism of Zhongxiao Branch of Taipei City Hospital (IRB: ISRCTN14306167), 57.4% of them were male without prior history of diabetic nephropathy. The two groups were separated by patients taking SGLT-2 inhibitors or not. Per the national insurance prior authorization guidelines, only those patients with eGFR>45 were prescribed with SGLT-2. Radial pulse measurements were taken and analyzed for all patients at the beginning of the trial. The spectrum analysis of the radial pressure wave was calculated and transformed. The patients are under quarterly routine renal function checkups. The results of renal outcome were determined by a specialist. Variables from medical records and from the spectrum analysis of radial pressure wave were calculated at the beginning of the trial in each group using the Student’s t-test. Results: During the 2 years, there were 8 patients (3.13%) developed diabetic nephropathy in the group taking SGLT-2 inhibitor (N=255), and 83 patients (4.51%) in the group not taking SGLT-2 inhibitor (N=1,840). The SGLT-2 inhibitor group had a lower incidence of diabetic nephropathy. In both groups, we found that the lower C3 is associated with diabetic nephropathy. After adjusting for age and gender, C3 is still significantly different (CI 0.200–0.320; P<0.01) between the group with (C3 = 0.239 ± 0.04) or without (C3 = 0.283 ± 0.084) diabetic nephropathy. Discussion: This result of study is consistent with other studies in which SGLT-2 use was associated with a lower incidence of diabetic nephropathy in patients with type 2 diabetes mellitus. Furthermore, C3 may be used as a predictor of diabetic nephropathy. Regardless of treatment with SGLT-2 inhibitors, the patients with lower C3 were more likely to develop diabetic nephropathy.

Comparision based Prediction of Diabetic Nephropathy using Deep Learning Algorithm

Comparision based Prediction of Diabetic Nephropathy using Deep Learning Algorithm

Evaluation Of Heat Shock Protein-27 Levels as A Predictor of Diabetic Nephropathy in Early Diabetics

Objective: The current study objective is to find out the levels of heat shock protein-27 in diabetes patients with and without diabetic nephropathy, and to appraise the functional role of HSP-27 as an early diagnostic biomarker in progressive diabetic nephropathy.&#x0D; Study Design: Case control study.&#x0D; Place and Duration of Study: The current study was conducted in physiology department, Basic Medical Science Institute (BMSI), Jinnah Post-Graduate Medical Center (JPMC), Karachi from March 2019 to September 2020.&#x0D; Methodology: A total 105 participants between 30-50 years of age were separated into three groups: Group A (n=35) diabetic-patients with history of diabetes &lt; 5 years without any sign of DN; Group B (n=35) diabetic patients with history of diabetes &gt;5 years duration of diabetes and microalbumin levels &lt; 30 mg/dl in urine and Group C (n=35) healthy individuals. All this study participants were gone through detailed history, anthropometric measurement, BMI, serum blood sugar, serum urea, serum creatinine, BUN, urinary albumin, and serum HSP-27 were estimated.&#x0D; Results: Elevated levels of HSP-27 were seen in group-A patients as compared to group-C (p&lt;0.001). Elevated levels of HSP-27 were presented in group-B as compared with group-C (p&lt;0.001) which signify early renal parenchyma injury. Strong association had been seen for HSP-27 with creatinine (r=0.69; p &lt; 0.001), and HbA1c (r =0.72; p &lt;0.001) and urea (r = 0.72; p &lt;0.001) in all these participants. While statistical highly significant and strong positive association were reported for HSP-27 with microalbumin (r = 0.86; p&lt; 0.001) in all participants.&#x0D; Conclusion: Elevated levels of HSP-27 with progression of renal injury with or without declining of renal function is seen in current study. These findings perhaps suggest and recognizing HSP-27 as key diagnostic marker for diabetic nephropathy in early diabetics.&#x0D; KEYWORDS: Diabetes Mellitus, Diabetic Nephropathy, HSP-27.

Plasma activity of the antioxidant enzymes in predicting diabetic nephropathy progression.

The aim of the study was to examine whether biomarkers of oxidative stress are predictors of diabetic nephropathy (DN) progression. The study involved 45 patients with type 2 diabetes and DN and 15 healthy controls. Patients were followed for 3 years and the annual percentage change in eGFR was used to estimate the progression of DN. Patients with an annual percentage change in eGFR above the cutoff value of - 5.48%/year were classified in group 1, those with an annual percentage change in eGFR ≤ - 5.48%/year in group 2. The 28 patients in group 1 had the annual percentage change in eGFR of - 4.78 and 39.12%/year, and for the 17 patients in group 2 it ranged from - 24.86 to - 6.18%/year. At the onset of the study no significant differences were found between the groups in demographic, clinical or laboratory parameters. Plasma activities of glutathione peroxidase (GPX) and superoxide dismutase (SOD) were significantly lower in patients than in the controls. During 3-year study kidney function and size changed insignificantly in group 1, while eGFR and kidney size decreased and proteinuria increased significantly in group 2. Multivariate linear regression analysis selected male gender, duration of diabetes, systolic blood pressure, fasting serum glucose, urine protein/creatinine ratio as factors associated with DN progression. Plasma activity of GPX and SOD were selected as positive predictors of annual percentage change in eGFR. Besides already known factors, plasma activity of GPX and SOD were found to be significant independent predictors of DN progression.

Incidence of Diabetic Nephropathy and Its Predictors among Type 2 Diabetes Mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Background Although the rate of diabetic nephropathy which is the leading cause of end-stage renal disease (ESRD) continues to rise, there is limited information about the problem. This study aimed to assess the incidence and predictors of diabetic nephropathy among type 2 DM patients. Methods Institution-based retrospective follow-up study was conducted at UGCSH with 462 newly diagnosed type 2 DM patients from January 2001 to February 2016, and the data were collected by reviewing their records. The Schoenfeld residuals test was used to check proportional hazard assumption. The best model was selected by using Akaike information criteria (AIC). Hazard ratios (HR) with its respective 95% confidence interval were reported to show significance and strength of association. Results The incidence rate of diabetic nephropathy was 14 (95% CI 10.8–17.7) cases per 10,000 patient-month observation. In addition, 63 (13.6%) DM patients developed diabetic nephropathy. The median time to develop diabetic nephropathy was 94.9 months with interquartile range (IOR) of (64.1–127.4) months. Type 2 DM patients who had coronary heart disease (AHR = 2.69, 95% CI 1.42–5.13) and anemia (AHR = 1.94, 95% CI 0.97–3.87) were at higher hazard for developing diabetic nephropathy. Besides this, having a long duration (>10 years) (AHR = 0.24, 95% CI 0.11–0.56) and being female (AHR = 0.44, 95% CI 0.26–0.73) was found to be protective against diabetic nephropathy. Conclusion The incidence of diabetic nephropathy among type 2 diabetes patients remains a significant public health problem. Duration of diabetes >10 years and female sex reduced the risk of diabetic nephropathy. Coronary heart disease and anemia increased the risk of diabetic nephropathy among type 2 DM patients. In light of these findings, early screening for diabetes complication is needed, and health professionals should give targeted intervention for type 2 DM patients with coronary heart disease comorbidity and anemia.

Incidence of diabetic nephropathy in patients with type 2 diabetes mellitus at a tertiary healthcare setting in Ethiopia

Background and aimsDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Despite the increasing number of patients with Diabetes Mellitus in Ethiopia, the incidence of diabetic nephropathy in patients with DM has not been well established. Therefore, this study aimed to estimate the incidence and predictors of DN in patients with T2DM at tertiary healthcare setting, Ethiopia. MethodsAn institution based retrospective follow study was conducted from March 1 to April 28, 2019. Kaplan-meier survival curve together with log rank test were used. Cox proportional hazard model was used at 5% level of significance to determine the net effect of each explanatory variable on diabetic nephropathy. An assumption was check by schoenfeld residual test. ResultsThe incidence rate of diabetic nephropathy was 3.6% per 100 person-years (95% CI = 2.49–11.47). The median time to develop nephropathy was 100(95% CI, 96.7–107) months. Predictors of diabetic nephropathy were males (AHR: 2.7, 95%CI: 1.39, 5.23), long duration of diabetes (AHR: 1.03, 95%CI: 1.01, 1.06), HbA1c> 7% (AHR: 1.74, 95% CI: 1.67, 3.12), high density lipoprotein (AHR: 0.37, 95% CI: 0.16, 0.83), and mixed anti-diabetic therapy (AHR: 0.07, 95% CI: 0.01, 0.59). ConclusionThe incidence of diabetic nephropathy among T2DM patients was relatively high. Males, longer duration of diabetes, HbA1c, and fasting blood glucose were increase the risk of diabetic nephropathy.

Prediction of Diabetic Nephropathy from the Relationship between Fatigue, Sleep and Quality of Life

Fatigue and poor sleep quality are the most common clinical complaints of people with diabetes mellitus (DM). These complaints are early signs of DM and are closely related to diabetic control and the presence of complications, which lead to a decline in the quality of life. Therefore, an accurate measurement of the relationship between fatigue, sleep status, and the complication of DM nephropathy could lead to a specific definition of fatigue and an appropriate medical treatment. This study recruited 307 people with Type 2 diabetes from two medical centers in Northern Taiwan through a questionnaire survey and a retrospective investigation of medical records. In an attempt to identify the related factors and accurately predict diabetic nephropathy, we applied hybrid research methods, integrated biostatistics, and feature selection methods in data mining and machine learning to compare and verify the results. Consequently, the results demonstrated that patients with diabetic nephropathy have a higher fatigue level and Charlson comorbidity index (CCI) score than without neuropathy, the presence of neuropathy leads to poor sleep quality, lower quality of life, and poor metabolism. Furthermore, by considering feature selection in selecting representative features or variables, we achieved consistence results with a support vector machine (SVM) classifier and merely ten representative factors and a prediction accuracy as high as 74% in predicting the presence of diabetic nephropathy.

Abstract #780646: Prevalence and Predictors of Diabetic Nephropathy Among Patients with Type 2 Diabetes: A Cross-Sectional Study

Abstract #780646: Prevalence and Predictors of Diabetic Nephropathy Among Patients with Type 2 Diabetes: A Cross-Sectional Study

Urinary Cyclophilin A and serum Cystatin C as biomarkers for diabetic nephropathy in children with type 1 diabetes

Currently, microalbuminuria is the gold standard for detection and prediction of diabetic nephropathy (DN). However, microalbuminuria appears once significant kidney damage has actually occurred. We investigated the diagnostic role of urinary Cyclophilin-A (uCypA), uCypA/creatinine ratio (uCypA/Cr) and serum Cystatin-C (sCysC) as biomarkers for early detection of DN in children with type 1 diabetes mellitus (T1DM) of short duration (2-5 years) before microalbuminuria emerges. uCypA, uCypA/Cr, and sCysC levels were assessed in three age- and sex-matched groups; microalbuminuric diabetic group (n = 31), normoalbuminuric diabetic group (n = 29), and control group (n = 30). Glomerular filtration rate was estimated (eGFR) based on both serum creatinine (eGFR-Cr) and sCysC (eGFR-CysC). Significantly higher sCysC and lower eGFR-CysC were detected in both diabetic groups compared to controls and in microalbuminuric compared to normoalbuminuric group. No detected significant difference in eGFR-Cr values across the studied groups. Both uCypA and uCypA/Cr were significantly elevated in microalbuminuric compared to both normoalbuminuric and control groups with no difference between normoalbuminuric and control groups. Prediction of microalbuminuria was conducted using sCysC with area under curve up to 0.980. Combined use of sCysC and uCypA had better diagnostic value than uCypA alone. sCysC is a promising early biomarker for DN in childhood T1DM before albuminuria detection. eGFR-CysC is superior to eGFR-Cr in evaluating renal status in childhood T1DM. uCypA and uCypA/Cr were useful tools in predicting microalbuminuria, although not regarded as diagnostic biomarkers for early-stage DN in T1DM children by the current study.

Relationship between fibrinogen and microalbuminuria in elderly patients with type 2 diabetes mellitus

Objective To analyze the relationship between plasma fibrinogen(FIB) within normal range and microalbuminuria in elderly patients with type 2 diabetes mellitus. Methods A total of 869 elderly subjects with type 2 diabetes mellitus admitted to the Department of Endocrinology of Shanghai Fifth People′s Hospital from October 2012 to October 2014 were included in the study. The patients were divided into four groups based on the quartile level of FIB: Q1 group(<2.42 g/L), Q2 group(2.42-2.89 g/L), Q3 group(2.90-3.61 g/L), and Q4 group(≥3.62 g/L). The relationship between FIB and urinary albumin/creatinine ratio(UACR) was analyzed. Results With the increasing of FIB, the level of UACR was significantly elevated(P<0.05). Pearson correlation analysis showed that FIB was positively associated with age, duration of diabetes, creatinine(Cr) and UACR in men and women(P<0.01). Multiple regression analysis showed that FIB was an independent factor of UACR(P<0.01). Logistic regression analysis showed that the risks of microalbuminuria and macroalbuminuria were respectively 4.536 folds(95%CI 2.516-8.175, P<0.01) and 13.314 folds(95%CI 2.925-60.612, P<0.01) in Q4 group, and 2.177 folds(95%CI 1.273-3.724, P<0.01) and 4.098 folds(95%CI 1.101-19.226, P<0.05) in Q3 group as compared with Q1 group after adjused by following factors: gender, age, duration of diabetes, body mass index(BMI), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), HbA1C, total cholesterol(TC), triglyceride(TG), low density lipoprotein-cholesterol(LDL-C), Cr, alanine aminotransferase(ALT), as well as smoking and drinking behavior. Based on the cut off values to UACR 30 mg/g and 300 mg/g, the receiver operating characteristic curve(ROC) was used to evaluate the value of FIB for UACR. The optimal cut-off value of FIB was 3.18 g/L and 3.22 g/L respectively. Conclusions Plasma FIB was closely associated with microalbuminuria in elderly patients with type 2 diabetes mellitus, which may be considered as one of the predictors for diabetic nephropathy. Key words: Fibrinogen; Diabetes mellitus, type 2; Microalbuminuria

English

English

Plausible diagnostic value of urinary isomeric dimethylarginine ratio for diabetic nephropathy

Altered circulatory asymmetric and symmetric dimethylarginines have been independently reported in patients with end-stage renal failure suggesting their potential role as mediators and early biomarkers of nephropathy. These alterations can also be reflected in urine. Herein, we aimed to evaluate urinary asymmetric to symmetric dimethylarginine ratio (ASR) for early prediction of diabetic nephropathy (DN). In this cross-sectional study, individuals with impaired glucose tolerance (IGT), newly diagnosed diabetes (NDD), diabetic microalbuminuria (MIC), macroalbuminuria (MAC), and normal glucose tolerance (NGT) were recruited from Dr. Mohans’ Diabetes Specialties centre, India. Urinary ASR was measured using a validated high-throughput MALDI-MS/MS method. Significantly lower ASR was observed in MIC (0.909) and MAC (0.741) in comparison to the NGT and NDD groups. On regression models, ASR was associated with MIC [OR: 0.256; 95% CI: 0.158–0.491] and MAC [OR 0.146; 95% CI: 0.071–0.292] controlled for all the available confounding factors. ROC analysis revealed ASR cut-point of 0.95 had C-statistic of 0.691 (95% CI: 0.627-0.755) to discriminate MIC from NDD with 72% sensitivity. Whereas, an ASR cut-point of 0.82 had C-statistic of 0.846 (95% CI: 0.800 - 0.893) had 91% sensitivity for identifying MAC. Our results suggest ASR as a potential early diagnostic biomarker for DN among the Asian Indians.

Prospects of using cystatin c as an early predictor of diabetic nephropathy

Hypothesis/aims of study. Using early non-invasive markers of diabetic nephropathy (DN) in clinical practice is important to early start of nephroprotective therapy and leads to improving the quality of life, while decreasing disability and mortality of diabetic patients. The aim of the study was to estimate the potential of using serum cystatin C and glomerular filtration rate (GFR) calculated by CKD-EPIcys and CKD-EPIcr-cys equations for an early diagnosis of DN in type 1 diabetic (T1D) women who were planning pregnancy or were in the I trimester of pregnancy.&#x0D; Study design, materials, and methods. 47 T1D women were examined, of whom 25 individuals were pregnant and 22 ones were planning pregnancy. In all patients, glycated hemoglobin and serum cystatin C levels were determined, GFR was estimated by the creatinine clearance test, MDRD, CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, with diabetes training done.&#x0D; Results. The pregnant group and the planning pregnancy group were distinguished by glycated hemoglobin (p = 0.001), serum creatinine (p = 0.001), and GFR estimated by the creatinine clearance test (р = 0.017), CKD-EPIcr (р = 0.005), and CKD-EPIcr-cys (р = 0.046) equations. There was no difference in urinary creatinine, serum cystatin C, and GFR estimated by CKD-EPIcys equation and daily urinary protein excretion between the study groups. Most pregnant women (87.5%) were in stage C1 and only 12,5% in stage C2 as determined by estimated GFR using the CKD-EPIcr formula, which was significantly different compared to the planning pregnancy group, where the percentage of women in stages C1 and C2 was comparable (р = 0.002). In addition, most pregnant patients were in stage C1, while most of the patients planning pregnancy were referred to stage C2 by GFR estimated by CKD-EPIcysequation. Stage C3a was diagnosed in the both study groups only when CKD-EPIcys equation for GFR estimation was used. Most women from both groups were in stage C1 when GFR was estimated by the creatinine clearance test, the percentage ratio of patients in stages C1 and C2 in both groups being comparable.&#x0D; Conclusion. Our results demonstrated that serum cystatin C and GFR estimation by CKD-EPIcys equation could improve nephropathy diagnostic accuracy among T1D patients with a normal serum creatinine level and intact GFR based on creatinine level.

The potential use of Endostatin and Angiopoietin-2 as valuable biomarkers for the prediction of Diabetic Nephropathy in Type 2 Diabetes Mellitus

Diabetic Nephropathy (DN) is considered a serious capillary complication of diabetes mellitus (DM) which leads to end-stage renal disease. Endostatin (EST) is considered as collagen XVIII fragment formed during extracellular matrix remodeling (ECMR). EST acts as an anti-angiogenic factor. Angiopoietin-2 (Ang II) is a growth factor that increases in several conditions, such as hyperglycemia. The present study was to scrutinize the association of EST and Ang II serum levels with nephropathy in patients with type 2 diabetes mellitus (T2DM). A total of 30 healthy individuals (control) and 120 T2DM patients classified into 60 patients with microalbuminuria and 60 patients without microalbuminuria), aged 45-65 years were included. Fasting Plasma Glucose (FPG), HbA1C%, lipid profile, urinary albumin/creatinine ratio of 30-300 mg/g (UACR), serum urea and creatinine levels were assessed. Both EST and Ang II were measured using the ELISA technique. Ang II and EST levels were elevated in patients with T2DM groups compared with the healthy control group (P<0.001). EST and Ang II were significantly correlated to UACR (r= 0.753, P<0.001) (r= 0.685, P<0.001) and therefore indicate progress to DN. Circulating EST and Ang II were significantly associated with T2DM and predict progression of DN and therefore can be used as biomarkers for the prediction of DN in such a group of patients.