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Background: Urinary N-acetyl-b -D-glucosaminidase (NAG) has been suggested as a marker for diabetic nephropathy. A prospective study has therefore been performed to compare albuminuria and urinary NAG activities in type 2 diabetic patients.Methods: Forty-one patients (23 men and 18 women) with type 2 diabetes between 40 and 78 years of age were selected for a 5-year follow-up study. The urinary activities of NAG to creatinine ratios (NAG index) and albumin to creatinine ratios (albumin index) were measured in random spot urine samples. All patients were normoalbuminuric (albumin index < 30 mg/g Cr) at the beginning of the study. The mean NAG indexes and albumin indexes were calculated yearly.Results: During the observation period, 15 patients developed diabetic nephropathy (albumin index ≥ 30 mg/g Cr). Significantly higher mean NAG index and albumin index were found at the beginning of the study in patients who later developed diabetic nephropathy in comparison with those who did not (5.5 ± 2.0 vs 10.6 ± 4.2 U/g Cr, 11.0 ± 5.0 vs 17.8 ± 5.7 mg/g Cr, respectively). A gradual increase of the NAG index was found during the study in both patients who developed diabetic nephropathy and those who did not. On multiple logistic regression analysis, the NAG index at the beginning of the study was an independent predictor for the development of diabetic nephropathy. Conclusions:These results suggest that the NAG index may serve as an early functional indicator of diabetic nephropathy.

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