Introduction: Although microalbuminuria remains the gold standard for early detection of diabetic nephropathy (DN), it is not a sufficiently accurate predictor of DN risk. Thus, new biomarkers that would help to predict DN risk earlier and possibly prevent the occurrence of end-stage kidney disease are being investigated. Objective: To investigate the role of zinc-alpha-2-glycoprotein (ZAG) as an early marker of DN in type 2 diabetic (T2DM) patients. Methods: 88 persons were included and classified into 4 groups: Control group (group I), composed of normal healthy volunteers, and three patient groups with type 2 diabetes mellitus divided into: normo-albuminuria group (group II), subdivided into normal eGFR subgroup and increased eGFR subgroup > 120 mL/min/1.73m2), microalbuminuria group (group III), and macroalbuminuria group (group IV). All subjects were submitted to urine analysis, blood glucose levels, HbA1c, liver function tests, serum creatinine, uric acid, lipid profile and calculation of eGFR, urinary albumin creatinine ratio (UACR), and measurement of urinary and serum ZAG. Results: The levels of serum and urine ZAG were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied groups regarding serum and urinary ZAG was found. Urine ZAG levels were positively correlated with UACR. Both ZAG levels were negatively correlated with eGFR. Urine ZAG levels in the eGFR ˃ 120 mL/min/1.73m2 subgroup were higher than that in the normal eGFR subgroup. Conclusion: These findings suggest that urine and serum ZAG might be useful as early biomarkers for detection of DN in T2DM patients, detectable earlier than microalbuminuria.
Background Cardiovascular disease is considered a common cause of morbidity and mortality in patients with end-stage renal disease on hemodialysis. Elevated levels of glycated hemoglobin (HbA1c) are associated with CVD in diabetic patients. However, there is lack of information regarding HbA1c and CVD risk in non-diabetic HD patients. This study aims to investigate the relationship between glycated hemoglobin levels and the risk for CVD in non-diabetic HD patients. Methods A prospective, cross-sectional study, which included 60 non-diabetic HD patients, 30 patients taking erythrocyte stimulating agents (ESA), and 30 patients with no-ESA. Each group was subdivided according to the presence or absence of CVD. All participants were subjected to full history taking, clinical examination, and laboratory investigations. Results Non-diabetic HD patients with CVD had higher mean ± SD HbA1c% (5.8 ± 0.2) and HOMA-IR (4.7 ± 0.7), than those with no-CVD (5.5 ± 0.3), and (4.2 ± 0.3) (p ˂0.05). Non-diabetic HD patients with CVD had longer dialysis duration, lower serum albumin, and HDL, but higher total cholesterol, CRP, Hb%, HbA1c%, and insulin resistance than those with no-CVD. HD patients who received higher doses of ESA therapy mean ± SD (80.8 ± 22.4) IU/Kg/Week had significantly lower HbA1c% (˂5%) than those who received lower doses (53.9 ± 23.8), who had HbA1c% (≥ 5.5–6%) (p˂0.05). There was a significantly positive correlation between the presence of CVD in HD patients and the HbA1c% levels (r = 0.492) (p˂0.05). Conclusion HbA1c can predict CVD in non-diabetic HD patients, and its lower levels are associated with lower CVD.
Background: Diabetic Kidney Disease (DKD) represents the major cause Chronic Kidney Disease (CKD) where 5-40% of patients with Type 2 Diabetes Mellitus (T2DM) ultimately develop DKD. CKD diagnosis is reliable on levels of blood urea nitrogen and serum creatinine, however, serum creatinine has a low predictive value in early detection of renal impairment. So, new biomarkers for early diagnosis of CKD is of interest. Our objective is to elucidate the significance of Neutrophil Gelatinase-Associated Lipocalin (NGAL) as an early predictor of diabetic nephropathy in comparison with albuminuria in (T2DM). Methods: Prospective, case control study, carried out on patients with T2DM with a duration of disease ranged from (5-15) years, presented to outpatient clinics of nephrology and endocrinology units of internal medicine department in Zagazig University hospitals from August 2018 to February 2019. The study included (100) participants divided into: group (A) 25 healthy control, group (B) 75 diabetic type 2 patients stratified into three subgroups according to albumin / creatinine ratio: subgroup (1): 25 normoalbuminuric, subgroup (2): 25 microalbuminuric, subgroup (3): 25 macroalbuminuric. Results: There was statistically significant difference between healthy individuals, normo, micro and macroalbuminuria diabetic patients regarding serum NGAL (sNGAL) & urinary NGAL (uNGAL), where their levels incremented parallel to the degree of albuminuria. Conclusion: tubular injury may precede glomerular injury in diabetic patients and As NGAL is a tubular marker, So NGAL is superior to albumin / Creatinine ratio (ACR) as an early predictor of DKD among T2DM patients.
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