Assessment of Urinary Podocin Level as an Early Indicator in Diabetic Nephropathy

Abstract

Background: Diabetic nephropathy one of the leading causes of end stage renal disease in which podocytes damage play a vital role. It will be interesting to recognize podocyturia as a first noninvasive marker of subclinical early renal damage. The current study was aimed to assess the Urinary podocin level (podocyte-specific protein detected in urine using antipodocin antibody ELISA kit) as an early indicator for the glomerular lesion in patients with type 2 diabetes mellitus. Methods: This study included 45 clinically stable type 2 diabetic patients with glomerular filtration rate (GFR) (>60 ml/min/1.73m 2) and excluded patients with fever, urinary tract infection, uncontrolled hypertension, congestive heart failure or malignancy collected from Zagazig University Hospitals and Air force Hospital. In addition to 15 apparently healthy volunteers matched in age and sex as a control group. Patients were classified according to albumin/creatinine (A/C) ratio into three groups 15 patients for each group. Results: There was statistically significant difference between all studied groups as regards urinary podocin levels (P <0.001). urinary podocin levels appeared even in normoalbuminuria group with median 9.2 (7.1-12 ng/ml) which was significantly higher compared to control group with median 3.9 (2.2-4.8) ng/ml and the higher level was found in macroalbuminuria group with median 41.5 (38.5-48.5)ng/ml. Conclusion: Urinary podocin levels were highly sensitive early marker to predict diabetic nephropathy in patients with type 2 diabetes mellitus for further studies.

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“…The presence of podocytes in the urine sediments, however, may be a strong indicator of serious damage and disease severity. When comparing the presence of urinary podocytes, they were found not to be present in diabetics with normoalbuminuria, diabetics having chronic renal disease or healthy controls, but were present in those with microalbuminuria and macroalbuminuria [ 24 ].…”

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“…Significant albuminuria occurred only after early and focal foot process effacement had progressed to diffuse involvement, with the complete absence of podocin immunolabeling at the slit diaphragm [35]. According to data from the literature, on the one hand, podocin might be an early biomarker of diabetic nephropathy associated with the severity of the disease [36,37]. The results have shown that podocin was higher in patients with diabetes mellitus as compared with a healthy group regardless of the level of albumin to creatinine ratio, even in those with normoalbuminuria.…”

“…The results have shown that podocin was higher in patients with diabetes mellitus as compared with a healthy group regardless of the level of albumin to creatinine ratio, even in those with normoalbuminuria. On the other hand, GFR and serum albumin showed negative correlations with urinary podocin and a positive correlation with serum creatinine [36,37]. Furthermore, detection of podocytes in the urinary sediments might be a marker of severe injury and disease activity [38].…”