Kim-1 and Ngal as Biomarkers of Nephropathy in Type Ii Diabetes.

Abstract

Background: clinically detectable diabetic nephropathy is based on albumin excretion and glomerular filtration rate that mainly reflects the glomerular damage. New biomarkers have arisen with the promise of detecting kidney damage prior to the currently used markers. Objectives: to assess the usefulness of the urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 for the early diagnosis of diabetic kidney disease in type2 diabetes mellitus and to estimate their relation to the degree of nephropathy in comparison to the level of albuminuria and other parameters. Design: cross sectional study. Setting: the internal medicine department -al-zahraa university hospital and endocrinology department -helwan university hospital from 2014 / 2015. Patients and methods: seventy diabetic patients were chosen and divided into 3 subgroups (normoalbuminuric, microalbuminuric and macroalbuminuric), compared to 19 healthy controls. For all participants, clinical examination, urine analysis, fasting and 2hours post prandial serum glucose, glycated hemoglobin a1c%, serum cholesterol, triglycerides, serum creatinine, urea, estimated glomerular filtration rate, urinary albumin to creatinine ratio, urinary kim-1 and ngal were done. Results: both urinary ngal and kim-1 correlated positively with urinary albumin, disease duration and hba1c. Ukim-1 correlated negatively with estimated glomerular filtration rate. The cutoff point to differentiate the normoalbuminuric group from control for ukim-1 was 88.5ng/l. The diagnostic sensitivity was 91.6%, diagnostic specificity was 84%. At the cutoff value 3.25 μg/l for ungal the diagnostic sensitivity was 100%, diagnostic specificity was 89.4%. Conclusion: ukim-1 and ungal are sensitive and specific markers for detection of diabetic nephropathy in patients with type2 diabetes mellitus.

Novel biomarkers for prognosticating diabetic kidney disease progression

“…Several studies have documented an estimation of KIM-1 in urine (uKIM-1) as a predictive indicator for AKI as it appears well before serum creatinine increases [ 68 ]. Fourth, Ali et al reported uKIM-1 with more specificity and sensitivity than urine albumin in diagnosing early stages of DKD [ 69 ], and Gohda et al reported a significant association of serum KIM-1 with a lower GFR rate. [ 70 ] Clinical studies have highlighted that uKIM-1 values were gradually increased in patients with T1DM and T2DM from normo- micro-macroalbuminuria [ 70 , 71 ].…”

“…Onset and progression (T1DM, T2DM) [74,78] Yes [75] Yes [72] KIM-1 Onset (T2DM) [69] Progression (T1DM) [90] n/a n/a L-FABP Progression (T2DM) [99] n/a Yes [79] Oxidative marker 8-OxodG Progression (T2DM) [104] Yes [84] Yes [86] Pentosidine Progression (T1DM, T2DM) [110,111] Yes [128] Yes [91] Inflammation MCP-1 Progression (T2DM) [113] Yes [115] n/a TNF-α Progression (T2DM) [98] Yes [100] Yes [101] TNF-α Receptors Progression (T1DM, T2DM) [104,129] Yes [107] n/a CTGF Predictor of ESRD (T1DM) [123] Yes [124] n/a IL-6…”