Serum and Urine Neutrophil Gelatinase- Associated Lipocalin: As an Indicator for Early Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients

Abstract

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.