Serum suPAR and Urinary Nephrin as Novel Sensitive and Specific Markers for Diabetic Nephropathy in Patients with Type 2 DM

Abstract

Background: The most frequent reason of end-stage kidney disease (ESKD) is diabetic nephropathy (DN), highlighting the need of early detection, treatment, and prevention. Objective: To assess the sensitivity and specificity of serum (soluble urokinase-type plasminogen activator receptor (suPAR) and urinary nephrin in cases with type 2 diabetes mellitus (T2DM) with and without nephropathy. Methods: This prospective study was conducted on 70 patients of T2DM and 15 healthy control group of age and sex matched persons. All patients and control group were subjected to pelviabdominal U/S, laboratory investigations (CBC, ESR, liver and kidney function test, fasting and 2 hours post prandial blood sugar, urine analysis, (urine albumin creatinine ratio (UACR), nephrin, and serum suPAR levels). Results: ROC analysis was done for suPAR to predict DN. It showed a significant AUC of 0.869, with a 95% CI ranging from 0.785 -0.953 (P < 0.001). The best cutoff was > 82.3, at which sensitivity and specificity were 97.1% and 68.6%, respectively. ROC analysis was done for urinary nephrin to predict DN. It showed a significant AUC of 0.760, with a 95% CI ranging from 0.642 -0.877 (P < 0.001). The best cutoff was > 10.8, at which sensitivity and specificity were 80% and 68.6%, respectively. Conclusions: In T2DM patients, serum suPAR and urinary nephrin were more specific and sensitive markers than microalbuminuria in early detection of DN.