TNF-αand Microalbuminuria in Patients with Type 2 Diabetes Mellitus

Abstract

Aim. Recent evidence suggests that chronic subclinical inflammation plays a key role in the pathogenesis and progression of diabetic nephropathy. Aim of the present study was to investigate possible correlation between the presence and degree of microalbuminuria and markers of inflammation in patients with type 2 diabetes mellitus (DM). Patients-Methods. Eighty patients were enrolled and clinical and laboratory data were recorded. Albumin-creatinine ratio (ACR) was calculated in first-morning urine samples. Serum and urinary tumor necrosis factor-α (TNF-α) levels were determined by ELISA. Results. Forty-five patients had normoalbuminuria, 33 microalbuminuria, and 2 macroalbuminuria. Patients with microalbuminuria were older, with higher glycosylated hemoglobin levels (HbA1c) and they more frequently had diabetic retinopathy, neuropathy, and cardiovascular disease and were on treatment with angiotensin converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARBs). ACR was significantly correlated with the presence of cardiovascular disease, hypertension, and HbA1c levels and the administration of clopidogrel and ACEi or ARBs. ACR was not correlated with C-reactive protein, fibrinogen, or serum TNF-α levels but had a strong correlation with urinary TNF-α levels. Conclusions. In patients with type 2 DM, urinary, but not serum, TNF-α levels are associated with the presence and severity of microalbuminuria.

Cytokines profile and its correlation with endothelial damage and oxidative stress in patients with type 1 diabetes mellitus and nephropathy

“…These data are in agreement with Lampropolou et al [15] and Ruotsalainen et al [16]. In a previous study [17], we have also shown that inflammatory status is associated with nephropathy in DM1, since higher plasma levels of INF-c, TNF-a, IL-6, IL-10 in patients with diabetes and CKD (albuminuria C30 mg/g and/or GFR \60 mL/min/ 1.73 m 2 ) were observed when compared to those without CKD.…”

Association of serum and urinary tumor necrosis factor-alpha (TNF-α) with albuminuria in diabetic nephropathy.

“…On the contrary, there were non-significant correlation between serum and urinary TNF-α and serum creatinine or eGFR; similar results confirmed by Lampropoulou et al, (2014), they observed no correlation between eGFR and serum or urinary TNF-α [30].…”

“…However, it should be noted that it remains unclear whether TNF-α urinary excretion is a marker of glomerular permeability or reflects tubulointerstitial damage [30]. Also Navarro et al, (1999) didn't find any significant correlation between serum and urinary concentrations and explained these results by an intra renal production of TNF-α [31].…”

“…Interestingly, Lampropoulou et al, (2014) found that, compared to patients with normoalbuminuria, patients with microalbuminuria had significantly higher urinary TNF-α, but similar serum TNF-α levels [30] and showed that urinary TNF-α was the only independent predictor of the degree of microalbuminuria and no correlation was observed between serum and urinary TNF-α level in their study suggesting mainly intra renal production of this cytokine and therefore local and non systemic activation of the inflammatory response and this was not in agreement with our study, we found significant linear correlation between serum and urinary TNF-α that was in agreement with Wong et al study .They supported their results by evaluation of the correlation between microalbuminuria and CRP, fibrinogen and serum TNF-α levels in their results. However, it should be noted that it remains unclear whether TNF-α urinary excretion is a marker of glomerular permeability or reflects tubulointerstitial damage [30].…”

Association of Diabetic Retinopathy, Albuminuria and CKD in Patients with Type 2 Diabetes Mellitus

“…This relationship has been found in other studies as well. (16)(17)(18)(19) However, not all studies have found this correlation between retinopathy and albuminuria. In the NHANES study, Kramer et al have found 30 % of patients with chronic renal insufficiency with neither retinopathy nor albuminuria; they did not find any correlation between retinopathy and albuminuria either.…”