Department of Pediatric Nephrology, Poznan University of Medical Sciences, Poznan, Poland.
Pediatr Nephrol. 2010 Aug;25(8):1445-51. doi: 10.1007/s00467-010-1443-z. Epub 2010 Feb 16.
Clinically detectable diabetic nephropathy (DN) begins with the development of microalbuminuria (MA). However, early renal dysfunction may be overlooked despite using that method. On the other hand, the gold standard in DN detection-that is, renal biopsy-is highly invasive. The aim of this study was to evaluate the level of neutrophil-gelatinase-associated lipocalin (NGAL) and interleukin (IL)-18 and their relations to albumin excretion rate (AER) in children with normal-range albuminuria, e.g. in those considered as not presenting diabetic nephropathy. The study group consisted of 22 children (age 12.7 +/- 3.5 years) with type 1 diabetes mellitus (T1DM). Long-term glycemic control was assessed on hemoglobin A1c (HbA1c) levels (8.52 +/- 1.78%). All patients presented normal estimated glomerular filtration rate (eGFR) (141 +/- 23 ml/min/1.73 m(2)) and normal urinary albumin excretion (13.09 +/- 7.63 mg/24 h). Fourteen healthy children served as a control group. Children with T1DM showed increased NGAL values with respect to controls-interestingly, both in serum (sNGAL) (867.43 +/- 341.98 vs. 655.29 +/- 196.17 ng/ml; p = 0.04) and in urine (uNGAL) (420.04 +/- 374.16 vs. 156.53 +/- 185.18 ng/ml, p = 0.04). IL-18 levels were not different in both groups both in serum (58.52 +/- 20.11 vs. 69.79 +/- 58.76 ng/ml; NS) and in urine (14.53 +/- 12.74 vs. 14.60 +/- 10.92 ng/ml; NS). Despite the relatively small study group, the positive correlation between sNGAL and AER was found [AER (mg/24 h) = 3.1893 + 0.01141 x sNGAL (ng/ml); r = 0.51; p = 0.014] as well as between uNGAL and AER [AER (mg/24 h) = 8.7538 + 0.01032 x uNGAL (ng/ml); r = 0.51; p = 0.016]. No relationship between sNGAL and uNGAL, and GFR and HbA1c were found. Normal-range albuminuria does not exclude diabetic nephropathy defined as increased sNGAL and uNGAL concentration. NGAL measurement can be more sensitive than MA and may become a useful tool for evaluating renal involvement in diabetic children.
临床可检测到的糖尿病肾病 (DN) 始于微量白蛋白尿 (MA) 的发展。然而，尽管使用了这种方法，早期的肾功能障碍仍可能被忽视。另一方面，DN 检测的金标准——即肾活检——具有高度的侵入性。本研究旨在评估中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 和白细胞介素 (IL)-18 的水平及其与正常范围白蛋白尿（即被认为没有发生糖尿病肾病的儿童）的白蛋白排泄率 (AER) 的关系。研究组由 22 名患有 1 型糖尿病的儿童（年龄 12.7 +/- 3.5 岁）组成。长期血糖控制通过血红蛋白 A1c (HbA1c) 水平评估（8.52 +/- 1.78%）。所有患者均表现出正常的估计肾小球滤过率 (eGFR)（141 +/- 23 ml/min/1.73 m(2)）和正常的尿白蛋白排泄率 (13.09 +/- 7.63 mg/24 h)。14 名健康儿童作为对照组。与对照组相比，1 型糖尿病儿童的 NGAL 值升高，有趣的是，血清 (sNGAL) (867.43 +/- 341.98 与 655.29 +/- 196.17 ng/ml；p = 0.04) 和尿液 (uNGAL) (420.04 +/- 374.16 与 156.53 +/- 185.18 ng/ml，p = 0.04) 中均如此。两组血清 (58.52 +/- 20.11 与 69.79 +/- 58.76 ng/ml；NS) 和尿液 (14.53 +/- 12.74 与 14.60 +/- 10.92 ng/ml；NS) 中 IL-18 水平均无差异。尽管研究组相对较小，但发现 sNGAL 与 AER 之间存在正相关 [AER (mg/24 h) = 3.1893 + 0.01141 x sNGAL (ng/ml)；r = 0.51；p = 0.014]，uNGAL 与 AER 之间也存在正相关 [AER (mg/24 h) = 8.7538 + 0.01032 x uNGAL (ng/ml)；r = 0.51；p = 0.016]。sNGAL 和 uNGAL 之间以及 GFR 和 HbA1c 之间没有关系。正常范围白蛋白尿并不能排除定义为 sNGAL 和 uNGAL 浓度增加的糖尿病肾病。NGAL 测量可能比 MA 更敏感，并可能成为评估糖尿病儿童肾脏受累的有用工具。
