de Carvalho José Antonio M, Tatsch Etiane, Hausen Bruna S, Bollick Yãnaí S, Moretto Maria B, Duarte Thiago, Duarte Marta M M F, Londero Sílvia W K, Premaor Melissa O, Comim Fabio V, Delanghe Joris R, Moresco Rafael N
Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil; University Hospital, Santa Maria, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil; Pharmaceutical Sciences Postgraduate Program, Center of Health Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
Clin Biochem. 2016 Feb;49(3):232-6. doi: 10.1016/j.clinbiochem.2015.10.016. Epub 2015 Oct 27.
Renal dysfunction has been reported in normoalbuminuric patients, demonstrating the necessity to improve the diagnostic and prognostic tools for diabetic kidney disease (DKD) investigation. Therefore, the aim of this study was to investigate whether the urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) are increased in type 2 diabetes mellitus (DM) patients with normal or mildly increased albuminuria.
In this study, 117 type 2 DM patients classified into three groups according to urinary albumin/creatinine ratio (uACR): uACR<10mg/g creatinine, uACR 10-30mg/g creatinine and uACR>30mg/g creatinine were enrolled. Urinary concentrations of KIM-1 (uKIM-1) and NGAL (uNGAL) were measured.
uKIM-1 levels increased progressively from uACR<10mg/g creatinine (69.0±20.8pg/ml) to uACR 10-30mg/g creatinine (106.1±41.2pg/ml) and to uACR>30mg/g creatinine (166.0±31.9pg/ml) (P<0.001). In addition, uNGAL levels increased progressively from uACR<10mg/g creatinine (29.5±8.8ng/ml) to uACR 10-30mg/g creatinine (51.7±10.9ng/ml) and to uACR>30mg/g creatinine (71.0±9.6ng/ml) (P<0.001) patients. Similarly, both uKIM-1 and uNGAL adjusted by urinary creatinine were increased in patients with uACR 10-30mg/g creatinine. Significant and positive correlations were observed between uACR, uKIM-1 and uNGAL.
uKIM-1 and uNGAL were increased in type 2 DM patients with normal or mildly increased albuminuria, which indicates that tubular and glomerular injuries may be occurring even at the earliest stage of DKD.
已有报道称正常白蛋白尿患者存在肾功能障碍，这表明有必要改进糖尿病肾病（DKD）研究的诊断和预后工具。因此，本研究的目的是调查在白蛋白尿正常或轻度升高的2型糖尿病（DM）患者中，中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤分子-1（KIM-1）的尿水平是否升高。
在本研究中，根据尿白蛋白/肌酐比值（uACR）将117例2型DM患者分为三组：uACR<10mg/g肌酐、uACR 10 - 30mg/g肌酐和uACR>30mg/g肌酐，并纳入研究。测量尿中KIM-1（uKIM-1）和NGAL（uNGAL）的浓度。
uKIM-1水平从uACR<10mg/g肌酐（69.0±20.8pg/ml）逐渐升高至uACR 10 - 30mg/g肌酐（106.1±41.2pg/ml），再到uACR>30mg/g肌酐（166.0±31.9pg/ml）（P<0.001）。此外，uNGAL水平从uACR<10mg/g肌酐（29.5±8.8ng/ml）逐渐升高至uACR 10 - 30mg/g肌酐（51.7±10.9ng/ml），再到uACR>30mg/g肌酐（71.0±9.6ng/ml）（P<0.001）。同样，在uACR 10 - 30mg/g肌酐的患者中，经尿肌酐校正的uKIM-1和uNGAL均升高。uACR、uKIM-1和uNGAL之间存在显著正相关。
在白蛋白尿正常或轻度升高的2型DM患者中，uKIM-1和uNGAL升高，这表明即使在DKD的最早阶段，肾小管和肾小球损伤可能已经发生。
