St. Queen Jadwiga Clinical District Hospital No. 2, 35-301 Rzeszów, Poland.
Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland.
Mediators Inflamm. 2018 Aug 9;2018:7659243. doi: 10.1155/2018/7659243. eCollection 2018.
Diabetic kidney disease develops in half of genetically predisposed patients with type 2 diabetes (T2DM). Early diagnosis of kidney damage and nephroprotective treatment are the ways of preventing the disease progression. Our aim was to evaluate selected laboratory markers of glomerular and tubular damage in T2DM patients with early stages of chronic kidney disease (G1/G2, A1/A2) for their associations with A2 albuminuria and early decline in the estimated glomerular filtration rate (eGFR). Among 80 T2DM patients with median eGFR of 92.4 ml/min/1.73 m and median urinary albumin to creatinine ratio (uACR) of 4.69 mg/g, 19 had uACR > 30 mg/g (A2). Higher serum cystatin C, serum and urine neutrophil gelatinase associated lipocalin (NGAL), urine kidney injury molecule 1 (KIM-1), detectable urine transferrin and IgG, and lower serum uromodulin significantly predicted A2 albuminuria, urine KIM-1/creatinine ratio, and IgG being the best predictors. Albuminuria, urine NGAL/creatinine, and IgG correlated with diabetes duration. Albuminuria, urine NGAL, transferrin, IgG, and uromodulin correlated with diabetes control. In a subgroup of 29 patients, retrospective data were available on changes in eGFR and uACR over one year. Decline in eGFR was observed in 17 patients and increase in uACR in 10 patients. Serum and urine NGAL correlated with eGFR changes. Higher urine NGAL, KIM-1/creatinine ratio, and detectable IgG were significantly associated with the increase in uACR. Widely available markers, serum cystatin C, urine IgG, transferrin, and NGAL, may help in early assessment of kidney disease in T2DM patients; however, large prospective studies are needed to confirm the conclusion.
在 2 型糖尿病（T2DM）患者中，有一半的遗传易感性患者会发展为糖尿病肾病。早期诊断肾脏损伤和肾保护治疗是预防疾病进展的方法。我们的目的是评估 T2DM 患者早期慢性肾脏病（G1/G2，A1/A2）肾小球和肾小管损伤的选定实验室标志物与 A2 白蛋白尿和估计肾小球滤过率（eGFR）的早期下降之间的相关性。在 80 名 T2DM 患者中，中位 eGFR 为 92.4ml/min/1.73m，中位尿白蛋白与肌酐比值（uACR）为 4.69mg/g，其中 19 名患者的 uACR＞30mg/g（A2）。较高的血清胱抑素 C、血清和尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、尿肾损伤分子 1（KIM-1）、可检测的尿转铁蛋白和 IgG，以及较低的血清尿调蛋白显著预测 A2 白蛋白尿、尿 KIM-1/肌酐比值和 IgG 是最佳预测因子。白蛋白尿、尿 NGAL/肌酐和 IgG 与糖尿病病程相关。白蛋白尿、尿 NGAL、转铁蛋白、IgG 和尿调蛋白与糖尿病控制相关。在 29 名患者的亚组中，一年来 eGFR 和 uACR 的变化有回顾性数据。在 17 名患者中观察到 eGFR 下降，在 10 名患者中观察到 uACR 增加。血清和尿 NGAL 与 eGFR 变化相关。较高的尿 NGAL、KIM-1/肌酐比值和可检测到的 IgG 与 uACR 的增加显著相关。广泛可用的标志物，如血清胱抑素 C、尿 IgG、转铁蛋白和 NGAL，可能有助于早期评估 T2DM 患者的肾脏疾病；然而，需要进行大型前瞻性研究来证实这一结论。
