A Study of the Risk Factors and Urinary Podocin as an Early Prognostic Indicator of Renal Injury in Diabetic Nephropathy.

BACKGROUND

The development of diabetic nephropathy demands an early detection aiming to decrease the incidence of end stage renal incidence. Podocyte injury is an essential element in the diabetic renal disease occurrence and progression. We attempted to identify podocyte markers in the urine of patients with and without overt diabetic nephropathy, in comparison with controls to diagnose early podocyte injury.

METHODS

The study included Type 2 Diabetic individuals with 45 of them having normoalbuminuria, 40 patients with microalbuminuria and 40 of them with macroalbuminuria (based on the albumin-creatinine ratio - ACR) and 45 non diabetic healthy controls from a medical college hospital from South India. Urinary podocin quantification was done among all these patients and compared among the different groups of study, along with other parameters.

RESULTS

The fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, all seemed to be strong risk factors for the diabetic kidney disease progression showing a significant correlation with microalbumin, glomerular filtration rate and urine albumin-creatinine ratio. Podocin was excreted in the urine at higher concentrations among patients with ACR less than 30, ACR 30-299 and ACR more than 300 compared to healthy controls respectively (p < 0.001). The glomerular filtration rate showed significant negative correlation with the levels of podocin excreted in urine whereas urinary podocin positively correlated with the fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, microalbumin and urine albumin-creatinine ratio.

CONCLUSION

The urinary podocin can serve as an early marker for diabetic nephropathy as well as a marker of disease progression and severity among the patients with Type 2 Diabetes. The standard risk factors have to be identified early and controlled inorder to slow down the progression of diabetic kidney disease.