Varatharajan Sakthivadivel, Jain Vishakha, Pyati Anand K, Neeradi Charan, Reddy Kotha Sugunakar, Pallavali Janardhana Reddy, Pandiyaraj Ilakkiya Priya, Gaur Archana
Department of General Medicine, All India Institute of Medical Sciences-Bibinagar, Hyderabad 508126, Telangana, India.
Department of Biochemistry, All India Institute of Medical Sciences-Bibinagar, Hyderabad 508126, Telangana, India.
World J Nephrol. 2024 Dec 25;13(4):98880. doi: 10.5527/wjn.v13.i4.98880.
Globally, diabetic nephropathy (DN) is the primary cause of chronic kidney disease. Currently, renal function is monitored indirectly using measures of serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria. Novel urinary biomarkers utilized in the early stages of DN have been described; these indicators can be used in the early identification of the disease, which is important for initiating treatment to halt or impediment the advance of diabetic nephropathy.
To estimate neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and periostin (POSTN) levels as novel urinary biomarkers in DN.
In this hospital based cross-sectional study, a total of 160 patients of both genders aged 18 years or more; 40 healthy participants and 120 patients with diabetes mellitus (DM) were included. Patients with DM were divided into normoalbuminuria ( = 40), microalbuminuria ( = 40), and macroalbuminuria ( = 40) groups as per urine albumin creatinine ratio (uACR). Blood urea, serum creatinine, uACR were measured. Urine NGAL, KIM-1, and POSTN were measured by enzyme linked immunosorbent assay. The eGFR was calculated and compared with urinary markers.
NGAL, KIM-1, and POSTN levels increased significantly in normo, micro, and macroalbuminuria with the highest in the macroalbuminuria group. Albumin creatinine ratio (ACR) showed a positive correlation with NGAL, KIM-1, and POSTN levels. The eGFR showed a weak negative correlation with ACR, NGAL, KIM-1, and POSTN. NGAL was significantly lower in stage 1 compared to stage 2, 3, and 4 kidney disease. KIM-1 was significantly decreased in stage 1 compared to stage 4 kidney disease. POSTN was significantly decreased in stage 1 compared to stage 3 and 4 kidney disease. The receiver operator curve analysis of ACR, NGAL, KIM-1, and POSTN showed good sensitivity of 80%, 75.8%, 63.3%, and 80 % respectively with a cut-off of 12.5 mg/g, 4.5 μg/L, 1.5 ng/mL, and 37.5 ng/mL.
Urinary NGAL and POSTN are independent markers of DN.
在全球范围内，糖尿病肾病（DN）是慢性肾脏病的主要病因。目前，通过血清肌酐、估算肾小球滤过率（eGFR）和蛋白尿指标间接监测肾功能。已有文献报道了在DN早期阶段使用的新型尿液生物标志物；这些指标可用于疾病的早期识别，这对于启动治疗以阻止或延缓糖尿病肾病的进展非常重要。
评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）和骨膜蛋白（POSTN）水平作为DN新型尿液生物标志物的情况。
在这项基于医院的横断面研究中，共纳入160名年龄在18岁及以上的男女患者；包括40名健康参与者和120名糖尿病（DM）患者。根据尿白蛋白肌酐比值（uACR）将DM患者分为正常白蛋白尿组（n = 40）、微量白蛋白尿组（n = 40）和大量白蛋白尿组（n = 40）。检测血尿素、血清肌酐、uACR。采用酶联免疫吸附测定法检测尿液NGAL、KIM-1和POSTN。计算eGFR并与尿液标志物进行比较。
正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组中NGAL、KIM-1和POSTN水平显著升高，大量白蛋白尿组最高。白蛋白肌酐比值（ACR）与NGAL、KIM-1和POSTN水平呈正相关。eGFR与ACR、NGAL、KIM-1和POSTN呈弱负相关。与2、3和4期肾病相比，1期肾病患者的NGAL显著降低。与4期肾病相比，1期肾病患者的KIM-1显著降低。与3期和4期肾病相比，1期肾病患者的POSTN显著降低。ACR、NGAL、KIM-1和POSTN的受试者工作特征曲线分析显示，截断值分别为12.5 mg/g、4.5 μg/L、1.5 ng/mL和37.5 ng/mL时，敏感性分别为80%、75.8%、63.3%和80%。
尿液NGAL和POSTN是DN的独立标志物。
