Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy

Abstract

Introduction:Diabetes mellitus (DM) is a major cause of concern because of its increasing prevalence rate and related microvascular as well as macrovascular complications, including kidney disease. Microalbuminuria has been accepted as the earliest marker for diabetic nephropathy; however, a large proportion of renal impairment occurs in nonalbuminuric state. We planned to investigate the serum and urinary levels of the tubular damage markers (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C [Cys C]) in patients of type 2 diabetes to detect early kidney injury.Materials and Methods:This cross-sectional hospital-based study included 180 patients with type 2 DM according to the American Diabetes Association criteria. Serum NGAL (S.NGAL) and urine NGAL (U.NGAL) and Cys C were measured in all study participants and investigated for correlation with microalbuminuria.Results:Our results showed that U.NGAL and S.NGAL levels were significantly high in patients with microalbuminuria as compared to normoalbuminuric controls. Serum Cys C was also higher in microalbuminuric patients than who had normoalbuminuria. A positive correlation of urinary albumin excretion with S.NGAL and U.NGAL was noted. U.NGAL also showed positive correlation with duration of diabetes, glycated hemoglobin, and dyslipidemia. Receiver operating characteristic curve analysis showed that the area under the curve for U.NGAL and S.NGAL were 1 and 0.8, respectively, which indicates that they are sensitive markers for early renal damage.Conclusion:Urinary biomarkers were significantly elevated in normoalbuminuric type 2 diabetic patients compared with nondiabetic controls and could be used as markers of nephropathy at a very early stage even before the development of microalbuminuria, the current gold standard for early diagnosis. Despite the promise of these new biomarkers, further large, multicenter prospective studies are still needed.

miR-30c-5p Reduces Renal Ischemia-Reperfusion Involving Macrophage

“…Serum Cr is a widely accepted biomarker of kidney injury or kidney toxicity and is used as one indicator to evaluate kidney function in clinical practice [19]. NGAL, a kidney tubular damage marker, is significantly high in type 2 diabetes patients with kidney injury and is a sensitive marker for kidney injury [20]. In our study, renal I/R decreased kidney function and damaged the kidney (Figure 1).…”

Diagnostic value of VDBP and miR‑155‑5p in diabetic nephropathy and the correlation with urinary microalbumin

“…Cys C, as an endogenous indicator, can freely filter through glomerulus and be reabsorbed and degraded in proximal convoluted tubules. Cys C is very sensitive to the early function of glomerulus and is also a sensitive indicator reflecting glomerular filtration function ( 20 ). However, 24-h proteinuria is one of the important indicators for judging glomerular function.…”

Evaluation of early biomarkers of renal dysfunction in diabetic patients

“… 20 - 23 For example, in a recent cohort study of 146 Chinese T2DM patients, with a disease duration ≥6 years, uNGAL was higher in T2DM patients with a normal ACR, 23 which like our finding supports the use of uNGAL as a marker of early detection of nephropathy before the development of moderately increased albuminuria. 22 The rise of uNGAL in normal albuminuria patients might indicate early glomerular and tubular injuries; therefore, uNGAL can act as a novel biomarker for renal impairment. Conversely, another explanation could be that uNGAL is a specific biomarker for hyperglycemia without kidney injury; however, this would require further experiments to determine.…”