Microalbuminuria and Traditional Serum Biomarkers of Nephropathy among Diabetic Patients at Mbarara Regional Referral Hospital in South Western Uganda

Abstract

Background. Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Early detection of microalbuminuria is very important; it allows timely interventions to prevent progression to macroalbuminuria and later end-stage renal disease (ESRD). Objectives. To determine the prevalence of microalbuminuria in diabetic patients and establish its association with traditional serum renal markers in assessment of incipient nephropathy. Methods. This cross-sectional study involved 140 participants with diabetes mellitus (DM) attending the diabetic clinic of Mbarara Regional Referral Hospital. Questionnaires were used to obtain participant data after obtaining written informed consent. Data collected included: age, sex, level of education, history of smoking and alcohol consumption, hypertension, body mass index, family history, and duration of DM. Morning spot urine samples were collected from each participant and blood drawn for analysis of other renal markers. Urine microalbumin was determined quantitatively using immunoturbidity assay (Microalbumin kit, Mindray). Serum creatinine and uric acid and glucose levels were determined by spectrophotometric methods. Results. The overall prevalence of microalbuminuria was 22.9%. Using a simple and multiple linear regression model, serum creatinine (β=0.010, 95% CI (0.005, 0.014), P=0.0001) and glucose (β=0.030, 95% CI (0.011, 0.048), P=0.0017) levels were significantly associated with microalbuminuria. After adjusting for linearity, family history of DM was the only predictor of microalbuminuria (β=0.275, 95% CI (0.043, 0.508), P=0.002). Although microalbuminuria was weakly associated with eGFR (OR=1.2, 95% CI (0.24, 5.96)), the relationship was not statistically significant (P=0.824). Conclusion. The prevalence of microalbuminuria in patients with diabetes in this study was high. The study suggests the need to screen for microalbuminuria early to reduce the possible burden of ESRD. When serum creatinine is used as a renal function marker among diabetic patients, it should be combined with microalbuminuria for better assessment of incipient nephropathy.

Amelioration of neuropilin-1 and RAGE/matrix metalloproteinase-2 pathway-induced renal injury in diabetic rats by rosuvastatin

“…These results are strongly supported by a previously published report [40]. Similarly, the diminished level of serum microalbumin is a recognized early biomarker of DN [41,42]. We observed the reduction in plasma microalbumin level in DC rats that could be attributed to increased urinary microalbumin secretion under abnormal kidney functioning due to persistent hyperglycemia.…”

Sinensetin ameliorates high glucose‐induced diabetic nephropathy via enhancing autophagy in vitro and in vivo

“…Early‐stage DN is marked by microalbuminuria (MIC), which prevents the progression of renal dysfunction. [ 5 ] Podocytes injury has become increasingly recognized as a crucial early risk factor causing DN, [ 6 ] because a podocyte is a highly specialized and terminally differentiated epithelial cell located on the outer surface of the glomerular basement membrane (GBM) that plays a key role in preventing proteinuria. [ 6 ] High glucose (HG) could reduce the adhesion between podocytes and GBM, and podocytes fall off, making the GBM exposed, which in turn aggravates the progression of DN.…”

Clinical, Laboratory, Instrumental, Anamnestic Characteristics in Children With Type I Diabetes Mellitus and Early Stage of Diabetic Nephropathy

“…Microalbuminuria is an early component in a continuum of progressive increases in albumin excretion rates (AERs) that usually characterizes DN. 9 …”

“…Microalbuminuria is an early component in a continuum of progressive increases in albumin excretion rates (AERs) that usually characterizes DN. 9 Early prediction of DN based on microalbuminuria detection in complex with clinical, laboratory, instrumental, anamnestic examinations data specifically for T1D patients is important for risk stratification and T1D management. Common predictors across studies as well as across types of microvascular complications included age, gender, diabetes duration, BMI, blood pressure, lipid level, and mean or a single HbA1C value.…”