Sat-154 Clinical Utility of Seric Metformin Levels in Lactic Acidosis

Abstract

Introduction: Diabetic nephropathy (DN) is a major complication of diabetes Mellitus. Early detection of DN and interventional methods can slow its progression and improves patients' outcome. Albuminuria has been accepted as the earliest marker for DN development. Serum and urine Neutrophil Gelatinase-Associated Lipocalin (sNGAL, uNGAL) as a marker of tubular damage might become useful biomarker for early detection of renal involvement in diabetic patients. The aim of this study is to assess the relationship between the serum and urine levels of NGAL and disease severity in patients with type 2 diabetes mellitus. Methods: In the present cross sectional study we evaluated the levels of NGAL in serum and urine in 148 patients with type 2 diabetes mellitus categorized into three groups (50 diabetics with normoalbuminuria, 58 diabetics with microalbuminuria and 40 diabetics with macroalbuminuria) and 50 control subjects. Results: All diabetics with albuminuria showed increased sNGAL values with respect to normoalbuminurics and control individuals (P<0.01). Serum NGAL increased in parallel with the severity of renal disease, approaching the highest levels in patients with overt diabetic nephropathy. The best cut-off point of sNGAL for macroalbuminuric state was 225.8 ng/ml with a specificity of 74 % and sensitivity of 70%. Urine NGAL showed significantly elevated level only in diabetics with macroalbuminuria compared to other diabetics and control subjects (P¼0.06). The best cut off point of uNGAL for macroalbuminuric state was 71.4 ng/ml with a sensitivity of 60% and specificity of 72%. Conclusions: Serum NGAL increases in diabetic patients with the appearance of albumin in urine, so that its level clearly correlates with severity of DN, while uNGAL increment is observed only in overt albuminuria. Furthermore Serum and urine NGAL measurement could be a useful, noninvasive, easily available test for the evaluation of renal involvement in the course of diabetes.