Urinary nephrin is earlier, more sensitive and specific marker of diabetic nephropathy than microalbuminuria

Abstract

Summary Background Diabetic nephropathy (DN) is a leading cause of end-stage renal disease. Progressive damage and decline in the number of podocytes often occur in the early stages of DN. Thus, nephrin as a podocyte-specific protein may be regarded as a potential biomarker of early detection of DN. The aim of this study is to determine whether urinary nephrin is an earlier marker in DN than microalbuminuria and to test the significance of urinary nephrin as a marker for early detection of DN. Methods Our cross-sectional study included 90 patients with type 2 diabetes mellitus (T2DM), 30 patients with diagnosed DN and 60 patients without diagnosed DN. As a control group, we used 30 healthy subjects. All patients with T2DM were classified into three subgroups according to urinary microalbumin/creatinine ratio (UMCR): normoalbuminuric, microalbuminuric and macroalbuminuric patients. Nephrin in urine was measured by immunoenzyme assay, microalbumin with turbidimetric and creatinine with the photometric method. In blood sera, we measured a few standard biochemical parameters. Results Nephrinuria was found to be present in 100% of patients with T2DM and macroalbuminuria, in 88% with microalbuminuria, as well as 82% of patients with T2DM and normoalbuminuria. A concentration of urinary nephrin was significantly increased in all groups of subjects with T2DM compared to the control group (p<0.05). Nephrinuria correlated statistically negative with eGFR (r=-0.54). ROC analysis showed that nephrin has a total predicted probability of 96% in patients with DN. Conclusions Urinary nephrin is earlier, more specific and sensitive marker than microalbumin in early detection of DN.

Utility of Urinary Nephrin in Patients With and Without Diabetic Nephropathy and Its Correlation With Albuminuria

“…Another study also showed an association between biomarkers of podocyte damage like urinary nephrin and vascular endothelial growth factor with normoalbuminuria in patients with type 2 diabetes mellitus [ 10 ]. Urinary nephrin was found to be a sensitive and specific marker for diagnosing early diabetic nephropathy than microalbumin in another study [ 11 ].…”

Effects of Allicin on Pathophysiological Mechanisms during the Progression of Nephropathy Associated to Diabetes

“…In contrast, other studies report that the expression of nephrin is reduced [ 36 , 37 ]. Studies in patients showed that the urinary excretion of nephrin can be a good marker of kidney damage since nephrinuria occurs even without albuminuria [ 40 , 41 ]. We hypothesize that the increase in the nephrin expression may represent a compensatory mechanism that allows restoring the nephrin loss through the urine, as our results showed.…”

Urinary Tubular Biomarkers As Predictors of Death in Critically Ill Patients with Covid-19

“…On the other hand, in this present study, biomarkers related to glomerular dysfunction such as urinary nephrin and MCP-1 had no association with mortality. Urinary MCP-1 and nephrin may be a proxy of glomerular impairment, which plays an important role in kidney diseases and has been studied in diverse scenarios [ 37 , 38 ]. The glomerular damage in COVID-19 is not common and has been described in patients with APOL1 genotypes, related to collapsing glomerulopathy in black patients [ 39 ].…”