دور بعض المؤشرات الالتهابية المختارة في البول وبروتينات خلية البودوسايت عند مرضى اعتلال الكلية السكري == The Role Of Selected Urinary Inflammatory Markers On Podocyte In Type 2 Diabetic Nephropathy
Author name:
داليا محمود خلف
Supervisor name:
رفيف صبيح الشوك | عصام نوري الكروي
General topic:
Medicine
Specific topic:
Microbiology
Degree:
Master
University:
Mustansiriyah University
Language:
English
University location:
Baghdad
First pages:
19T1137 - p.pdf
Abstract:
اعتلال الكلية السكري هو السبب الرئيسي للمرض الكلوي المزمن وويرتبط ذلك مع زيادة وفيات مرضى القلب والاوعية الدموية. التعريف الكلاسيكي لاعتلال الكلية السكري هو زيادة افراز البروتين في البول. وتتميز المرحلة المبكرة للمرض عن طريق زيادة صغيرة في افراز الزلا | Diabetic nephropathy (DN) is the leading cause of chronic renal disease. It is associated with increased cardiovascular mortality. The DN has been classically defined as increased protein excretion in urine. Early stage is characterized by a small increase in urinary albumin excretion (UAE), also called microalbuminuria or incipient DN. More advanced disease is defined by the presence of macroalbuminuria or proteinuria. The latter is classically named overt DN.This study was planned with the aim of evaluate the levels of urinary Monocyte Chemoattractant Protein - 1(MCP - 1), interleukin (IL - 18), Osteopontin and Nephrin at diabetic nephropathy and its correlation with the parameters in Iraqi type 2 diabetic subjects and to explore the impact of albuminuria and duration of the diabetes on fine glomerular architecture using podocyte injury related marker (Nephrin) in urine. This may explore the more specific, and sensitive early biomarkers for nephropathy in diabetic patients and could help the physicians in controlling the occurrence of renal failure.Sixty Iraqi type 2 diabetes mellitus patients attending the National Diabetes Center for Treatment and Research at Al - Mustansiriyah University during the period October 2014 - June 2017 were recruited for this study. For the purpose of comparison, 20 control subjects matched for age, gender and ethnic background were also included. The patients and controls were characterized in family history of diabetes, diabetic nephropathy groups divide by used Albumin to creatinine ratio. The patients were also assessed for duration of disease, fasting serum glucose, and serum creatinine and blood urea.The mean urinary level of MCP - 1 (15.38±15.50 vs. 6.10±7.23pg/ml) and IL - 18 (35.90±16.67 vs. 23.55±12.67pg/ml) and osteopontin (337.15±257.06 vs. 174.11±183.65ng/ml) and nephrin (100.01±88.66 vs. 52.23±19.61ng/ml) were significantly higher in T2DM patients as compared to controls.The mean levels of urinary MCP - 1, uIL - 18 and osteopontin in macroalbuminurea group of patients were significantly higher than those in normoalbumine ( p < 0.008, p< 0.0001 and p< 0.03 respectively), and only of the Nephrin in the normoalbuminurea group of patients showed significant increased level as compared to the controls (52.23±19.61 vs.75.05±37.8 ng/ml) (p<0.022).The duration of disease showed an increase in mean of urinary level for all the markers MCP - 1, IL - 18, osteopontin and nephrin (17.01±18.09 vs. 19.76±21.30 pg/ml, 29.24±15.98 vs. 42.98±17.25pg/ml, 321.1±291.05 vs. 409.05±210.0ng/ml, 99.40±48.40 vs. 79.21±44.23 ng/ml) respectively, in late duration of disease as compared with early duration of disease except in Nephrin showed the early duration of disease higher than the late duration of disease (99.40±48.40 vs. 79.21±44.23), although the differences were not significant.The Receiver operating characteristic (ROC) curve analysis for all markers MCP - 1, IL - 18, Osteopontin and Nephrin levels (MCP - 1 = 0.72, IL - 18 = 0.71, Osteopontin =0.70 and Nephrin =0.72) for early diagnosis and detection of DN revealed that the cut - off value of uMCP - 1 was 6.23 pg/mg with 70% sensitivity and 75% specificity; whereas, the cut - off value of u IL - 18 pg/ml was 23.69 ng/mg with 80% sensitivity and 59% specificity and Nephrin was 49.5 ng/ml with 78% sensitivity and 55% specificity. uOsteopontin was 182 ng /ml with 68% sensitivity and 69% specificity.The linear correlation revealed a significant positive linear correlation between urinary MCP - 1, IL - 18, Nephrin and A : C ratio, also showed a significant negative linear correlation between urinary MCP - 1, IL - 18, osteopontin and GFR.In conclusion the Nephrin may be considered as potential diagnostic and prognostic biomarker a for the early detection and progression of diabetic nephropathy while the uMCP - 1, uIL - 18 and uOsteopontine may be considered as potential prognostic biomarkers for the diabetic nephropathy. The duration of disease also affect investigated biomarkers suggesting the long term effect of hyperglycemia
