Early markers of nephropathy in patients with type 2 diabetes mellitus

الملخص EN

Aim : To identify early markers of nephropathy in Egyptian patients with type 2 diabetes mellitus, for both genders.

Subjects : The study included 48 type-2 diabetic (DM-2) patients divided into three groups : normotensive ("DM" ; 15 patients : 7 males, 8 females), hypertensive ("HTN" 16 patients : 9 males, 7 females) and hypertensive with nephropathy ("DN"' ; 17 patients : 7 males, 10 females) together with 16 healthy control subjects (8 males, 8 females).

Methods : Glycated hemoglobin (HbAlc), serum cystatin-C, transforming growth factor-fi'j (TGF-fij), lipid profile, and/or urinary N-acetyl-fi-D-glucosamidase (NAG-fi) were evaluated as potential markers of nephropathy, used individually or combined.

Tiiey were compared and correlated, in both genders, to the well known renal function parameters; serum creatinine (s.

Cr), urine creatinine (u.

Cr), creatinine clearance (Cra), microalbuminuria (MA) and albumin/creatinine ratio (ACR), as well as glomerular filtration rate (GFR) determined by 2 formulas,.

Results : In the DN group s.Cr, Cra, NAG-fi, MA, cystatin-C, triglycerides (TG), and ACR were significantly altered compared to the other three groups.

These parameters were chosen to construct different equations for the early detection of nephropathy.

Receiver operating characteristic (ROC) curve analysis revealed that a model formula from combined 3 parameters (CTP) : (200 /(ACR + s.

Cr + TG mmol / L)) showed a higher diagnostic accuracy for the detection of renal dysfunction tfian Cra GFR or any single parameter.

The odds ratio (OR) for developing nephropathy in patients with CTP < 60 were found to be 42.5 for total patients, 38 for males and 45 for females, with a sensitivity of 83.3 %, 85 % and 100 %, and specificity of 94 %, 100 % and 90 % respectively.

Conclusion : The use of the simple formula "CTP" {200 / (ACR + s.

Cr + TG mmol / L)} with a cutoff value of60 is potentially a better marker for detecting impaired renal function in total and female diabetic patients, but GFR formula, depending on cystatin-Q is slightly a better marker for male patients.