14875

Urinary Markers for Early Detection of Diabetic Nephropathy in Type 1 Diabetes Mellitus

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Last updated: 03 Jan 2025

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Abstract

     Background: diabetic nephropathy (DN) is a serious complication of diabetic mellitus associated with increased risk of morbidity and mortality. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney functions and improve patient outcomes. N-acetyl-β-d-glucosaminidase (NAG) is a lysosomal enzyme, present in high concentrations in renal proximal tubular cells, Gamma-glutamyltransferase (GGT) is an enzyme which located along the proximal tubular brush border,  Malondialdehyde (MDA) is a highly toxic product, formed in part by lipid oxidation derived free radicals, Reactive carbonyl derivatives (RCDS) is an oxidative stress marker in urine, as a measure of the oxidative modification of proteins and bete-2-microglobulin is filtered by the glomerulus, absorbed and catabolized by the proximal tubules.  The aim of this study is to investigate the urinary outcome of these markers as early detectors of diabetic nephropathy in type 1 diabetic children.     Subjects and methods: This case-control study included 67 children with type 1 diabetes mellitus (33 male; 34 female), age (11.03±1.05 years) and thirty one age (10.58±1.11 years) and sex (13 male; 18 female) matched healthy children (13 male; 18 female). Type 1 diabetic children were further subdivided into microalbuminuric and normoalbuminuric subgroups according to microalbuminuria concentration (30 mg/ g creatinine).  Age, sex, diabetic duration and the current daily insulin dose, and family history of diabetes, weight, height, body mass index, systolic and diastolic blood pressure were recorded. Fasting plasma glucose, glycated hemoglobin, blood urea nitrogen, plasma creatinine, urinary creatinine, micoalbumin,  N-acetyl-B-D glucosaminidase (NAG), Gama glutamyl transferase (GGT), Beta-2-microglobulin, Malondialdehyde (MDA) and Reactive carbonyl groups (RCDSS) were measured in all subjects.  Results: a significant increase in tubular injury markers of diabetes (NAG, GGT, beta-2-microglobulin) and oxidative stress parameters (MDA, RCDSS) as compared to control subjects was found.  Microalbuminuric subjects showed a significant elevatation in the urinary markers including NAG, GGT, beta-2-microglobulin, MDA, RCDSS as compared to normoalbuminuric subjects. The studied urinary tubular enzymes (NAG, GGT), oxidative stress markers (MDA, RCDSS) and Beta-2- microglobulin showed positive correlations with one another. Conclusion: The results of this study introduced the possibility of depending on tubular enzymes (NAG, GGT), oxidative stress markers (MDA, RCDSS) and β2 microglobulin as early, reliable, and sensitive predictors for diabetic nephropathy. The NAG activity index proved to be the most sensitive biomarker, then beta-2- microglobulin for early discovering the tubule cells damage.  

DOI

:10.12816/0018752

Keywords

Diabetic nephropathy- Micralbuminurea-Type 1 diabetic children- Glucose- N-acetyl-B-D glucosaminidase (NAG), Gama glutamyl transferase (GGT), Beta-2-microglobulin, Malondialdehyde (MDA) - Reactive carbonyl groups (RCDSS)

Authors

First Name

Shawkia S.

Last Name

Abd El-Halim

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Affiliation

Faculty of Art and Science – Qilwa – El-Baha University.

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First Name

Awatif M.

Last Name

Abd El-Maksoud

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Affiliation

Nutritional Requirements and Growth Department, National Nutrition Institute, Cairo

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Orcid

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First Name

Mohammed A.

Last Name

Abdel-Rahman

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Affiliation

Zoology Department, Faculty of Science, Suez Canal University, Ismailia

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First Name

El-sayed H.

Last Name

El-Tamany

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Affiliation

Chemistry Department, Faculty of Science, Suez Canal University, Ismailia

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Orcid

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First Name

Mohammed H.

Last Name

El-Hefnawy

MiddleName

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Affiliation

Pediatric Department, National Diabetes and Endocrinology Institute, Cairo, Egypt

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Orcid

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First Name

Amal H.

Last Name

Abd El-Razek

MiddleName

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Affiliation

Nutritional biochemistry Department, National Nutrition Institute, Cairo

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Volume

61

Article Issue

1

Related Issue

3110

Issue Date

2015-10-01

Receive Date

2018-09-26

Publish Date

2015-10-01

Page Start

479

Page End

488

Print ISSN

1687-2002

Online ISSN

2090-7125

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https://ejhm.journals.ekb.eg/article_14875.html

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https://ejhm.journals.ekb.eg/service?article_code=14875

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13

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Original Article

Type Code

606

Publication Type

Journal

Publication Title

The Egyptian Journal of Hospital Medicine

Publication Link

https://ejhm.journals.ekb.eg/

MainTitle

Urinary Markers for Early Detection of Diabetic Nephropathy in Type 1 Diabetes Mellitus

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Article

Created At

22 Jan 2023