A Study of the Risk Factors and Urinary Podocin as an Early Prognostic Indicator of Renal Injury in Diabetic Nephropathy.

BACKGROUND: The development of diabetic nephropathy demands an early detection aiming to decrease the incidence of end stage renal incidence. Podocyte injury is an essential element in the diabetic renal disease occurrence and progression. We attempted to identify podocyte markers in the urine of patients with and without overt diabetic nephropathy, in comparison with controls to diagnose early podocyte injury. METHODS: The study included Type 2 Diabetic individuals with 45 of them having normoalbuminuria, 40 patients with microalbuminuria and 40 of them with macroalbuminuria (based on the albumin-creatinine ratio - ACR) and 45 non diabetic healthy controls from a medical college hospital from South India. Urinary podocin quantification was done among all these patients and compared among the different groups of study, along with other parameters. RESULTS: The fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, all seemed to be strong risk factors for the diabetic kidney disease progression showing a significant correlation with microalbumin, glomerular filtration rate and urine albumin-creatinine ratio. Podocin was excreted in the urine at higher concentrations among patients with ACR less than 30, ACR 30-299 and ACR more than 300 compared to healthy controls respectively (p < 0.001). The glomerular filtration rate showed significant negative correlation with the levels of podocin excreted in urine whereas urinary podocin positively correlated with the fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, microalbumin and urine albumin-creatinine ratio. CONCLUSION: The urinary podocin can serve as an early marker for diabetic nephropathy as well as a marker of disease progression and severity among the patients with Type 2 Diabetes. The standard risk factors have to be identified early and controlled inorder to slow down the progression of diabetic kidney disease.

A Study of Association of Urinary Nephrin with Albuminuria in Patients with Diabetic Nephropathy.

BACKGROUND AND AIMS: Diabetes mellitus and its complications are associated with high mortality and morbidity. Early detection is mandatory to improve quality of life years in patients with diabetic nephropathy. Hyperglycaemia disrupts podocytes, both structurally and functionally, leading to excretion of nephrin which is present in the glomerular filtration barrier. This study was undertaken to find out whether urinary nephrin is a better indicator of podocyte injury than albuminuria in patients with diabetic nephropathy. METHODS: The study included 125 type 2 diabetes mellitus patients as cases categorized into three groups, depending upon albumin excretion. Age and sex matched 45 individuals without diabetes mellitus were chosen as the control group. The study protocol was approved by Institutional Ethics committee. Microalbumin was estimated by immunoturbidometry and urinary nephrin by ELISA. ANOVA and Tukey post-hoc tests were done to compare the data between the groups. Correlation studies were done. Odds ratio for nephrin was calculated. P value less than 0.05 was considered statistically significant. The statistical analyses were performed with SPSS software version 13.0. RESULTS: The urinary nephrin was found to be proportionately increased from normoalbuminuria to macroalbuminuria and it was statistically significant, with sensitivity of 92.5% and specificity of 76.7%, the cut-off value of urinary nephrin was 97.5ng/mL. CONCLUSION: Albuminuria has been used as an independent predictor of diabetic nephropathy. The statistical significant difference between the groups inferred that urinary nephrin excretion increased even in the stage of normoalbuminuria. Nephrin expression and its phosphorylation get altered by hyperglycaemia, contributing to renal damage. Nephrin was found to be a sensitive marker of early kidney dysfunction in diabetic patients.