Diagnostic performance of kidney injury molecule-1 for detection of abnormal urinary albumin-to-creatinine ratio in type 2 diabetes mellitus.

In this study, we aimed to investigate whether serum and urinary levels of kidney injury molecule 1 (KIM-1) are increased in type 2 diabetes mellitus (DM) patients with albuminuria. While the correlation of urinary KIM-1 with renal impairment has been well established, the association with serum KIM-1 has not yet been so well documented. The present pilot study included Egyptian patients with type 2 diabetes (T2D): A total of 84 patients with T2D (age 49-64 years; 20 men) were included in the analysis of the present study. They were divided into two groups according to Alb/Cr ratio: the first group included 32 patients (38.1%) with abnormal Alb/Cr ratio (38.6 mg/g·Cr), and the second group included 52 patients with normal Alb/Cr ratio (17.9 mg/g·Cr). Serum and urinary KIM-1 were measured using enzyme-linked immunoassays. There was a significant difference between both serum and urine KIM-1 and Alb/Cr ratio. Patients with abnormal Alb/Cr ratio had significantly higher serum and urinary KIM-1. These results yielded sensitivity (75.0%) and specificity (96.2%) regarding serum KIM-1 with a cut-off point of 37.5 pg/mL, and sensitivity (93.8%) and specificity (88.5%) regarding urinary KIM1 with a cut-off point of 32.00 ng/g.Cr. Serum KIM-1 and urinary KIM-1 were significantly correlated with eGFR and Alb/Cr ratio. In this pilot study, we found that urinary, serum, and urinary levels of KIM-1 are associated with significant impairments in renal function among diabetic patients. Our results also showed that serum and urine KIM-1 can be used as potential biomarkers for diabetic kidney disease.

Toll-like receptor 7 mRNA is reduced in hepatitis C-based liver cirrhosis and hepatocellular carcinoma, out-performs alpha-fetoprotein levels, and with age and serum aspartate aminotransferase is a new diagnostic index.

BACKGROUND: Hepatitis B and C viruses are leading causes of liver cirrhosis and hepatocellular carcinoma (HCC). Toll-like receptor 7 (TLR-7) has been implicated in the pathogenesis of HCC linked to hepatitis B. We hypothesised a role of leukocyte TLR-7 mRNA in hepatitis C related liver cirrhosis and HCC, using alpha-fetoprotein (AFP) and liver function tests as comparators. METHODS: We recruited 102 patients with HCV-related HCC, 97 with HCV-related liver cirrhosis and 60 healthy controls. Quantification of TLR-7 mRNA was performed using real-time PCR, AFP and routine LFTs by standard techniques. RESULTS: TLR-7 mRNA levels were significantly lower in HCC patients compared to cirrhotic patients and lower again in healthy controls (p < 0.001 for trend). In multivariate analysis, age, aspartate transaminase (AST), AFP, and TLR-7 mRNA were significant predictors of HCC. The ROCC/AUC for age, AST and TLR-7 mRNA were all between 0.64 and 0.78 (all P < 0.01), but for AFP was 0.57 (95% CI 0.48-0.65, P = 0.09). We derived an index score using age, AST and TLR-7 mRNA for the diagnosis of HCC. The ROCC/AUC for the index was superior to all three root indices in the prediction of HCC. The index linked significantly with the Tokyo and Vienna liver cancer staging systems, but not with those of the CLIP and Okuda systems, in distinguishing HCC from liver cirrhosis. CONCLUSION: The combination of TLR-7 mRNA levels with age and AST improves the performance of TLR-7 in HCC diagnosis, out-performs alpha-fetoprotein and predicts early HCC.