الفهرس 
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Abstract
Diabetic nephropathy is one of the most serious complications of diabetes and the appearance of pathological levels of urinary albumin excretion represents the most reliable diagnostic test of early renal involvement in patients affected by diabetes mellitus.
Liver-type fatty acid-binding protein (L-FABP) is expressed in the proximal tubules of the human kidney and participates in fatty acid metabolism. In one clinical study , urinary excretion of L-FABP was reported to offer potential as a clinical marker to screen for kidney dysfunction and thereby identify patients who are likely to experience deterioration of renal function in the future.
Tubular hypoxia upregulated the expression of the L-FABP gene in the kidney and increased the urinary excretion of L-FABP from the proximal tubules. Thus, in early-stage diabetic nephropathy, it is possible that chronic hypoxia could have induced an increase in urinary excretion of L-FABP.
The current study aimed to evaluate the urinary L-FABP level as an early biomarker of diabetic nephropathy in type 2 diabetic patients.
This work performed on 60 patients with diabetes mellitus type 2 and 20 apparently healthy subjects working as control.
Patients were further classified according to their microalbumin/creatinine ratio into three groups: group I; normoalbuminuric diabetic, group II; microalbuminuric diabetic group and group III; diabetics with overt proteinuria.
Candidates of the present study were subjected to clinical evaluation and determination of fasting blood sugar, serum creatinine, HbA1c, lipid profile, albumin creatinine ratio and urinary L-FABP.
The results of the present work showed that:-
• The duration of diabetes in diabetic patients with macroalbuminuria was statistically significant longer than in both normoalbuminuric and microalbuminuric diabetic patients. Patients with microalbuminuria was statistically significant longer than in normoalbuminuric diabetic patients.
• Fasting blood sugar and HbA1c was significantly higher in patients with advanced stage of diabetic nephropathy (macroalbuminuric diabetic patients) compared to normoalbuminuric diabetic patients and microalbuminuric diabetic patients.
• A significant increase of serum T.cholesterol, triglecyride, LDL-C in diabetic patients with macroalbuminuria compared to normoalbuminuric diabetic patients and microalbuminuric diabetic patients.
• A significant increase of serum creatinine in diabetic patients with macroalbuminuria compared to normoalbuminuric diabetic patients and microalbuminuric diabetic patients.
• Urinary microalbumin was significantly higher in microalbuminuric diabetic group and macroalbuminuric diabetic group compared to normoalbuminuric diabetic group and in diabetic patients with macroalbuminuria was significantly higher in diabetic patients with microalbuminuria.
• A significant increase of ACR in diabetic patients with microalbuminuria and diabetic patients with macroalbuminuria compared to the normoalbuminuric diabetic group.
• A significant increase of urinary L-FABP level in in diabetic patients with macroalbuminuria compared to normoalbuminuric diabetic patients and microalbuminuric diabetic patients.
• A significant increase of urinary L-FABP level in microalbuminuric diabetic patients compared to normoalbuminuric diabetic patients and in normoalbuminuric diabetic patients compared to control subjects.
• A significant positive correlation between urinary L-FABP level with the duration of diabetes, fasting blood glucose, HbA1c, triglyceride and ACR. Urinary L-FABP level values showed a significant negative correlation with HDL-C.
Conclusion:
The current study found that the level of urinary L-FABP accurately reflected the severity of diabetic nephropathy.
In addition to urinary albumin, the measurement of L-FABP in urine provides a suitable biomarker for the early detection of diabetic nephropathy.