الفهرس 
Diabetic Kidney Disease
Calculation of ResultsOnly 14 pages are availabe for public view
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Abstract
Background Diabetic nephropathy (DN) is considered one of the major microvascular complications of diabetes and has become the most common single cause of end-stage renal disease (ESRD). Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. In clinical practice, estimated glomerular filtration rate (eGFR) and albuminuria are used to assess renal function. New evidence show that activated innate immunity and inflammation are relevant factors in the pathogenesis of diabetes and play a critical role in the development of microvascular diabetic complications. Aim of the work This study aimed to determine urine concentration of TNF-α receptor-1 (sTNFR1) in Egyptian patients with type 2 diabetes mellitus (DM) and correlate it to the changes in the glomerular filtration rate (GFR) and its possible use as predictor of early stage of diabetic nephropathy. Subjects and Methods This study was conducted on seventy two individuals attending the outpatient clinic of National Institute of Diabetes and Endocrinology. The patients were classified into two groups. group I: included thirty seven patients with type 2 DM and normal estimated glomerular filtration rate (eGFR) (≥ 60 ml/min/1.73 m2). group II: included thirty five patients with type 2 DM and decreased eGFR (≤ 60 ml/min/1.73 m2). For each patient body mass index and estimated glomerular filtration rate were calculated. Laboratory investigations included fasting blood sugar, glycosylated hemoglobin (HbA1c), renal function tests, Lipid profile, albumin-creatinine ratio (ACR) and urinary TNFR1 (UTNFR1) was measured using a commercially available specific enzyme-linked immunosorbent (ELISA) assay. Results Patients having type 2 DM with decreased eGFR had higher levels of UTNFR1 than those with normal eGFR. UTNFR1 was also positively correlated with each of BUN, creatinine and ACR and inversely correlated with eGFR. Using the multiple ROC curve analysis for UTNFR1 and ACR to detect best cut off for detection of DN revealed that UTNFR1 at cut off > 3500 pg/ml has diagnostic sensitivity, specificity of 54.29 % and 100 % respectively. Additionally, binary logistic regression analysis was performed to determine the significant influence of different studied variables over eGFR as dependent factor. Although ACR, BMI and UTNFR1 were significantly different between two groups, binary logistic regression analysis revealed that UTNFR1 and BMI were significantly predictor of eGFR < 60 ml/min/1.73 m2 than ACR. Conclusion The study had demonstrated that UTNFR1 is significant predictor of eGFR ≤ 60 ml/min/1.73 m2 in patients with type 2 DM and it is specific marker of DN but it lack the sensitivity as early detecting marker of DN.