الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Although Diabetic Nephropathy (DN) has long been
considered a glomerular disease, tubulointerstitial injury
has also been demonstrated to play a role in the
pathogenesis. In this context, it is attractive to study
molecules that are linked to tubular dysfunction. These
molecules may serve as potential new markers for DN and
may also provide additional information about clinical
course or prognosis that may enable an earlier diagnosis
and means to better tailor the treatment.
Urinary liver-type fatty acid–binding protein (LFABP)
is mainly regarded as a urinary tubular biomarker
associated with structural and functional kidney damage.
Urinary levels of L-FABP are not influenced by its serum
levels because urinary L-FABP originates mainly from the
tubular cells. This biomarker is elevated in the early stages
of diabetes. Our results regarding prediction of DN
progression are due to the continuous increase in the LFABP
levels alongside the worsening of the nephropathy
stage. The pathophysiological role of this continuous
increase is not completely known but may mirror different
mechanisms across DN stages.
Our study was conducted on 90 patients were chosen
randomly from inpatient and outpatient clinic of internal
medicine,endocrinology department of Ain Shams
University and Kobre El Koba Military Hospitals. They
were 65 males and 35 females, their age ranged from 40-60
years.The studied cases were classified according to
albuminuria (Albumin\creatinine ratio) into 3 groups:
Group A: 30 patients with type 2 DM with
normoalbuminuria (Albumin\creatinine ratio ≤ 2.5mg /
mmol (men) or ≤3.5mg/mmol (women) in random urine
sample consists of 18 males and 12 females.
Group B: 30 patients with type 2 DM with
microalbuminuria (Albumin\ creatinine ratio >2.5mg/mmol
(men) or >3.5mg/mmol (women) consists of 18 males and
12 females.
Group C: 30 patients with type 2 DM with
macroalbuminuria (Albumin\ creatinine ratio > 30mg/mmol
consists of 19 males and 11 females.
All subjects will be subjected to the following:
Full history taking, thorough clinical examination,
laboratory investigations including: Fasting plasma glucose
level (mg/dl), 2- hours post prandial plasma glucose level
(mg/dl), glycatedhaemoglobin (HbA1c%), Albumin/
creatinine ratio (mg/mmol) in random urine sample and
urinary L- FABP level (μg/g creatinine) by ELISA.
Aim of this work to evaluate the relationship
between urinary L-FABP and the severity of Diabetic
nephropathy in type 2 DM.The results were statistically analyzed and we
observed the following:
On comparing between the three studied groups:
There was high statistical significant difference
between studied groups regarding duration of diabetes,
systolic blood pressure, fasting blood glucose, 2 hours post
prandial blood glucose, glycatedhaemoglobin, Albumin
creatinine ratio and Urinary liver-type fatty acid–binding
protein (P<0.01).
Our result showed a highly significant positive
correlation between L-FABP and fasting blood glucose
(FBG) (r=0.531), 2 hours post prandial blood glucose (PPBG)
(r=0.525), glycatedhaemoglobin (HbA1c%) (r=0.601) and
Albumin creatinine ratio (ACR) (r=0.855) (P<0.01).
Our result showed L-FABP cut point was 8.1 if LFABP
>8.1 the patient could be classified with
microalbuminuria or macroalbuminuria with sensitivity
71.7 if <8.1 classified normoalbuminuria with specificity
100% with accuracy 88.7%.
In conclusion, our study showed the level of urinary
L-FABP accurately reflected the severity of diabetic
nephropathy and was significantly higher in the patients
with type 2 diabetes who had normoalbuminuria. Urinary
L-FABP was a risk factor for progression of diabetic
nephropathy. Therefore, urinary L-FABP appears to be a
useful marker for the detection of early-stage diabetic
nephropathy and for the prediction of the progression of
diabetic nephropathy.