الفهرس 
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Abstract
Nephropathy, a major complication of diabetes, is the leading cause of end-stage renal disease. Early identification of nephropathy in diabetes patients is crucial because it creates opportunity for preventing the incidence of DN and/or even slows down the process of end-stage renal disease attributed to diabetes. Human podocytes (Pods) have been demonstrated to be functionally and structurally injured in the natural history of diabetic nephropathy.
Injuries to podocytes are accompanied by characteristic morphologic changes, as observed in the electron microscopy, including vacuolization, loss of slit diaphragms, effacement of foot process, and detachment from GBM into urine space which is the most severely lesion of podocytes.
Because of the proximity of the apical region of Pods to the urinary space, pathological events occurring in this region are expected to be more easily detectable in urine than those occurring in the basal or slit diaphragm regions of Pods.
The number of podocytes per glomerulus reduced in diabetes patients with microalbuminuria and/or macroalbuminuria, Urinary podocytes have been detected in those two stages of diabetes patients.
Recent studies have demonstrated that podocytes detachment presented in diabetes patients with normoalbuminuria by electron microscopic morphometric analysis based on kidney biopsy.
These finds suggest that detached podocytes and their fragments (marked podocalyxin) might appear in urines of diabetes patients with normoalbuminuria, and podocalyxin-positive element (PCX + EL) might be a possible marker of early stage of nephropathy, but the role of it has remained obscure.
In Our study we aim to evaluate the possible association between the urinary podocalyxin levels and severity and grade of diabetic nephropathy and to use urinary podocalyxin as a non-invasive marker for early stage of diabetic nephropathy in type 2 DM.
We collect 60 known clinically and biochemically type 2 diabetic patients.20 diabetic patients with no evidence of diabetic nephropathy, 20 patients diagnosed as diabetic nephropathy in microalbuminuria stages and 20 patients diagnosed as diabetic nephropathy in macroalbuminuria stages from Ain Shams University hospitals between April and December 2018 and 20 apparently healthy volunteers will included as a control group. Inclusion criteria was age 30-50 years, known diabetic patients with nephropathy and exclusion criteria was age less than 30 or more than 50 years , other causes of nephropathy and end stage renal disease. All patients were subjected to full history taking, full clinical evaluation, serum creatinine, FBS, 2HrPP, HbA1C, albumin/creatinine ratio and urinary podocalyxin.
Our results show that urinary PCX was significantly higher in patients group compared to control group.
Urinary PCX was significantly higher in microalbuminuric group than in normoalbuminuric group and higher in macroalbuminuric group than in microalbuminuric group.
There was no significant correlation between BMI, SBP, DBP and urinary PCX. There was a positive significant correlation between FBS, 2HrPP, HBA1C and urinary PCX. There was a positive significant correlation between s.create and urinary PCX. There was a positive significant correlation between ACR and urinary PCX.
So urinary podocalyxin seems to be beneficial as an early marker for early stages of diabetic nephropathy in type 2 DM patients.