Assessment of Urinary Fetuin - Aasa Marker for Diabetic Nephropathy in Type2 Diabetic patients

Abstract

Background: Type 2 diabetes mellitus (DM) is the most common type of diabetes, accounting foraround 90% of all cases of diabetes. Diabetic nephropathy (DN) is the largest single cause of end-stage kidney disease, therefore, there is an urgent need to identify more sensitive and specificbiomarkersthan microalbuminuriaforearly detection ofDN. Aim of study: This study is aimed for early detection of diabetic nephropathy in type 2 DM.SubjectsandMethods:This case controlstudywascarriedout onsixty-nine individualsadmittedtodepartmentandoutpatientclinicofinternalmedicineatZagazigUniversityHospitals.Theparticipantsweredividedintothreegroups:GroupA:(23subjects)Controlgroup.healthyindividuals,ageandsex-matched,withnegativefamilyhistoryofhypertensionandischemicheartdiseases.GroupB:(23patients)Type2Diabeticpatients.GroupC:(23patients):Type2Diabeticpatientswithdiabeticnephropathy.Allpatientsweresubjectedto(I)Fullhistory:priormedicalrecordsincludingthefollowing:Familyhistoryofdiabetesmellitusandobesity.Type2diabetes(evidenceofraisedbloodglucosemeasurements,HA1C,FBS,2HPP,orRBSrecordedondifferentdaysbeforestudyduringadmission,(III)RoutineLaboratorytesting(IV)Specificlaboratory;HbA1C,FastingInsulin,andMeasurementofUrinaryLeveloffetuin-Aintype2diabeticpatientsand control group by ELISA. Results: A highly significant difference in duration of DM and diabetic retinopathy among studiedgroups; with (p <0.001). A significant difference in family history of DM among studied groups;with(p<0.05UrinaryAngiostatin;withhighlysignificantstatisticaldifference(p<0.01).Activityand chronicity indices had a highly significant positive correlation with Urinary Angiostatin; withhighly significant statistical difference (p < 0.01 respectively). A highly significant difference inhemoglobin,platelets,albumin,TGs,urea,creatinine,andUrinaryAlbumin/Creatinineratio,amongstudied groups; with (p < 0.001). A significant difference in ALT among studied groups; with (p <0.05). High Urea level in Type 2 DM and Type 2 DM with nephropathy patients in comparison toControl group; with (p < 0.01), and high Urea level in Type 2 DM with nephropathy patients incomparison to Type 2 DM patients; with (p < 0.01). High creatinine level in Type 2 DM withnephropathypatients in comparison to Control group and Type2DM.
High Albumin/Creatinine ratio in Type 2 DM with nephropathy patients in comparison to
Controlgroup. A highly significant difference in FBS and HbA1c, fasting insulin, HOMA-IR, and UrinaryFetuin-A among studied groups; with (p < 0.001). High Urinary Fetuin-A level in Type 2 DM andType 2 DM with nephropathy patients in comparison to Control group; with (p < 0.01), and highUrinary Fetuin-A level in Type 2 DM with nephropathy patients in comparison to Type 2 DMpatients;with (p <0.01). Conclusion:FromthisstudywecouldconcludethatUrinaryexcretionofFetuin-Acanbeusedforearlydetection ofDNinType2 DM patients withexcellent accuracy.