CLINICAL UTILITY OF ESTIMATION OF URINARY NEPHRIN LEVELS AS AN EARLY BIOMARKER IN DIABETIC NEPHROPATHY
Main Article Content
Keywords
Biomarker, Diabetic Nephropathy, Urinary Nephrin.
Abstract
Background
Diabetes mellitus (DM) is major cause of chronic kidney disease (CKD). Proteinuria is the clinical significance of diabetic nephropathy (DN). In diabetes mellitus, a disruption of the glomerular capillary blood barrier with the development of proteinuria will leads to clinical diabetic nephropathy. Nephrin is an important protein component of the slit diaphragm that maintains the integrity of the filtration barrier. So estimation of nephrin levels is important to rule out as early biomarker for diabetic nephropathy.
Objectives
This study investigates whether if nephrin, as opposed to albumin, can serve as a earlier sing of CKD in diabetic mellitus.
Methods
This quantitative correlational study included 75 participants of age group between 45-60 years in the month June 2013, of which 15 did not have DM or CKD confirmed by testing blood sugar levels and blood urea-creatinine levels, 15 participants had DM but not CKD confirmed by testing blood sugar levels and blood urea-creatinine levels and 45 participants had both DM and CKD confirmed by testing blood sugar levels and blood urea-creatinine levels, further CKD divided into subgroups CKD -Stage 2,3 and 4 based on the creatinine levels in the blood, where all data was collected from the medical records in the month of June 2013 at JSS Hospital, Mysore. Urinary nephrin was measured using enzyme linked immunosorbent assay (ELISA) and correlated with other parameters using Statistical package for social sciences (SPSS) Software.
Results
The concentration of urinary nephrin increased progressively as the kidney function worsened. Nephrinuria had significant positive correlation with urine creatine ratio (r=0.237). Receiver operator curve (ROC) analysis showed that urinary nephrin had high sensitivity and but low specificity. At urinary nephrin level of 1.317 ng/µL, sensitivity and specificity were maximum at 90.3% and 75%, respectively and hence can be used as the cut off value.
Conclusions
Compared to albumin, urinary nephrin can serve as an early biomarker of diabetic nephropathy and can help in the staging of CKD.
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Mr. Yashwanth Gangadhar
Junior Scientific Officer, NIMHANS, Bengaluru, Karnataka, India.
Ms. Iffath Uzma
Tutor, Department of Biochemistry, Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India
Mr. Nandeesh S.N
Medical Laboratory Technologist, Department of Biochemistry, ESIC Medical College PGIMSR and Model Hospital, Bengaluru, Karnataka, India.
Ms. Shaila M.D.
Tutor, Department of Physiology, Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India.
Ms. Akula Rajani
Assistant Professor, Department of Paramedical and Allied Sciences, School of Paramedical and Allied Health Care Sciences, Tirupati, Andhra Pradesh, India.
Dr. Prashant Vishwanath
Dean of Research, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.