The Research On Urine Kidney Damage Markers In Patients With Type 2 Diabetes

ObjectiveAccording to the research and analysis of the morning urine sample from hospitalized patients with type 2 diabetes in Tianjin Union Medical Center,we aim to:(1)evaluate the associations of urinary markers(e.g.albumin),glomerular(e.g.transferrin [TRF] and immunoglobulin G [IgG]),and tubular(e.g.?1-microglobulin [?1-MG],?2-microglobulin [?2-MG])markers with the development of diabetic kidney disease(DKD)in type 2 diabetes patients,as assessed by estimated glomerular filtration rate(eGFR)and albuminuria.(2)calculateof ?1-microglobulin to creatinine ratio(?1CR)and estimate glomerular filtration rate(eGFR)and investigatethe prevalence of tubules injury and renal function decline in patients with type 2 diabetes and analyze their risk factors.Method1.252 type 2 diabetes patients and 50 nondiabetic controls from Tianjin,China,were selected.Diabetic patients were divided into three groups according to eGFR levels,including groups A,B,and C with eGFR ?90(n=94),60-89(n=94),and 30-59(n=64)m L/min/1.73 m2.Urine levels of glomerular and tubular markers were detected in first morning urine samples,and their associations with eGFR and albuminuria analyzed.2.A total of 237 hospitalized patients with type 2 diabetes patients were studied.Urine?1-MG,urine creatinine and serum cystatin C(Cys C),HbA1 c,fasting plasma glucose(FPG)were measured in first morning sample.Then we calculated ?1CR and eGFR.?1CR>30mg/g was used as the cutoff value to assess tubular injury;eGFR?60 ml/min/1.73m2 was used as the cutoff value to assessrenal function decline.Then we calculated the prevalence of renal tubular damage and renal function decline,respectively,and analyzed their risk factors.Result1.In patients with type 2 diabetes mellitus,the abnormal rate of ?1-MG was higher than urinary albumin.Urinary levels of TRF and ?2-MG were significantly elevated in diabetic patients with normal eGFR compared with nondiabetic control subjects.Urinary levels of all markers increased per eGFR stratum.All kidney damage markers were significantly associated with albuminuria.After adjusting for known confounders,only the tubular markers ?1-MG(standard ?=-0.25;p=0.013)and ?2-MG(standard ?=-0.18;p=0.039)retained significant associations with eGFR.2.The percent of participants with increased ?1CR was 67.93%,with decreased eGFRwas 35.02%,with normal eGFR but increased ?1CR was 37.55%,with increased ?1CR and decreased eGFR 30.38%.The risk factors of renal damage had different influence to proximal tubules and renal function.Gender(OR=2.136,p=0.047),dabetic duration(OR=1.058,p=0.020)and(albumin to creatinine ratio,ACR)(OR=1.008,p=0.007)were the risk factors of tubular injury;however,?1CR(OR=1.035,P<0.001)were the risk factors of renal function decline.Conclusion1.In patients with type 2 diabetes mellitus,the abnormal rate of ?1-MG was higher than urinary albumin.the urinary levels of all the investigated damage markers were elevated in patients with diabetes compared with nondiabetic control subjects.Interestingly,some markers were already elevated in normal eGFR diabetic patients.Only the tubular markers ?1-MG and ?2-MG were negatively associated with eGFR independently of albuminuria,suggesting that ?1-MG and ?2-MG may play an important role in the development of DKD.Furthermore,measuring urinary ?1-MG and ?2-MG concentrations may be useful in assessing the severity of diabetic kidney damage in addition to measuring albuminuria.2.The prevalence of tubular injury is much higher than the prevalence of renal function decline in patients with type 2 diabetes.It's worth noting that some patients only with tubular injury without renal function decline.In addition,The risk factors had different influence to tubules and renal function.ACR was not a risk factor associated with renal function decline,but it was a risk factor for tubular injury,meanwhile,tubular injury is a risk factor associated with renal function decline.