Usefulness of measuring urine neutrophil gelatinase-associated lipocalin (NGAL) and calculating NGAL to creatinine ratio as early predictors of kidney dysfunction in patients with type 2 diabetes

2015 ◽  
Vol 51 (2) ◽  
pp. 97-104
Author(s):  
Agnieszka Gala-Błądzińska ◽  
Agnieszka Żyłka ◽  
Katarzyna Rybak ◽  
Paulina Dumnicka ◽  
Marek Kuźniewski ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ldl Cholesterol ◽  
Early Stage ◽  
Control Group ◽  
Creatinine Ratio ◽  
Kidney Dysfunction ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Urine Albumin ◽  
Positive Correlations

The aim of the study was to assess the usefulness of measuring concentrations of NGAL in first morning urine and calculating NGAL/creatinine ratio (uNGAL/uCr) among patients with early stage diabetic kidney disease (DKD) in course of type 2 diabetes (DMt2) and to assess the correlations between these markers and routine biochemical and blood count parameters. Material and Methods: The studied group consisted of 55 patients with DKD in course of DMt2 and 22 controls without diabetes; the study included patients with estimated glomerular filtration rate >60ml/min/1,73m2 without overt proteinuria. NGAL was measured with chemiluminescence microparticle immunoassay (CMIA) with ARCHITECT analyzer (Abbott Diagnostics). Results: Studied group had higher values of uNGAL/uCr than controls (median 21.3 vs. 12.2 μg/g; p=0.014). Among studied group, women presented higher uNGAL/uCr comparing to men (38.6 vs. 11.7 μg/g; p=0.001). Both in patients and controls, uNGAL concentrations were positively correlated with urine creatinine. In studied group, we observed positive correlations of uNGAL and uNGAL/uCr with urine albumin and albumin/creatinine retaio (UACR); in control group, only the correlation between uNGAL and albuminuria was statistically significant. Additionally, in studied group, positive correlations were observed between uNGAL and uNGAL/uCr and serum cholesterol, LDL-cholesterol and triglycerides concentrations. In multiple regression, albuminuria and LDL-cholesterol significantly predicted uNGAL and UACR and triglycerides significantly predicted uNGAL/uCr in the studied group. Conclusions: The obtained results confirm the usefulness of measuring uNGAL and calculating uNGAL/uCr as early markers of kidney dysfunction in patients with DMt2. The results of the study should be confirmed in larger group of patients.

Associations of Bone Mineral Density and Bone Metabolism Indices with Urine Albumin to Creatinine Ratio in Chinese Patients with Type 2 Diabetes

2018 ◽  
Vol 6 (01) ◽  
pp. 50-55 ◽  
Author(s):  
Xin Zhao ◽  
Xiao-Mei Zhang ◽  
Ning Yuan ◽  
Xiao-Feng Yu ◽  
Li-Nong Ji
Keyword(s):  
Bone Mineral Density ◽  
Type 2 Diabetes ◽  
Diabetic Nephropathy ◽  
Bone Metabolism ◽  
Early Stage ◽  
Chinese Patients ◽  
Creatinine Ratio ◽  
Mineral Density ◽  
Urine Albumin

Abstract Objective To identify correlations of bone mineral density (BMD) and bone metabolism indices with the urine albumin to creatinine ratio (ACR) as an indicator of nephropathy in Chinese patients with type 2 diabetes (T2D). Methods In this retrospective analysis, 297 patients with T2D were divided into 3 groups according to the urine ACR. Patients’ data were analyzed to identify associations of general conditions, blood glucose level, lipid levels, and uric acid level with BMD and bone metabolism indices. Results BMD at every location tested (femoral neck, trochanter, inside hip, Ward’s triangle, total hip, and lumbar vertebrae) was negatively correlated with the urine ACR (all p<0.05). Osteocalcin, beta-C-terminal telopeptide (β-CTX), and procollagen type 1 N- peptide (P1NP) were positively correlated with urine ACR (all p<0.05). Finally, 25-hydroxyvitamin D [25(OH)D] was negatively correlated with urine ACR (p<0.05). Multiple regression analysis with adjustment for age, body mass index, disease duration, and other clinical measurements revealed no significant correlation between urine ACR and BMD measurements or β-CTX (p>0.05). However, significant correlations remained between urine ACR and osteocalcin, P1NP, and 25(OH)D (p<0.05). The same results were obtained for postmenopausal women specifically, with the exception of a significant correlation between the ACR and β-CTX (p<0.05). Conclusion In the early stage of diabetic nephropathy, BMD changes and bone transformation acceleration may occur, and the acceleration of bone transformation may occur before the change in BMD. Therefore, it is important to monitor bone metabolism indices in the early stage of diabetic nephropathy in T2D patients.

scholarly journals Urinary Neutrophil Gelatinase-Associated Lipocalin Is Complementary to Albuminuria in Diagnosis of Early-Stage Diabetic Kidney Disease in Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Agnieszka Gala-Błądzińska ◽  
Paulina Dumnicka ◽  
Beata Kuśnierz-Cabala ◽  
Katarzyna Rybak ◽  
Ryszard Drożdż ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Early Stage ◽  
Control Group ◽  
Tubular Damage ◽  
Diabetic Kidney ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background. Two clinical phenotypes of diabetic kidney disease (DKD) have been reported, that is, with or without increased albuminuria. The aim of study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for the early diagnosis of DKD in the type 2 diabetes mellitus (T2DM). Methods. The study group consisted of 123 patients with T2DM (mean age 62 ± 14 years), with urine albumin/creatinine ratio (uACR) < 300 mg/g and eGFR ≥ 60 ml/min/1.73 m2. The control group included 22 nondiabetic patients with comparable age, sex, and comorbidities. uNGAL, albumin, and creatinine were measured in the first morning urine samples. uACR and uNGAL/creatinine ratios (uNCR) were calculated. Results. In the control group, maximum uNCR was 39.64 µg/g. In T2DM group, 24 patients (20%) had higher results, with the maximum value of 378.6 µg/g. Among patients with uNCR > 39.64 µg/g, 13 (54%) did not have markedly increased albuminuria. Women with T2DM had higher uNCR than men (p<0.001), without difference in uACR (p=0.09). uNCR in T2DM patients correlated significantly with HbA1c. Sex, total cholesterol, and uACR were independent predictors of uNCR above 39.64 µg/g. Conclusions. Increased uNGAL and uNCR may indicate early tubular damage, associated with dyslipidemia and worse diabetes control, especially in females with T2DM.

scholarly journals Elabela levels in patients with type 2 diabetes: can it be a marker for diabetic nephropathy?

2020 ◽  
Vol 20 (2) ◽  
pp. 833-840
Author(s):  
Erhan Onalan ◽  
Yusuf Doğan ◽  
Ebru Onalan ◽  
Nevzat Gozel ◽  
Ilay Buran ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Nephropathy ◽  
High Serum ◽  
Control Group ◽  
Diabetic Patients ◽  
Healthy Individuals ◽  
Urine Albumin ◽  
Healthy Control ◽  
Group 2

Backround: Elabela (ELA) is a hormone that is secreted at high levels in the kidneys of a healthy adult. This study aims to investigate whether serum ELA levels of patients with Type 2 Diabetes vary with the severity of renal damage. Methods: Our study included 50 healthy control subjects and 100 diabetic patients, who were categorized into groups based on urine albumin/creatinine ratios (ACR). Patients included in the study were assigned to four groups: Group 1 (healthy control), Group 2 (ACR<29mg/g), Group 3 (ACR=30-299 mg/g), and Group 4 (ACR>300 mg/g normal or high serum creatinine). Physical examination findings, demographic characteristics of the study group were recorded, and serum ELA levels and other laboratory parameters were assessed using appropriate methods. Results: The results of the study indicated that ELA levels determined in healthy individuals gradually decreased through stages of normal albuminuria, microalbuminuria, and macroalbuminuria. Moreover, ELA had a significant negative corre- lation with LDL-C (r=-0.201, p=0.014), glucose (r=-0.437, P<0.001), retinopathy (r=-0.222, P=0.006), serum BUN (r=- 0.161, P=0.049), and a positive correlation with eGFR (r=0.250, P=0.002). Conclusions: The fact that ELA levels are higher in healthy individuals compared to diabetic patients without microalbu- minuria, and higher in diabetic patients without microalbuminuria compared to patients with advanced albuminuria and kidney damage, suggests that the ELA level can be an important clinical prognostic variable and even a promising agent for the treatment of diabetic nephropathy patients. Keywords: Elabela, diabetes, diabetic kidney disease, albuminuria.

scholarly journals Dapagliflozin, as Add-on Therapy in Type 2 Diabetes Patients, Is Associated With a Reduction in Albuminuria and Serum Transaminase Levels

2021 ◽  
Vol 2 ◽  
Author(s):  
Silas Benjamin ◽  
Manjunath Ramanjaneya ◽  
Alexandra E. Butler ◽  
Imran Janjua ◽  
Firjeeth Paramba ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Group Analysis ◽  
Serum Transaminase ◽  
Hypoglycemic Agents ◽  
Combination Group ◽  
Creatinine Ratio ◽  
Urine Albumin

IntroductionSGLT-2 inhibitors are shown to be nephroprotective, slowing progression of nonalcoholic steatohepatitis (NASH) in addition to improving glycemic control in patients with type 2 diabetes (T2D). To date, no real-life clinical data is available on the effect of SGLT-2 inhibitors on urine albumin-creatinine ratio (ACR) and liver enzymes in a Middle Eastern population. Therefore, we evaluated the effect of dapagliflozin (DAPA) on urine ACR, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) when added to standard therapy for T2D.MethodsThis is an observational study of 40 patients with T2D in whom DAPA was added to their existing anti-diabetic regimen to improve glycemic control. The primary outcomes were changes in serum transaminase level and urine albumin-to-creatinine ratio (ACR). Secondary outcomes include changes in glycosylated hemoglobin (HbA1C), body mass index (BMI), oral hypoglycemic agents and insulin dose.ResultsWhole group analysis showed a reduction in ALT (p&lt;0.0001), (AST) (p=0.009), ACR (p=0.009) and BMI (p&lt;0.0001) following DAPA treatment. Further sub-group analysis showed that patients on insulin and DAPA combination had a reduction in ACR (p=0.0090), ALT (p=0.0312), BMI (p=0.0007) and HbA1c (p&lt;0.0001) compared to the sulfonylurea and DAPA combination group. In the sulfonylurea and DAPA combination group, there was a reduction in the sulfonylurea requirement following DAPA therapy (p=0.0116), with reductions in ALT (p=0.0122), AST (p=0.0362), BMI (p=0.0026) and HbA1c (p&lt;0.0001) but with no change in ACR (p=0.814).ConclusionIn routine clinical practice, the addition of DAPA to standard medical therapy is well tolerated and beneficial for T2D patients and is associated with a reduction of ALT and ACR.

scholarly journals Efficacy and Safety of Imarikiren in Patients with Type 2 Diabetes and Microalbuminuria

2019 ◽  
Vol 14 (3) ◽  
pp. 354-363 ◽  
Author(s):  
Sadayoshi Ito ◽  
Tomoya Kagawa ◽  
Takuya Saiki ◽  
Kohei Shimizu ◽  
Shingo Kuroda ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Adverse Events ◽  
Candesartan Cilexetil ◽  
Creatinine Ratio ◽  
Efficacy And Safety ◽  
Urine Albumin ◽  
End Of Treatment

Background and objectivesImarikiren is a novel, potent, and selective direct renin inhibitor that has shown high oral availability during clinical development for the treatment of diabetic nephropathy. We evaluated the efficacy and safety of imarikiren in patients with type 2 diabetes mellitus and microalbuminuria.Design, setting, participants, & measurementsThis was a randomized, multicenter, placebo-controlled, double-blind, phase 2, dose-finding trial. A total of 415 patients were randomized to imarikiren 5, 20, 40, or 80 mg; placebo; or candesartan cilexetil 8 mg treatment for 12 weeks. The primary end point was change in log-transformed urine albumin-to-creatinine ratio from baseline to the end of treatment analyzed using analysis of covariance and a fixed sequence testing procedure. Secondary efficacy end points included urine albumin-to-creatinine ratio at each assessment point and remission and progression rates. Exploratory efficacy end points included eGFR and sitting BP before dosing.ResultsChanges in the urine albumin-to-creatinine ratio from baseline to the end of treatment were 16% (placebo), −16% (imarikiren 5 mg), −27% (imarikiren 20 mg), −38% (imarikiren 40 mg), −39% (imarikiren 80 mg), and −31% (candesartan cilexetil 8 mg). Urine albumin-to-creatinine ratio reductions from baseline were statistically significant in all imarikiren groups versus placebo (P<0.001 each) as well as for candesartan cilexetil 8 mg versus placebo (P<0.001). Remission rates (urine albumin-to-creatinine ratio <30 mg/g creatinine and decreased ≥30% from baseline) were higher in all imarikiren groups versus the placebo group. Incidence of adverse events was higher in the imarikiren 80-mg group (52%) versus placebo (42%) and candesartan cilexetil (43%) groups. Incidence of adverse events for the other imarikiren groups ranged from 33% to 42%. Adverse events were mild or moderate in severity. All imarikiren doses were well tolerated.ConclusionsImarikiren resulted in a dose-dependent improvement in albuminuria compared with placebo, and it was well tolerated in patients with type 2 diabetes mellitus and microalbuminuria.

scholarly journals Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yongwen Zhang ◽  
Lanfang Chu
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Health Education ◽  
Ldl Cholesterol ◽  
Lifestyle Modification ◽  
Randomized Study ◽  
Control Group ◽  
Education Model

Background. Health education is considered to be essential in the overall care of patients with type 2 diabetes mellitus (T2DM); systematic health education integrates individual education not only during hospitalization but also extended care outside of a hospital. To test effectiveness of the systematic health education model for T2DM, we conducted a randomized study with a control group among patients with T2DM living in Nanjing, China. Methods. 998 eligible patients completed the enrollment and were randomized to systematic health education model and conventional model groups (498 and 500 patients, resp.). The systematic health education model was based on the following aspects: image education, visitation of the exhibition hall, dissemination of educational materials, individualized medical nutrition therapy and exercise programs, WeChat group and regular health lectures, evaluation of complications, lifestyle modification, systematic treatment scheme, self-monitoring of glycemic control, monthly evaluation of the therapeutic effect, proposed improvement measures, and individualized follow-up scheme. The main outcome measures were glycated hemoglobin A1c (HbA1c), blood pressure, body mass index (BMI), and lipids during the 2-year follow-up. Results. The systematic health education model led to a favorable variation in HbA1c, LDL cholesterol, and systolic blood pressure (SBP) (P<0.05). After adjusted analysis, the HbA1c decreased by 0.67% (P<0.01) in the systematic health education model, SBP decreased by 10.83 mmHg (P<0.01), and the level of diastolic blood pressure (DBP), HDL cholesterol, and total cholesterol decreased slightly and was not significant. The BMI did not change significantly during the study in either of the two groups. Conclusions. The systematic health education model is a useful method in the treatment of T2DM because it contributes to decrease in HbA1c, LDL cholesterol, and SBP levels, as well as helps in increasing the compliance with the control criteria, except for DBP and BMI.

Sign in / Sign up

Export Citation Format

Share Document