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Soltani-Fard E, Taghvimi S, Karimi F, Vahedi F, Khatami SH, Behrooj H, Deylami Hayati M, Movahedpour A, Ghasemi H. Urinary biomarkers in diabetic nephropathy. Clin Chim Acta 2024; 561:119762. [PMID: 38844018 DOI: 10.1016/j.cca.2024.119762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
Diabetic nephropathy (DN), a significant consequence of diabetes, is associated with adverse cardiovascular and renal disease as well as mortality. Although microalbuminuria is considered the best non-invasive marker for DN, better predictive markers are needed of sufficient sensitivity and specificity to detect disease in general and in early disease specifically. Even prior to appearance of microalbuminuria, urinary biomarkers increase in diabetics and can serve as accurate nephropathy biomarkers even in normoalbuminuria. In this review, a number of novel urine biomarkers including those reflecting kidney damage caused by glomerular/podocyte damage, tubular damage, oxidative stress, inflammation, and intrarenal renin-angiotensin system activation are discussed. Our review also includes emerging biomarkers such as urinary microRNAs. These short noncoding miRNAs regulate gene expression and could be utilized to identify potential novel biomarkers in DN development and progression. .
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Affiliation(s)
- Elahe Soltani-Fard
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran; Department of Molecular Medicine, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sina Taghvimi
- Department of Biology, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | | | - Farzaneh Vahedi
- Biomedical and Microbial Advanced Technologies Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyyed Hossein Khatami
- Student Research Committee, Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | - Hassan Ghasemi
- Research Center for Environmental Contaminants (RCEC), Abadan University of Medical Sciences, Abadan, Iran.
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2
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Zhang W, Li J, Zhu L, Zeng S, Lu Y, Zhang Y, Gu X, Wu H, Yang L. Choroidal Vascularity Index and Choroidal Structural Changes in Children With Nephrotic Syndrome. Transl Vis Sci Technol 2024; 13:18. [PMID: 38512284 PMCID: PMC10960224 DOI: 10.1167/tvst.13.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/11/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose To investigate the choroidal vascularity index (CVI) and choroidal structural changes in children with nephrotic syndrome. Methods This was a cross-sectional study involving 45 children with primary nephrotic syndrome and 40 normal controls. All participants underwent enhanced depth imaging-optical coherence tomography examinations. An automatic segmentation method based on deep learning was used to segment the choroidal vessels and stroma, and the choroidal volume (CV), vascular volume (VV), and CVI within a 4.5 mm diameter circular area centered around the macular fovea were obtained. Clinical data, including blood lipids, serum proteins, renal function, and renal injury indicators, were collected from the patients. Results Compared with normal controls, children with nephrotic syndrome had a significant increase in CV (nephrotic syndrome: 4.132 ± 0.464 vs. normal controls: 3.873 ± 0.574; P = 0.024); no significant change in VV (nephrotic syndrome: 1.276 ± 0.173 vs. normal controls: 1.277 ± 0.165; P = 0.971); and a significant decrease in the CVI (nephrotic syndrome: 0.308 [range, 0.270-0.386] vs. normal controls: 0.330 [range, 0.288-0.387]; P < 0.001). In the correlation analysis, the CVI was positively correlated with serum total protein, serum albumin, serum prealbumin, ratio of serum albumin to globulin, and 24-hour urine volume and was negatively correlated with total cholesterol, low-density lipoprotein cholesterol, urinary protein concentration, and ratio of urinary transferrin to creatinine (all P < 0.05). Conclusions The CVI is significantly reduced in children with nephrotic syndrome, and the decrease in the CVI parallels the severity of kidney disease, indicating choroidal involvement in the process of nephrotic syndrome. Translational Relevance Our findings contribute to a deeper understanding of how nephrotic syndrome affects the choroid.
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Affiliation(s)
- Wenbo Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Junmeng Li
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Lei Zhu
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
- National Biomedical Imaging Center, Peking University, Beijing, China
| | - Shuang Zeng
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
- National Biomedical Imaging Center, Peking University, Beijing, China
| | - Yanye Lu
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
- National Biomedical Imaging Center, Peking University, Beijing, China
| | - Yadi Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Xiaopeng Gu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Hailong Wu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
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Lv S, Li H, Zhang T, Su X, Sun W, Wang Q, Wang L, Feng N, Zhang S, Wang Y, Cui H. San-Huang-Yi-Shen capsule ameliorates diabetic nephropathy in mice through inhibiting ferroptosis. Biomed Pharmacother 2023; 165:115086. [PMID: 37418978 DOI: 10.1016/j.biopha.2023.115086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Diabetic nephropathy (DN) is one of the main complications of diabetes. However, effective therapy to block or slow down the progression of DN is still lacking. San-Huang-Yi-Shen capsule (SHYS) has been shown to significantly improve renal function and delay the progression of DN. However, the mechanism of SHYS on DN is still unclear. In this study, we established a mouse model of DN. Then, we investigated the anti-ferroptotic effects of SHYS including the reduction of iron overload and the activation of cystine/GSH/GPX4 axis. Finally, we used a GPX4 inhibitor (RSL3) and ferroptosis inhibitor (ferrostatin-1) to determine whether SHYS ameliorates DN through inhibiting ferroptosis. The results showed that SHYS treatment was effective for mice with DN in terms of improving renal function, and reducing inflammation and oxidative stress. Besides, SHYS treatment reduced iron overload and upregulated the expression of cystine/GSH/GPX4 axis-related factors in kidney. Moreover, SHYS exhibited similar therapeutic effect on DN as ferrostatin-1, RSL3 could abolish the therapeutic and anti- ferroptotic effects of SHYS on DN. In conclusion, SHYS can be used to treat mice with DN. Furthermore, SHYS could inhibit ferroptosis in DN through reducing iron overload and upregulating the expression of cystine/GSH/GPX4 axis.
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Affiliation(s)
- Shuquan Lv
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China; Hebei University of Traditional Chinese Medicine, Hebei, China
| | - Huajun Li
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Tianyu Zhang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Xiuhai Su
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Wenjuan Sun
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Qinghai Wang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Lixin Wang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Nana Feng
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China
| | - Shufang Zhang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China.
| | - Yuansong Wang
- Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Hebei, Hebei, China.
| | - Huantian Cui
- Yunnan University of Chinese Medicine, Yunnan, China; Shandong Provincial Key Laboratory of Animal Cell and Developmental Biology, School of Life Sciences, Shandong University, Shandong, China.
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Han SY, Han SH, Ghee JY, Cha JJ, Kang YS, Cha DR. SH3YL1 Protein Predicts Renal Outcomes in Patients with Type 2 Diabetes. Life (Basel) 2023; 13:life13040963. [PMID: 37109492 PMCID: PMC10141384 DOI: 10.3390/life13040963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
NADPH oxidase (NOX)-derived oxidative stress is an important factor in renal progression, with NOX4 being the predominant NOX in the kidney. Recently, Src homology 3 (SH3) domain-containing YSC84-like 1 (SH3YL1) was reported to be a regulator of NOX4. In this study, we tested whether the SH3YL1 protein could predict 3-year renal outcomes in patients with type 2 diabetes. A total of 131 patients with type 2 diabetes were enrolled in this study. Renal events were defined as a 15% decline in the estimated glomerular filtration rate (eGFR) from the baseline, the initiation of renal replacement therapy, or death during the 3 years. The levels of the urinary SH3YL1-to-creatinine ratio (USCR) were significantly different among the five stages of chronic kidney disease (CKD) and the three groups, based on albuminuria levels. The USCR levels showed a significant negative correlation with eGFR and a positive correlation with the urinary albumin-to-creatinine ratio (UACR). Plasma SH3YL1 levels were significantly correlated with UACR. The highest tertile group of USCR and plasma SH3YL1 had a significantly lower probability of renal event-free survival. Furthermore, the highest tertile group of USCR showed a significant association with the incidence of renal events after full adjustment: adjusted hazard ratio (4.636: 95% confidence interval, 1.416-15.181, p = 0.011). This study suggests that SH3YL1 is a new diagnostic biomarker for renal outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Sang Youb Han
- Department of Internal Medicine, Inje University, Ilsan-Paik Hospital, Goyang 10380, Republic of Korea
| | - Seung Hyun Han
- Department of Internal Medicine, Inje University, Ilsan-Paik Hospital, Goyang 10380, Republic of Korea
| | - Jung Yeon Ghee
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Young Sun Kang
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University, Ansan Hospital, Ansan 15368, Republic of Korea
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Moriya R, Hokari S, Ohshima Y, Suzuki R, Nagai A, Fujito N, Takahashi A, Aoki N, Watanabe S, Koya T, Nakayama H, Izumizaki M, Kikuchi T. Continuous positive airway pressure treatment reduces renal tubular damage in patients with obstructive sleep apnea: A retrospective single-center cohort study. Sleep Med 2023; 106:106-115. [PMID: 37087824 DOI: 10.1016/j.sleep.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Chronic intermittent hypoxia (IH) plays a significant role in the pathogenesis of obstructive sleep apnea (OSA) comorbidities. The prevalence of chronic kidney disease is higher in patients with OSA than the general population, and renal function decline is well correlated with renal tubular injury. However, little is known about the impact of OSA-induced chronic IH on the renal tubules. METHODS We conducted a retrospective survey of clinical records performing multiple regression analysis and cluster analysis with particular attention to the 3% oxygen desaturation index (ODI) and urinary N-acetyl-β-d-glucosaminidase (NAG). RESULTS In patients with suspicion of OSA, urinary NAG creatinine ratio (UNCR) was elevated as their 3% ODI increased (n = 197, p < 0.001), and the elevated UNCR decreased following CPAP treatment in patients with OSA (n = 46, p = 0.014). Multiple regression analysis showed that 3% ODI was associated with UNCR. Cluster analysis identified three clusters of patients with OSA, including two younger age clusters, one of which was characterized by high BMI, high 3% ODI, and high prevalence of major comorbidities. In a comparative analysis of younger age cases (age ≤ 55, n = 82), the UNCR level was higher in patients with severe 3% ODI (3% ODI > 40 events/h, n = 24) (p = 0.014). CONCLUSIONS Our results indicate that even at younger ages, OSA patients with severe chronic IH and major comorbidities are susceptible to renal tubular damage. Early treatment with CPAP may attenuate renal tubular injury and progression toward end-stage renal disease.
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Affiliation(s)
- Rika Moriya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan; Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Satoshi Hokari
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan.
| | - Yasuyoshi Ohshima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Ryoko Suzuki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Asuka Nagai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Nobuhiro Fujito
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Atsunori Takahashi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Toshiyuki Koya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
| | - Hideaki Nakayama
- Department of Somnology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8520, Japan
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Veluri G, Mannangatti M. Urinary Nephrin is a Sensitive Marker to Predict Early Onset of Nephropathy in Type 2 Diabetes Mellitus. J Lab Physicians 2022; 14:497-504. [PMID: 36531542 PMCID: PMC9750756 DOI: 10.1055/s-0042-1757718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective The present study has been designed to evaluate urinary nephrin that best predicts the occurrence of renal dysfunction in type 2 diabetes mellitus patients and its correlation with clinical parameters of nephropathy. Materials and Methods A total of 80 type 2 diabetes mellitus and 40 age- and gender-matched healthy controls were recruited. Biochemical and clinical parameters were analyzed in all the study participants. Analysis of variance was performed to compare the differences between the groups. Pearson's correlation analysis was used to analyze the association of nephrin with clinical parameters of nephropathy. Receiver operating characteristic curves were constructed to study the diagnostic accuracy of markers to identify diabetic nephropathy. Results The levels of nephrin were significantly elevated in both groups of type 2 diabetes mellitus patients when compared with healthy individuals ( p = 0.0001). The urinary nephrin was positively correlated with hemoglobin A1c and urinary albumin creatinine ratio ( r = 0.520, 0.657, p < 0.0001) and negatively correlated with estimated glomerular filtration rate ( r = -0.539, p < 0.0001). The diagnostic sensitivity and specificity of nephrin for nephropathy were 100 and 88%, respectively, and urinary albumin creatinine ratio was 43 and 76%, respectively. Conclusion The study findings suggest that nephrin levels are strongly and positively associated with nephropathy in type 2 diabetes mellitus patients and it has a greater potential to be an early predictable marker of nephropathy than urinary albumin creatinine ratio.
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Affiliation(s)
- Ganesh Veluri
- Department of Biochemistry, Arupadai Veedu Medical College and Hospital, Vinayaka Missions Research Foundation (deemed to be university, Salem, Tamil Nadu), Kirumampakkam, Puducherry, India
| | - Murugan Mannangatti
- Department of Biochemistry, Arupadai Veedu Medical College and Hospital, Vinayaka Missions Research Foundation (deemed to be university, Salem, Tamil Nadu), Kirumampakkam, Puducherry, India
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Taha MM, Mahdy-Abdallah H, Shahy EM, Mansour NAEM, Fouad MM, Helmy MA. Preference between serum homocysteine and urinary periostin as early predictive biomarkers of renal dysfunction among uncontrolled diabetics. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:399-405. [PMID: 34995023 DOI: 10.1515/jcim-2021-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) represents a serious public health problem. Environmental toxins, other than infectious agents or exposures can stimulate immune responses which are associated with the occurrence of T2DM. Diabetic nephropathy (DN) is a serious complication of diabetes that leads to changes in the structure and function of the kidneys. The study aimed to detect diagnostic biomarkers for (DN), at an early stage, to prevent disease progression in these patients and improve their outcomes. METHODS This study was performed on 102 T2DM patients and 80 normal controls. Blood glucose, HbA1c, serum homocysteine (Hcy) and urinary periostin were assessed. Patients were divided into: controlled (n=46) (HbA1c <6.5%) and uncontrolled diabetics (n=56) (HbA1c >6.5%). RESULTS The study results revealed a significant rise in blood glucose and HbA1c as well as serum Hcy levels in diabetic groups compared to controls. Also, urinary periostin exhibited significant elevation in diabetic groups. Serum glucose, HbA1c and serum Hcy revealed a highly significant difference between diabetic subgroups and control groups, while urinary periostin demonstrated a non-significant difference. Only, urinary periostin showed a significant increase in uncontrolled diabetics. CONCLUSIONS The highest levels of serum Hcy and urinary periostin were recorded only in the uncontrolled diabetics. Urinary periostin was demonstrated as a more preferable biomarker being a non-invasive sample for predicting renal insult in diabetic subjects. This biomarker could be performed regularly for early detection of DN. Also, it could be added to the periodic medical examinations of workers occupationally exposed to workplace pollutants inducing diabetes.
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Affiliation(s)
- Mona Mohamed Taha
- Environmental and Occupational Medicine Department, National Research Centre, Giza, Egypt
| | - Heba Mahdy-Abdallah
- Environmental and Occupational Medicine Department, National Research Centre, Giza, Egypt
| | - Eman Mohamed Shahy
- Environmental and Occupational Medicine Department, National Research Centre, Giza, Egypt
| | | | - Marwa Mohamed Fouad
- Occupational and Environmental Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Adel Helmy
- Environmental and Occupational Medicine Department, National Research Centre, Giza, Egypt
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Choi MS, Jun JE, Park SW, Yoo JH, Ahn J, Kim G, Jin SM, Hur KY, Lee MK, Kim JH. Association of Urinary N-Acetyl-β-D-Glucosaminidase with Cardiovascular Autonomic Neuropathy in Type 1 Diabetes Mellitus without Nephropathy. Diabetes Metab J 2021; 45:349-357. [PMID: 33517614 PMCID: PMC8164949 DOI: 10.4093/dmj.2019.0211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a common microvascular complication of diabetes and related to albuminuria in diabetic nephropathy (DN). Urinary N-acetyl-β-D-glucosaminidase (uNAG) is a renal tubular injury marker which has been reported as an early marker of DN even in patients with normoalbuminuria. This study evaluated whether uNAG is associated with the presence and severity of CAN in patients with type 1 diabetes mellitus (T1DM) without nephropathy. METHODS This cross-sectional study comprised 247 subjects with T1DM without chronic kidney disease and albuminuria who had results for both uNAG and autonomic function tests within 3 months. The presence of CAN was assessed by age-dependent reference values for four autonomic function tests. Total CAN score was assessed as the sum of the partial points of five cardiovascular reflex tests and was used to estimate the severity of CAN. The correlations between uNAG and heart rate variability (HRV) parameters were analyzed. RESULTS The association between log-uNAG and presence of CAN was significant in a multivariate logistic regression model (adjusted odds ratio, 2.39; 95% confidence interval [CI], 1.08 to 5.28; P=0.031). Total CAN score was positively associated with loguNAG (β=0.261, P=0.026) in the multivariate linear regression model. Log-uNAG was inversely correlated with frequency-domain and time-domain indices of HRV. CONCLUSION This study verified the association of uNAG with presence and severity of CAN and changes in HRV in T1DM patients without nephropathy. The potential role of uNAG should be further assessed for high-risk patients for CAN in T1DM patients without nephropathy.
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Affiliation(s)
- Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Woon Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
- Corresponding author: Jae Hyeon Kim https://orcid.org/0000-0001-5001-963X Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea E-mail:
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Li KX, Ji MJ, Sun HJ. An updated pharmacological insight of resveratrol in the treatment of diabetic nephropathy. Gene 2021; 780:145532. [PMID: 33631244 DOI: 10.1016/j.gene.2021.145532] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
As one of the most common complications of diabetes, nephropathy develops in approximately 40% of diabetic individuals. Although end stage kidney disease is known as one of the most consequences of diabetic nephropathy, the majority of diabetic individuals might die from cardiovascular diseases and infections before renal replacement treatment. Moreover, the routine medical treatments for diabetes hold undesirable side effects. The explosive prevalence of diabetes urges clinicians and scientists to investigate the complementary or alternative therapies. Phytochemicals are emerging as alternatives with a wide range of therapeutic effects on various pathologies, including diabetic kidney disease. Of those phytochemicals, resveratrol, a natural polyphenolic stilbene, has been found to exert a broad spectrum of health benefits via various signaling molecules. In particular, resveratrol has gained a great deal of attention because of its anti-oxidative, anti-inflammatory, anti-diabetic, anti-obesity, cardiovascular-protective, and anti-tumor properties. In the renal system, emerging evidence shows that resveratrol has already been used to ameliorate chronic or acute kidney injury. This review critically summarizes the current findings and molecular mechanisms of resveratrol in diabetic renal damage. In addition, we will discuss the adverse and inconsistent effects of resveratrol in diabetic nephropathy. Although there is increasing evidence that resveratrol affords great potential in diabetic nephropathy therapy, these results should be treated with caution before its clinical translation. In addition, the unfavorable pharmacokinetics and/or pharmacodynamics profiles, such as poor bioavailability, may limit its extensive clinical applications. It is clear that further research is needed to unravel these limitations and improve its efficacy against diabetic nephropathy. Increasing investigation of resveratrol in diabetic kidney disease will not only help us better understand its pharmacological actions, but also provide novel potential targets for therapeutic intervention.
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Affiliation(s)
- Ke-Xue Li
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, China
| | - Miao-Jin Ji
- Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China.
| | - Hai-Jian Sun
- Department of Basic Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore.
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10
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Choi GS, Min HS, Cha JJ, Lee JE, Ghee JY, Yoo JA, Kim KT, Kang YS, Han SY, Bae YS, Lee SR, Yoo JY, Moon SH, Lee SJ, Cha DR. SH3YL1 protein as a novel biomarker for diabetic nephropathy in type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2021; 31:498-505. [PMID: 33223406 DOI: 10.1016/j.numecd.2020.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Oxidative stress contributes to development of diabetic nephropathy. We implicated SH3YL1 in oxidative stress-induced inflammation and examined whether SH3YL1 could be used as a new biomarker of diabetic nephropathy. METHODS AND RESULTS In this study, we investigated the relationship between plasma level of SH3YL1 and diabetic nephropathy in patients with type 2 diabetes. In addition, we examined the physiological role of SH3YL1 in db/db mice and cultured podocytes. Plasma SH3YL1 concentration was significantly higher in patients with diabetes than in controls, even in normoalbuminuric patients, and was markedly increased in the macroalbuminuria group. Plasma SH3YL1 level was positively correlated with systolic blood pressure, HOMA-IR, postprandial blood glucose, plasma level of retinol binding protein 4 (RBP 4), and urinary albumin excretion (UAE) and was inversely correlated with BMI. Regression analysis showed that plasma level of RBP 4, UAE, and BMI were the only independent determinants of plasma SH3YL1 concentration. In db/db mice, plasma and renal SH3YL1 levels were significantly increased in mice with diabetes compared with control mice. In cultured podocytes, high glucose and angiotensin II stimuli markedly increased SH3YL1 synthesis. CONCLUSION These findings suggest that plasma level of SH3YL1 offers a promising new biomarker for diabetic nephropathy.
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Affiliation(s)
- Gyu S Choi
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea
| | - Hye S Min
- Department of Internal Medicine, Division of Nephrology, Wonkwang University, South Korea
| | - Jin J Cha
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea
| | - Ji E Lee
- Department of Internal Medicine, Division of Nephrology, Wonkwang University, South Korea
| | - Jung Y Ghee
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea
| | - Ji A Yoo
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea
| | - Ki T Kim
- Department of Internal Medicine, BHS Hanseo Hospital, Busan, South Korea
| | - Young S Kang
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea
| | - Sang Y Han
- Department of Internal Medicine, Inje University, Ilsan Paik Hospital, Goyang, South Korea
| | - Yun S Bae
- Department of Life Science, Division of Life and Pharmaceutical Sciences, Ewha Woman's University, South Korea
| | - Sae R Lee
- Department of Life Science, Division of Life and Pharmaceutical Sciences, Ewha Woman's University, South Korea
| | - Jung Y Yoo
- Department of Life Science, Division of Life and Pharmaceutical Sciences, Ewha Woman's University, South Korea
| | | | - Soo J Lee
- Aptabio Therapeutics Inc, South Korea
| | - Dae R Cha
- Department of Internal Medicine, Division of Nephrology, Korea University, South Korea.
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11
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Abstract
The continuous accumulation of extracellular matrix will eventually lead to glomerular sclerosis, interstitial fibrosis, tubular atrophy and vascular sclerosis, which are involved in the progression of chronic kidney disease (CKD). If these processes can be discovered early and effective interventions given in time, the progression of kidney disease may be delayed. Therefore, exploring new biomarkers and therapeutic targets that can identify CKD at an early stage is urgently needed. In recent years, studies have shown that urine periostin may be used as a marker of early renal tubular injury. And in an animal model experiment of hypertensive nephropathy, periostin is involved in the progression of kidney injury and reflects its progression. Here we review the current progress on the role of periostin in pathologic pathways of kidney system to explore whether periostin is a potential therapeutic target for the treatment of CKD.
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Affiliation(s)
- Yuan-Yuan Jia
- Department of Health Management Medical Center, The Third Hospital of Jilin University, Changchun, China
| | - Yue Yu
- Department of Endocrinology and Metabolism, The Third Hospital of Jilin University, Changchun, China
| | - Hong-Jun Li
- Department of Health Management Medical Center, The Third Hospital of Jilin University, Changchun, China
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12
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Abstract
Recent developments in biomarkers relating to the interrelationship of diet, disease and health were surveyed. Most emphasis was placed on biomarkers of deleterious effects, since these are of greatest relevance to the subject of this review. The area of greatest activity was found to be that relating to biomarkers of mutagenic, genotoxic and carcinogenic effects. This is also one of the major areas of concern in considerations of the beneficial and deleterious effects of dietary components, and also the area in which regulatory testing requires studies of the longest duration. A degree of progress has also been made in the identification and development of biomarkers relating to certain classes of target organ toxicity. Biomarkers for other types of toxicity, such as immunotoxicity, neurotoxicity, reproductive toxicity and developmental toxicity, are less developed, and further investigation in these areas is required before a comprehensive biomarker strategy can be established. A criticism that recurs constantly in the biomarker literature is the lack of standardisation in the methods used, and the lack of reference standards for the purposes of validation and quality control. It is encouraging to note the growing acknowledgement of the need for validation of biomarkers and biomarker assays. Some validation studies have already been initiated. This review puts forward proposals for criteria to be used in biomarker validation. More discussion on this subject is required. It is concluded that the use of biomarkers can, in some cases, facilitate the implementation of the Three Rs with respect to the testing of food chemicals and studies on the effects of diet on health. The greatest potential is seen to be in the refinement of animal testing, in which biomarkers could serve as early and sensitive endpoints, in order to reduce the duration of the studies and also reduce the number of animals required. Biomarkers could also contribute to establishing a mechanistic basis for in vitro test systems and to facilitating their validation and acceptance. Finally, the increased information that could result from the incorporation of biomarker determinations into population studies could reduce the need for supplementary animal studies. This review makes a number of recommendations concerning the prioritisation of future activities on dietary biomarkers in relation to the Three Rs. It is emphasised, however, that further discussions will be required among toxicologists, epidemiologists and others researching the relationship between diet and health.
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Affiliation(s)
- Krys Bottrill
- FRAME, Russell & Burch House, 96–98 North Sherwood Street, Nottingham NG1 4EE, UK
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13
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Han E, Kim MK, Lee YH, Kim HS, Lee BW. Association between nonalbumin proteinuria and renal tubular damage of N-acetyl-β-d-glucosaminidase and its clinical relevance in patients with type 2 diabetes without albuminuria. J Diabetes Complications 2019; 33:255-260. [PMID: 30236543 DOI: 10.1016/j.jdiacomp.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022]
Abstract
AIM Although albuminuria and urinary N-acetyl-β-d-glucosaminidase (uNAG) are known as progression markers of diabetic kidney disease, there is limited information regarding the association between urinary nonalbumin proteinuria (NAP) and uNAG and the clinical relevance thereof in patients without albuminuria. METHODS This cross-sectional study included samples from 244 consecutive patients with type 2 diabetes mellitus (T2D) without albuminuria. Proteinuria and albuminuria were defined according to protein-to-creatinine ratio (uPCR) and albumin-to-creatinine ratio (uACR), respectively. NAP was indirectly calculated by the difference between uPCR and uACR. RESULTS NAP and uNAG excretion were significantly correlated (r = 0.525, P < 0.001). Individuals whose NAP levels were in the highest tertile had a longer duration of diabetes, uncontrolled hyperglycemia, and impaired insulin stimulation (all P < 0.05), although more patients in the highest NAP tertile were prescribed insulin and sulfonylurea. Multiple linear regression analyses revealed associations among uNAG, diabetes duration, and waist circumference. CONCLUSIONS T2D patients without albuminuria excrete proteinuria and that presence of the protein in urine is associated with uNAG. NAP was positively correlated with T2D duration and waist circumference, but negatively correlated with body mass index. Lean, but centrally obese, T2D patients in late diabetes experience more tubular damage, regardless of the presence of albuminuria.
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Affiliation(s)
- Eugene Han
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Mi-Kyung Kim
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Soon Kim
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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14
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Thethi TK, Batuman V. Challenging the conventional wisdom on diabetic nephropathy: Is microalbuminuria the earliest event? J Diabetes Complications 2019; 33:191-192. [PMID: 30651179 DOI: 10.1016/j.jdiacomp.2018.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 12/15/2022]
Abstract
Microalbuminuria, urine albumin-to-creatinine ratio >30 and less than <300 mg/g has widely been accepted as biomarker of early diabetic kidney disease (DKD). Based on absence of beta-2 microglobulinuria in earlier studies on microalbuminuria, its possible tubular origin has been dismissed. Microalbuminuria has been assumed as a marker of endothelial injury. Low-molecular-weight (LMW) proteins are smaller than albumin and less restricted by the glomerular filtration barrier. Normal individuals excrete no >10 to 20 mg/day low-molecular-weight proteins in urine, as they are absorbed in the proximal tubules. Thus, LMW proteinuria, or non-albumin proteinuria (NAP) is a reliable marker of tubular dysfunction in patients without glomerular involvement. In some cohorts of patients with diabetes (DM), tubular proteinuria preceded microalbuminuria, and similar to the findings reported by Han et al. in this issue of the journal, the tubular origin of these proteins was confirmed through correlations with the increased urinary concentrations of N‑Acetyl‑β‑d‑Glucosaminidase (NAG), a marker of tubular-lysosomal injury. Observations show significant NAP in the urine of DM patients without microalbuminuria; and that NAP correlates with NAG. In many studies it appears that NAP often precedes microalbuminuria, and is likely not the earliest biomarker of diabetic kidney disease. The conclusion that microalbuminuria is a biomarker of glomerular endothelial injury and that it is the earliest finding in DKD requires a re-appraisal. Data increasingly suggest that in early stages of DKD, NAP precedes microalbuminuria, and that microalbuminuria itself may be a consequence of impaired tubular reabsorption.
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Affiliation(s)
- Tina K Thethi
- Tulane University Health Sciences Center, New Orleans, LA 70112, United States of America; Southeast Louisiana Veterans Health Care System, New Orleans, LA 70112, United States of America.
| | - Veichi Batuman
- Tulane University Health Sciences Center, New Orleans, LA 70112, United States of America; Southeast Louisiana Veterans Health Care System, New Orleans, LA 70112, United States of America
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15
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Urinary N-acetyl-beta-d-glucosaminidase (NAG) with neutrophil gelatinase-associated lipocalin (NGAL) improves the diagnostic value for proximal tubule damage in diabetic kidney disease. 3 Biotech 2019; 9:66. [PMID: 30729090 DOI: 10.1007/s13205-019-1593-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/23/2019] [Indexed: 12/14/2022] Open
Abstract
Screening for diabetic kidney disease (DKD) remains a challenge; however, there has been an ongoing research to investigate the diagnostic value of different biomarkers to identify DKD. The aim of this study was to assess the diagnostic value of both N-acetyl-beta-d-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) in the progression of DKD. This cross-sectional case-control study included 92 type 2 diabetic patients with or without DKD. Urinary NAG and NGAL were measured to evaluate their diagnostic values as biochemical markers related to DKD. Both urinary NAG and NGAL levels were significantly higher among patients with DKD. In multiple linear regression analysis, NAG showed a positive significant association with NGAL in the three different adjusted models, while no significant correlation with fasting blood glucose, glycated hemoglobin, serum creatinine, estimated glomerular filtration rate, and albumin creatinine ratio were observed. The area under the curve for NGAL was 0.659 (p = 0.01) and 0.564 (p = 0.297) for NAG in DKD patients. This study demonstrates the association between urinary NAG and NGAL as a tubular damage marker for DKD although longitudinal studies are needed to evaluate its diagnostic value.
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16
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Lee M, Hong N, Lee YH, Kang ES, Cha BS, Lee BW. Elevated N-acetyl-β-d-glucosaminidase, a urinary tubular damage marker, is a significant predictor of carotid artery atherosclerosis in type 1 diabetes, independent of albuminuria: A cross-sectional study. J Diabetes Complications 2018; 32:777-783. [PMID: 29980431 DOI: 10.1016/j.jdiacomp.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 01/07/2023]
Abstract
AIMS Recent evidence has shown that renal tubulointerstitial injuries play an important role in diabetic nephropathy. In this study, we evaluated the association between urinary N-acetyl-β-d-glucosaminidase (uNAG), an early renal tubular damage marker, and carotid artery atherosclerosis in patients with type 1 diabetes (T1D). METHODS This was a cross-sectional study of 88 patients with T1D. Demographic and laboratory data; urinary indices, including urinary NAG-to-creatinine ratio (uNCR), and albumin-to-creatinine ratio (uACR); and carotid ultrasonography were investigated. RESULTS Eighty-eight subjects were divided into three groups based on uNCR tertiles. Subjects belonging to the highest tertile of uNCR had the highest average mean and maximum carotid intima-media thickness (IMT). An elevated uNCR was also significantly correlated with increased average mean and maximum carotid IMT, whereas an elevated uACR was not. Even after adjusting for confounding factors, uNCR continued to be a meaningful predictive marker for increased average mean and maximum IMT. Conversely, the uACR could not predict carotid IMT after adjustment for confounding factors. CONCLUSIONS Elevated levels of uNAG are significantly associated with carotid artery atherosclerosis in patients with T1D independently of albuminuria, a marker of glomerular damage.
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Affiliation(s)
- Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Namki Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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Kamal NM, Elsayed AM, Amin E, Zedan A. Urinary immunoglobulin G versus microalbuminuria as an indicator of diabetic nephropathy in type 2 diabetic patients. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_80_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Chen CJ, Liao WL, Chang CT, Liao HY, Tsai FJ. Urine proteome analysis by C18 plate-matrix-assisted laser desorption/ionization time-of-flight mass spectrometry allows noninvasive differential diagnosis and prediction of diabetic nephropathy. PLoS One 2018; 13:e0200945. [PMID: 30024955 PMCID: PMC6053209 DOI: 10.1371/journal.pone.0200945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the most common complications in diabetic patients. New noninvasive markers are still needed for the early detection of DN before identifiable alternations in kidney function or urine albumin excretion occurs. A C18 plate and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) were used to compare the urinary protein profiles of 238 subjects from the following 4 groups: patients with type 2 diabetic (T2D) with microalbuminuria, patients with DM without micro- or macroalbuminuria, patients with micro- or macroalbuminuria due to nondiabetic disease, and healthy controls. β2-microglobulin (B2M) and Clara-cell protein (CC16) were found to be highly released in the urine of patients with proteinuria due to nondiabetic or diabetic diseases. In differentiating nephropathy from healthy subject, the B2M and CC16 markers have a combined sensitivity and specificity of 77.3% and 91.8%, respectively. In distinguishing T2D with microalbuminuria from T2D patients, the combined markers have sensitivity and specificity of 66% and 73%, respectively. The predictive ability of B2M and CC16 for early renal functional decline (ERFD) was validated in 125 T2D patients with a follow-up times. The odds ratio (OR) of combined B2M and CC16 markers for developing ERFD was 7.59 (95% CI: 1.97-29.24). The detection of B2M and CC16 with the C18 plate-MALDI-TOF MS approach could be an attractive and practical assay for rapid diagnosis of nephropathy in nondiabetic/diabetic patients and as a predictor of ERFD among T2D patients who had not manifested significant kidney disease at baseline.
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Affiliation(s)
- Chao-Jung Chen
- Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (CJC); (FJT)
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chiz-Tzung Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Yi Liao
- Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Genetics, China Medical University Hospital, Taichung, Taiwan
- * E-mail: (CJC); (FJT)
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Ni X, Gu Y, Yu H, Wang S, Chen Y, Wang X, Yuan X, Jia W. Serum Adipocyte Fatty Acid-Binding Protein 4 Levels Are Independently Associated with Radioisotope Glomerular Filtration Rate in Type 2 Diabetic Patients with Early Diabetic Nephropathy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4578140. [PMID: 29992142 PMCID: PMC5994326 DOI: 10.1155/2018/4578140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 12/14/2022]
Abstract
Serum fatty acid-binding protein 4 (FABP4) has been linked to renal dysfunction. This study evaluated the association between serum FABP4 and the radioisotope glomerular filtration rate (rGFR) in type 2 diabetic patients (T2DM) with early diabetic nephropathy. Twenty healthy controls and 172 patients with T2DM were enrolled. Serum FABP4 and renal impairment biomarkers including urinary albumin-to-creatinine ratio (UACR), serum retinal-binding protein 4 (RBP4), urinary cystatin C-to-creatinine ratio (CysC/Cr), and neutrophil gelatinase-associated lipocalin-to-creatinine ratio (NGAL/Cr) were measured. Diethylenetriaminepentaacetic acid (99mTc-DTPA) was used to test rGFR. Serum FABP4 levels were higher in T2DM patients compared with the controls. There was no significant correlation between serum FABP4 and UACR in patients with T2DM. Multivariate stepwise regression analysis showed that, in patients with T2DM, FABP4 was significantly associated with rGFR while CysC/Cr and RBP4 were significantly associated with UACR independently. But UACR had no independent association with rGFR. NGAL/Cr had no significant correlation with either rGFR or UACR. FABP4 might be an early biomarker for diabetic nephropathy if combined with UACR.
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Affiliation(s)
- Xiaoqing Ni
- Department of Geriatrics, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Yunjuan Gu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Shenqi Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Ying Chen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Xinlei Wang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Xinlu Yuan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai, China
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20
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George B, Joy MS, Aleksunes LM. Urinary protein biomarkers of kidney injury in patients receiving cisplatin chemotherapy. Exp Biol Med (Maywood) 2017; 243:272-282. [PMID: 29231123 DOI: 10.1177/1535370217745302] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite recent progress in the development of novel approaches to treat cancer, traditional antineoplastic drugs, such as cisplatin, remain a mainstay of regimens targeting solid tumors. Use of cisplatin is limited by acute kidney injury, which occurs in approximately 30% of patients. Current clinical measures, such as serum creatinine and estimated glomerular filtration rate, are inadequate in their ability to detect acute kidney injury, particularly when there is only a moderate degree of injury. Thus, there is an urgent need for improved diagnostic biomarkers to predict nephrotoxicity. There is also interest by the U.S. Food and Drug Administration to validate and implement new biomarkers to identify clinical and subclinical acute kidney injury in patients during the drug approval process. This minireview provides an overview of the current literature regarding the utility of urinary proteins (albumin, beta-2-microglobulin, N-acetyl-D-glucosaminidase, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, and cystatin C) as biomarkers for cisplatin-induced AKI. Many of the well-studied urinary proteins (KIM-1, NGAL, B2M, albumin) as well as emerging biomarkers (calbindin, monocyte chemotactic protein-1, and trefoil factor 3) display distinct patterns of time-dependent excretion after cisplatin administration. Implementation of these biomarker proteins in the oncology clinic has been hampered by a lack of validation studies. To address these issues, large head-to-head studies are needed to fully characterize time-dependent responses and establish accurate cutoff values and ranges, particularly in cancer patients. Impact statement There is growing interest in using urinary protein biomarkers to detect acute kidney injury in oncology patients prescribed the nephrotoxic anticancer drug cisplatin. We aim to synthesize and organize the existing literature on biomarkers examined clinically in patients receiving cisplatin-containing chemotherapy regimens. This minireview highlights several proteins (kidney injury molecule-1, beta-2-microglobulin, neutrophil gelatinase-associated lipocalin, calbindin, monocyte chemotactic protein-1, trefoil factor 3) with the greatest promise for detecting cisplatin-induced acute kidney injury in humans. A comprehensive review of the existing literature may aid in the design of larger studies needed to implement the clinical use of these urinary proteins as biomarkers of kidney injury.
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Affiliation(s)
- Blessy George
- 1 Department of Pharmacology and Toxicology, Rutgers, The State University of New Jersey, Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA
| | - Melanie S Joy
- 2 Department of Pharmaceutical Sciences, 129263 University of Colorado at Denver - Anschutz Medical Campus , Skaggs School of Pharmacy and Pharmaceutical Sciences, 129263 University of Colorado at Denver - Anschutz Medical Campus , University of Colorado, Aurora, CO 80045, USA
| | - Lauren M Aleksunes
- 1 Department of Pharmacology and Toxicology, Rutgers, The State University of New Jersey, Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA.,3 Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA.,4 Lipid Center, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
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21
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Kidney involvement in psoriasis: a case-control study from China. Int Urol Nephrol 2017; 49:1999-2003. [PMID: 28939941 DOI: 10.1007/s11255-017-1692-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/29/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Kidney involvement secondary to psoriasis is still a controversial issue. In this study, we aimed to evaluate the prevalence of urinary abnormalities in psoriasis patients and to find out whether the abnormality is related to the severity of psoriasis. METHODS Ninety-seven psoriasis patients (62 females, 35 males, mean age 35.74 ± 13.45 years) and ninety-six age- and gender-matched control subjects (58 males, 38 females, mean age 35.82 ± 13.48 years) without hypertension or diabetes were enrolled in this study. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Twenty-four-hour proteinuria, albuminuria, RBP, and NAG were measured in all patients and controls. Pathologic proteinuria was defined as the total protein excretion of more than 0.4 g/24 h, as measured by the turbidimetric assay. Pathologic albuminuria was defined as albumin excretion of more than 17 mg/24 h. Pathologic NAG and RBP were defined as the excretion of more than 16.5 u/g cr and 0.5 mg/L, respectively. RESULTS Increased 24-h microalbuminuria (11.53 ± 7.29 vs. 9.79 ± 3.72, P = 0.039) and 24-h proteinuria (0.24 ± 0.21 vs. 0.18 ± 0.09, P = 0.002) were found in patients with psoriasis compared with controls. Patients with psoriasis had an increased prevalence of pathological albuminuria (15.46 vs. 5.21%, P = 0.019), NAG (10.31 vs. 3.13%, P = 0.046), and RBP (9.28 vs. 2.08%, P = 0.031) compared with controls. PASI scores in patients with psoriasis correlated positively with 24-h albuminuria (χ 2 = 10.75, P = 0.005). CONCLUSIONS The prevalence of abnormal urinalysis was more common in patients with psoriasis than in controls. The positive correlation between the prevalence of pathological albuminuria and psoriasis severity may indicate a subclinical renal dysfunction in patients with psoriasis.
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Uwaezuoke SN. The role of novel biomarkers in predicting diabetic nephropathy: a review. Int J Nephrol Renovasc Dis 2017; 10:221-231. [PMID: 28860837 PMCID: PMC5566367 DOI: 10.2147/ijnrd.s143186] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the microvascular complications of the kidney arising commonly from type 1 diabetes mellitus (T1DM), and occasionally from type 2 diabetes mellitus (T2DM). Microalbuminuria serves as an early indicator of DN risk and a predictor of its progression as well as cardiovascular disease risk in both T1DM and T2DM. Although microalbuminuria remains the gold standard for early detection of DN, it is not a sufficiently accurate predictor of DN risk due to some limitations. Thus, there is a paradigm shift to novel biomarkers which would help to predict DN risk early enough and possibly prevent the occurrence of end-stage kidney disease. These new biomarkers have been broadly classified into glomerular biomarkers, tubular biomarkers, biomarkers of inflammation, biomarkers of oxidative stress, and miscellaneous biomarkers which also include podocyte biomarkers, some of which are also considered as tubular and glomerular biomarkers. Although they are potentially useful for the evaluation of DN, current data still preclude the routine clinical use of majority of them. However, their validation using high-quality and large longitudinal studies is of paramount importance, as well as the subsequent development of a biomarker panel which can reliably predict and evaluate this renal microvascular disease. This paper aims to review the predictive role of these biomarkers in the evaluation of DN.
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Affiliation(s)
- Samuel N Uwaezuoke
- Pediatric Nephrology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Aguiar P, Azevedo O, Pinto R, Marino J, Baker R, Cardoso C, Ducla Soares JL, Hughes D. New biomarkers defining a novel early stage of Fabry nephropathy: A diagnostic test study. Mol Genet Metab 2017; 121:162-169. [PMID: 28526293 DOI: 10.1016/j.ymgme.2017.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal involvement in Fabry disease is a major determinant of overall disease prognosis and early enzyme replacement therapy seems effective in preventing progression of kidney injury. Gb3 storage, glomerular sclerosis and tubulo-interstitial fibrosis may occur with minimal or no changes on standard renal tests, hence alternative markers of renal dysfunction are crucial. In this study we compared several biomarkers with albuminuria in the identification of incipient Fabry nephropathy and their diagnostic accuracy to identify chronic kidney disease (CKD) stage≥2. METHODS In this multicentre, prospective, cross-sectional and diagnostic test study, a cohort of 78 Fabry patients and 25 healthy controls was consecutively recruited. Patients were grouped by severity of nephropathy: 1) albuminuria<30mg/g; 2) albuminuria 30-299mg/g; 3) albuminuria>300mg/g; 4) glomerular filtration rate (GFR)<60mL/min/1.73m2. Several index tests, namely biomarkers of glomerular (transferrin and type IV collagen) and tubular (α1-microglobulin, N-acetyl-β-glucosaminidase and alanine aminopeptidase) dysfunction were compared with the reference standard (albuminuria). RESULTS Significant increase of all tested biomarkers in Fabry patients, even in the subgroup of patients without evidence of nephropathy. We also found inverse significant correlations between estimated GFR and collagen type IV (ρ=-0.289; p=0.003) or N-acetyl-β-glucosaminidase (ρ=-0.448; p<0.001), which were stronger than with albumin (ρ=-0.274; p=0.019). There was also better diagnostic accuracy of N-acetyl-β-glucosaminidase to predict CKD stage≥2. CONCLUSIONS These results suggest that studied biomarkers may overcome the limitations of albuminuria as sensitive marker of early renal dysfunction and as marker for CKD progression risk. These biomarkers may also define novel early stages of nephropathy characterized by mesangial expansion and/or tubular damage.
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Affiliation(s)
- Patrício Aguiar
- Medicine 1 Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
| | - Olga Azevedo
- Department of Cardiology, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Pinto
- JCS. Dr Joaquim Chaves, Lab Análises Clínicas, Miraflores, Portugal
| | - Jacira Marino
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
| | - Robert Baker
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
| | - Carlos Cardoso
- JCS. Dr Joaquim Chaves, Lab Análises Clínicas, Miraflores, Portugal
| | | | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
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Li Z, Xu Y, Liu X, Nie Y, Zhao Z. Urinary heme oxygenase-1 as a potential biomarker for early diabetic nephropathy. Nephrology (Carlton) 2017; 22:58-64. [PMID: 26733347 DOI: 10.1111/nep.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/24/2015] [Accepted: 12/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our previous study showed that increases of urinary heme oxygenase-1 (uHO-1) could be a potential biomarker indicating evaluating intrarenal oxidative damage in obstructive nephropathy. Activation of oxidative stress is an important mediator of diabetic nephropathy (DN). The aim of this study was to investigate the clinical implications of uHO-1 levels in patients with type 2 diabetes. METHODS Eighty-four type 2 diabetic patients with normoalbuminuria (n=28), microalbuminuria (n=28), and macroalbuminuria (n=28) were included in this study. Control samples were collected from healthy volunteers (n=28) who had normal albuminuria and renal function. Urine HO-1 levels were evaluated by enzyme-linked immunosorbent assay. RESULTS Urinary HO-1/creatinine (cr.) levels were significantly elevated in diabetic patients with microalbuminuria and macroalbuminuria compared to those in diabetic patients with normoalbuminuria (P<0.001) and control subjects (all P<0.001). In diabetic patients with normoalbuminuria, uHO-1/cr. levels were also higher than those in controls (P<0.001). Multivariate regression analyses revealed that uHO-1/cr. levels were positively correlated to urinary albumin/creatinine ratio and inversely correlated to glomerular filtration rate. Receiver operating characteristic (ROC) curve analysis of uHO-1/cr. levels for early diagnosis and detection of DN revealed that the cut-off value of uHO-1/cr. was 4.59 ng/mg (sensitivity 75%, specificity 78.6%). CONCLUSIONS The findings of this study indicate that increases of urine HO-1 levels can be detected in patients with type 2 diabetes before the onset of significant albuminuria, and associated with renal derangement in patients with established diabetic nephropathy. Urinary HO-1 may be used as an early biomarker for diabetic renal injury.
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Affiliation(s)
- Zhenzhen Li
- Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuliang Xu
- Department of Nephrology, the People's Hospital of Hebi, Hebi, China
| | - Xianghua Liu
- Center for Experimental Pathology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yali Nie
- Department of Pharmacology, School of Medicine, Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kim SR, Lee YH, Lee SG, Kang ES, Cha BS, Kim JH, Lee BW. Urinary N-acetyl-β-D-glucosaminidase, an early marker of diabetic kidney disease, might reflect glucose excursion in patients with type 2 diabetes. Medicine (Baltimore) 2016; 95:e4114. [PMID: 27399115 PMCID: PMC5058844 DOI: 10.1097/md.0000000000004114] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/30/2016] [Accepted: 06/10/2016] [Indexed: 12/17/2022] Open
Abstract
Recently, several renal tubular damage markers have gained considerable attention because of their clinical implications as sensitive and specific biomarkers for early stage diabetic kidney disease. However, little is known about the demographic and glucometabolic factors affecting levels of urinary N-acetyl-β-D-glucosaminidase (NAG), a marker of proximal tubular damage, in type 2 diabetes mellitus (T2DM).The aim of this study was to investigate the clinical relevance of urinary NAG with regard to demographic and glucometabolic parameters, as well as nephropathic parameters, by comparing the glomerulopathic marker of albuminuria.In this retrospective cross-sectional study, we enrolled a total of 592 patients with either prediabetes (N = 29) or T2DM (N = 563). Glucometabolic parameters (glucose, hemoglobin A1c, glycated albumin [GA], insulin, C-peptide, homeostasis model assessment [HOMA] of insulin resistance, HOMA-β, postprandial C-peptide-to-glucose ratio [PCGR], and urinary glucose-to-creatinine ratio) and nephropathic parameters (urinary NAG, albumin-to-creatinine ratio [ACR], and estimated glomerular filtration rate) were measured.The levels of urinary NAG showed moderate positive correlation with the levels of urinary ACR in T2DM (r = 0.46). In correlation analysis, urinary NAG was more strongly correlated with body mass index (BMI) (r = -0.22; P < 0.001 vs. r = -0.02; P = 0.74), plasma stimulated glucose (r = 0.25; P < 0.001 vs. r = 0.08; P = 0.10), GA (r = 0.20; P < 0.001 vs. r = 0.13; P = 0.01), PCGR (r = -0.17; P = 0.001 vs. r = -0.09; P = 0.11), and HOMA-β (r = -0.10; P = 0.05 vs. r = -0.02; P = 0.79) than urinary ACR. In multiple regression analysis, age, lower BMI, stimulated glucose, GA, and urinary ACR predicted increased urinary NAG.In conclusion, increase in urinary NAG may be related to glycemic parameters reflecting glucose fluctuation and decreased insulin secretory capacity in patients with T2DM. Further longitudinal, prospective studies are needed to investigate a causal relationship between glucose fluctuations, renal tubular damage, and other vascular complications of diabetes.
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Affiliation(s)
- So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine
- Severance Hospital
| | - Yong-ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine
- Severance Hospital
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine
- Severance Hospital
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine
- Severance Hospital
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Graduate School, Yonsei University College of Medicine
- Severance Hospital
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Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, Kaycsa A, Timar B. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy. J Diabetes Res 2016; 2016:4626125. [PMID: 27413755 PMCID: PMC4927990 DOI: 10.1155/2016/4626125] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022] Open
Abstract
Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition-mainly cardiovascular ones-and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new "gold standard" biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN.
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Affiliation(s)
- Cristina Gluhovschi
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
- *Cristina Gluhovschi:
| | | | - Ligia Petrica
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Silvia Velciov
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Adriana Kaycsa
- Department of Biochemistry, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
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Abstract
Diabetic nephropathy (DN), a leading cause of end-stage renal disease (ESRD) affecting ∼20-30% diabetics, is associated with increased cardiovascular mortality. The progression of kidney disease in patients with diabetes can take many years. It occurs as a result of interaction between both genetic and environmental factors in individuals with both type 1 and type 2 diabetes. Hyperglycaemia, hypertension, and genetic pre-disposition are the main risk factors besides elevated serum lipids, smoking habits, and the amount of dietary proteins. Interventions such as glycaemic control, blood pressure control and inhibition of the renin-angiotensin-aldosterone system have been shown to slow this progression. Despite the implementation of these strategies, the number of patients with diabetes that ultimately develop end-stage renal disease remains high. The treatment of DN, therefore, has posed a formidable challenge besides optimization of renin-angiotensin-aldosterone system blockade in patients with DN; additional investigation has focused on the potential of novel therapies that target various pathways upregulated by hyperglycaemia or other targets believed to promote the progression of DN such as oxidative stress, inflammation, endothelin system and vitamin D receptors. This review article addresses the pathogenesis and some of the well established principles regarding the progression and accepted management of DN, and also includes the perspectives of novel anti-DN agents and the future directions for the prevention of DN.
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Affiliation(s)
- Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India.
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Efficacy of urinary N-acetyl-β-D-glucosaminidase to evaluate early renal tubular damage as a consequence of type 2 diabetes mellitus: a cross-sectional study. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0404-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Brott DA, Furlong ST, Adler SH, Hainer JW, Arani RB, Pinches M, Rossing P, Chaturvedi N. Characterization of renal biomarkers for use in clinical trials: effect of preanalytical processing and qualification using samples from subjects with diabetes. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:3191-8. [PMID: 26124642 PMCID: PMC4482374 DOI: 10.2147/dddt.s78792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Identifying the potential for drug-induced kidney injury is essential for the successful research and development of new drugs. Newer and more sensitive preclinical drug-induced kidney injury biomarkers are now qualified for use in rat toxicology studies, but biomarkers for clinical studies are still undergoing qualification. The current studies investigated biomarkers in healthy volunteer (HV) urine samples with and without the addition of stabilizer as well as in urine from patients with normoalbuminuric diabetes mellitus (P-DM). METHODS Urine samples from 20 male HV with stabilizer, 69 male HV without stabilizer, and 95 male DM without stabilizer (39 type 1 and 56 type 2) were analyzed for the following bio-markers using multiplex assays: α-1-microglobulin (A1M), β-2-microglobulin, calbindin, clusterin, connective tissue growth factor (CTGF), creatinine, cystatin-C, glutathione S-transferase α (GSTα), kidney injury marker-1 (KIM-1), microalbumin, neutrophil gelatinase-associated lipocalin, osteopontin, Tamm-Horsfall urinary glycoprotein (THP), tissue inhibitor of metalloproteinase 1, trefoil factor 3 (TFF3), and vascular endothelial growth factor. RESULTS CTGF and GSTα assays on nonstabilized urine were deemed nonoptimal (>50% of values below assay lower limits of quantification). "Expected values" were determined for HV with stabilizer, HV without stabilizer, and P-DM without stabilizer. There was a statistically significant difference between HV with stabilizer compared to HV without stabilizer for A1M, CTGF, GSTα, and THP. DM urine samples differed from HV (without stabilizer) for A1M CTGF, GSTα, KIM-1, microalbumin, osteopontin, and TFF3. A1M also correctly identified HV and DM with an accuracy of 89.0%. SUMMARY These studies: 1) determined that nonstabilized urine can be used for assays under qualification; and 2) documented that A1M, CTGF, GSTα, KIM-1, microalbumin, osteopontin, and TFF3 were significantly increased in urine from P-DM. In addition, the 89.0% accuracy of A1M in distinguishing P-DM from HV may allow this biomarker to be used to monitor efficacy of potential renal protective agents.
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Affiliation(s)
| | | | | | | | | | - Mark Pinches
- Drug Safety and Metabolism, AstraZeneca Pharmaceuticals, Alderley Park, UK
| | - Peter Rossing
- Steno Diabetes Center, Gentofte, Denmark ; Aarhus University, Aarhus, Denmark ; University of Copenhagen, Denmark
| | - Nish Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
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Satirapoj B, Tassanasorn S, Charoenpitakchai M, Supasyndh O. Periostin as a tissue and urinary biomarker of renal injury in type 2 diabetes mellitus. PLoS One 2015; 10:e0124055. [PMID: 25884625 PMCID: PMC4401767 DOI: 10.1371/journal.pone.0124055] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving the early detection of diabetic nephropathy remains a great challenge in disease management. Periostin is a marker of renal tubular injury and related to progressive kidney injury in animal models of chronic kidney disease. The clinical implications of urinary periostin activities in patients with type 2 diabetes have not been evaluated. METHODS Urine samples were obtained from 30 healthy volunteers and 328 type 2 diabetic patients with normoalbuminuria (n=114), microalbuminuria (n=100) and macroalbuminuria (n=114). The excretion levels of urinary periostin were quantified with enzyme-linked immunosorbent assay. Immunohistochemical periostin expression was determined in kidney tissues from overt diabetic nephropathy. RESULTS Increased periostin expression in glomeruli and tubular epithelium in diabetic renal pathology was observed. Urinary periostin levels were significantly elevated in the patients of the normoalbuminuria [3.06 (IQR: 1.12, 6.77) ng/mgCr], microalbuminuria [8.71 (IQR: 5.09, 19.29) ng/mgCr] and macroalbuminuria [13.58 (IQR: 3.99, 16.19) ng/mgCr] compared with healthy controls [1.15 (IQR: 0.60, 1.63) ng/mgCr] (P<0.01).Increased urine periostin level significantly correlated with aging, high albuminuria and decline of GFR. Urine periostin ELISA also demonstrated high performance for the diagnosis of established normoalbuminuric, microalbuminuric and macroalbuminuric type 2 diabetes (AUC 0.78 (95%CI, 0.71 to 0.86), 0.99 (95%CI, 0.98 to 1.00) and 0.95 (95%CI, 0.91 to 0.98), respectively). CONCLUSION The study indicates that increased urine periostin levels can be detected in patients with type 2 diabetes before the onset of significant albuminuria. Urinary periostin is an associated renal derangement in patients with established diabetic nephropathy and it may be used as an early marker of diabetic renal injury.
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Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Surat Tassanasorn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Huang GM, Huang KY, Lee TY, Weng J. An interpretable rule-based diagnostic classification of diabetic nephropathy among type 2 diabetes patients. BMC Bioinformatics 2015; 16 Suppl 1:S5. [PMID: 25707942 PMCID: PMC4331704 DOI: 10.1186/1471-2105-16-s1-s5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The prevalence of type 2 diabetes is increasing at an alarming rate. Various complications are associated with type 2 diabetes, with diabetic nephropathy being the leading cause of renal failure among diabetics. Often, when patients are diagnosed with diabetic nephropathy, their renal functions have already been significantly damaged. Therefore, a risk prediction tool may be beneficial for the implementation of early treatment and prevention. Results In the present study, we developed a decision tree-based model integrating genetic and clinical features in a gender-specific classification for the identification of diabetic nephropathy among type 2 diabetic patients. Clinical and genotyping data were obtained from a previous genetic association study involving 345 type 2 diabetic patients (185 with diabetic nephropathy and 160 without diabetic nephropathy). Using a five-fold cross-validation approach, the performance of using clinical or genetic features alone in various classifiers (decision tree, random forest, Naïve Bayes, and support vector machine) was compared with that of utilizing a combination of attributes. The inclusion of genetic features and the implementation of an additional gender-based rule yielded better classification results. Conclusions The current model supports the notion that genes and gender are contributing factors of diabetic nephropathy. Further refinement of the proposed approach has the potential to facilitate the early identification of diabetic nephropathy and the development of more efficient treatment in a clinical setting.
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Currie G, McKay G, Delles C. Biomarkers in diabetic nephropathy: Present and future. World J Diabetes 2014; 5:763-776. [PMID: 25512779 PMCID: PMC4265863 DOI: 10.4239/wjd.v5.i6.763] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetic nephropathy (DN) is the leading cause of end stage renal disease in the Western world. Microalbuminuria (MA) is the earliest and most commonly used clinical index of DN and is independently associated with cardiovascular risk in diabetic patients. Although MA remains an essential tool for risk stratification and monitoring disease progression in DN, a number of factors have called into question its predictive power. Originally thought to be predictive of future overt DN in 80% of patients, we now know that only around 30% of microalbuminuric patients progress to overt nephropathy after 10 years of follow up. In addition, advanced structural alterations in the glomerular basement membrane may already have occurred by the time MA is clinically detectable.Evidence in recent years suggests that a significant proportion of patients with MA can revert to normoalbuminuria and the concept of nonalbuminuric DN is well-documented, reflecting the fact that patients with diabetes can demonstrate a reduction in glomerular filtration rate without progressing from normo-to MA. There is an unmet clinical need to identify biomarkers with potential for earlier diagnosis and risk stratification in DN and recent developments in this field will be the focus of this review article.
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Paepe D, Ghys LFE, Smets P, Lefebvre HP, Croubels S, Daminet S. Routine kidney variables, glomerular filtration rate and urinary cystatin C in cats with diabetes mellitus, cats with chronic kidney disease and healthy cats. J Feline Med Surg 2014; 17:880-8. [DOI: 10.1177/1098612x14559788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives Diabetic kidney disease (DKD) is a frequent and serious complication in human diabetic patients, but data are limited in cats. This study was undertaken to assess whether diabetic cats are susceptible to DKD. Methods Kidney function was compared between 36 cats with diabetes mellitus (DM), 10 cats with chronic kidney disease (CKD) and 10 age-matched healthy cats by measuring routine kidney variables (serum creatinine [sCreat], serum urea [sUrea], urine specific gravity [USG], urinary protein:creatinine ratio [UPC]), urinary cystatin C:creatinine ratio and glomerular filtration rate (GFR). Urinary cystatin C (uCysC) was measured with a human particle-enhanced nephelometric immunoassay, validated to measure feline cystatin C, in all but two diabetic cats. GFR was evaluated by exo-iohexol clearance in 17 diabetic cats, all cats with CKD and all healthy cats. Results Diabetic cats had significantly (mean ± SD) lower sCreat (123 ± 38 vs 243 ± 80 µmol/l), sUrea (11 ± 3 vs 18 ± 7 mmol/l) and urinary cystatin C:creatinine ratio (6 ± 31 vs 173 ± 242 mg/mol), and a significantly higher USG (1.033 ± 0.012 vs 1.018 ± 0.006) and GFR (2.0 ± 0.7 vs 0.8 ± 0.3 ml/min/kg) compared with cats with CKD. Compared with healthy cats, diabetic cats only had significantly lower USG (1.033 ± 0.012 vs 1.046 ± 0.008). Proteinuria (UPC >0.4) was present in 39% of diabetic cats, in 30% of cats with CKD and in none of the healthy cats. However, the UPC did not differ statistically between the three groups. Conclusions and relevance Based on evaluation of routine kidney variables, GFR and uCysC as a tubular marker at a single time point, a major impact of feline DM on kidney function could not be demonstrated.
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Affiliation(s)
- Dominique Paepe
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Liesbeth FE Ghys
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pascale Smets
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hervé P Lefebvre
- University of Toulouse, INP, National Toulouse Veterinary School, Clinical Research Unit, Toulouse, France
| | - Siska Croubels
- Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sylvie Daminet
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Bouvet BR, Paparella CV, Arriaga SMM, Monje AL, Amarilla AM, Almará AM. Evaluation of urinary N-acetyl-beta-D-glucosaminidase as a marker of early renal damage in patients with type 2 diabetes mellitus. ACTA ACUST UNITED AC 2014; 58:798-801. [PMID: 25465599 DOI: 10.1590/0004-2730000003010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion for the detection of early tubular damage in type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS Thirty six patients with T2DM were divided into two groups based on urinary albumin to creatinine ratio (ACR): normoalbuminuria (ACR <30 mg/g; n=19) and microalbuminuria (ACR =30-300 mg/g; n=17). The following parameters were determined in both groups: urinary NAG and albumin, serum and urine creatinine, fasting plasma glucose and glycated hemoglobin (HbA1c). RESULTS Urinary NAG levels [Units/g creatinine; median (range)] were significantly increased in microalbuminuria group [17.0 (5.9 - 23.3)] compared to normoalbuminuria group [4.4 (1.5 - 9.2)] (P<0.001). No differences between groups were observed in fasting glucose, HbA1c, serum creatinine levels and estimated glomerular filtration rates (eGFR). Urinary NAG positively correlated with ACR (r=0.628; p<0.0001), while no significant association was observed between NAG and glycemia, HbA1c, serum creatinine and eGFR. CONCLUSIONS The increase of urinary NAG at the microalbuminuria stage of diabetic nephropathy (DN) suggests that tubular dysfunction is already present in this period. The significant positive association between urinary NAG excretion and ACR indicates the possible clinical application of urinary NAG as a complementary marker for early detection of DN in T2DM.
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Affiliation(s)
- Beatriz R Bouvet
- Clinical Biochemistry Department, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Cecilia V Paparella
- Clinical Biochemistry Department, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Sandra M M Arriaga
- Clinical Biochemistry Department, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Adriana L Monje
- Nephrology Service, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Ana M Amarilla
- Clinical Biochemistry Department, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Adriana M Almará
- Clinical Biochemistry Department, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
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Park SE, Lee NS, Park JW, Rhee EJ, Lee WY, Oh KW, Park SW, Park CY, Youn BS. Association of urinary RBP4 with insulin resistance, inflammation, and microalbuminuria. Eur J Endocrinol 2014; 171:443-9. [PMID: 24994759 DOI: 10.1530/eje-14-0247] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Serum concentrations of retinol-binding protein 4 (RBP4) are elevated in type 2 diabetes and associated with the severity of insulin resistance; however, there are few data about the relationship between urinary RBP4 levels and metabolic parameters. We assessed urinary RBP4 as a new biomarker by establishing its relationship with clinical parameters associated with insulin resistance and urinary albumin excretion. DESIGN AND METHODS We measured RBP4 in the serum and urine of 689 subjects with diverse glucose tolerance status. We also evaluated the relationship between urinary RBP4 and cardiometabolic risk factors, including insulin resistance, high-sensitivity C-reactive protein (hsCRP), arterial stiffness, and microalbuminuria. RESULTS Urinary RBP4 levels were higher in insulin-resistant subjects with prediabetes or type 2 diabetes than in subjects with normal glucose tolerance (NGT) (type 2 diabetes>prediabetes>NGT; all P<0.001). Urinary RBP4 correlated strongly with homeostasis model assessments of insulin resistance (HOMA-IR), fasting glucose, triglycerides, blood pressure, hsCRP, arterial stiffness, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio (all P<0.01). HOMA-IR and arterial stiffness were found to be independent determinants of urinary RBP4 concentration. Furthermore, urinary RBP4 was highly predictive of microalbuminuria (odds ratio 2.6, 95% CI 1.6-4.2), even after adjustment for other metabolic parameters. The area under the ROC curve for urinary RBP4 to detect the presence of microalbuminuria was 0.80±0.02 (95% CI 0.76-0.84) and the cut-off value was 157.01 μg/gCr. CONCLUSIONS Urinary RBP4 concentrations were elevated in patients with dysregulation of glucose metabolism and were related to various cardiometabolic risk factors including insulin resistance, inflammation, and microalbuminuria.
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Affiliation(s)
- Se Eun Park
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Nam Seok Lee
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Ji Woo Park
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Won-Young Lee
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Ki-Won Oh
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Sung-Woo Park
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
| | - Byung-Soo Youn
- Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea Division of Endocrinology and MetabolismDepartment of Internal medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaAdipoGen, Inc.Room 401, Venture Building B, Songdo Technopark, 7-50 Songdo-dong, Yeonsu-gu, Incheon, Republic of KoreaDepartment of AnatomyWonkwang University School of Medicine, #22 Wonkwang Daehak-ro, Iksan, Jeollabuk-do 570-749, Republic of KoreaOsteoNeuroGen 40 MiKeum-ROBundang-Gu, Sungnam-City, Gyeonggi-do 461-871, Republic of Korea
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Figueira MF, Monnerat-Cahli G, Medei E, Carvalho AB, Morales MM, Lamas ME, da Fonseca RN, Souza-Menezes J. MicroRNAs: potential therapeutic targets in diabetic complications of the cardiovascular and renal systems. Acta Physiol (Oxf) 2014; 211:491-500. [PMID: 24837225 DOI: 10.1111/apha.12316] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/27/2014] [Accepted: 05/12/2014] [Indexed: 12/28/2022]
Abstract
Diabetes mellitus is a serious health problem that can lead to several pathological complications in numerous organs and tissues. The most important and most prevalent organs affected by this disease are the heart and the kidneys, and these complications are the major causes of death in patients with diabetes. MicroRNAs (miRNAs), short non-coding RNAs, have been found to be functionally important in the regulation of several pathological processes, and they are emerging as an important therapeutic tool to avoid the complications of diabetes mellitus. This review summarizes the knowledge on the effects of miRNAs in diabetes. The use of miRNAs in diabetes from a clinical perspective is also discussed, focusing on their potential role to repair cardiovascular and renal complications.
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Affiliation(s)
- M. F. Figueira
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
- Laboratório Integrado de Ciências Morfofuncionais; Núcleo em Ecologia e Desenvolvimento Sócio-Ambiental de Macaé; Centro de Ciências da Saúde; Universidade Federal do Rio de Janeiro; Macaé Brazil
| | - G. Monnerat-Cahli
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - E. Medei
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - A. B. Carvalho
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - M. M. Morales
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - M. E. Lamas
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - R. N. da Fonseca
- Laboratório Integrado de Ciências Morfofuncionais; Núcleo em Ecologia e Desenvolvimento Sócio-Ambiental de Macaé; Centro de Ciências da Saúde; Universidade Federal do Rio de Janeiro; Macaé Brazil
| | - J. Souza-Menezes
- Centro de Ciências da Saúde; Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
- Laboratório Integrado de Ciências Morfofuncionais; Núcleo em Ecologia e Desenvolvimento Sócio-Ambiental de Macaé; Centro de Ciências da Saúde; Universidade Federal do Rio de Janeiro; Macaé Brazil
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Jha JC, Jandeleit-Dahm KA, Cooper ME. New insights into the use of biomarkers of diabetic nephropathy. Adv Chronic Kidney Dis 2014; 21:318-26. [PMID: 24780461 DOI: 10.1053/j.ackd.2014.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/05/2014] [Accepted: 03/10/2014] [Indexed: 12/21/2022]
Abstract
Diabetic nephropathy (DN) is a major microvascular complication of diabetes characterized by increasing albuminuria and progressive loss of kidney function. Increased excretion of albumin into the urine is a key feature of DN, and its assessment is considered to be an early marker predicting the onset and progression of DN. However, albuminuria has certain limitations; therefore, the quest for more reliable renal biomarkers with higher sensitivity and specificity are needed for early prediction of the onset and monitoring of the progression of DN. Furthermore, such biomarkers may also provide a better insight into identifying the complex pathophysiological processes responsible for DN. This article aims to provide a comprehensive and critical review of the current literature on relevant biomarkers of kidney injury, including markers of renal fibrosis, inflammation, and oxidative stress, as well as addressing contemporary proteomic approaches.
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Moresco RN, Sangoi MB, De Carvalho JAM, Tatsch E, Bochi GV. Diabetic nephropathy: traditional to proteomic markers. Clin Chim Acta 2013; 421:17-30. [PMID: 23485645 DOI: 10.1016/j.cca.2013.02.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/06/2013] [Accepted: 02/09/2013] [Indexed: 01/11/2023]
Abstract
Diabetic nephropathy (DN) is one of the major microvascular complications of diabetes and it is defined as a rise in the urinary albumin excretion (UAE) rate and abnormal renal function. Currently, changes in albuminuria are considered a hallmark of onset or progression of DN. However, some patients with diabetes have advanced renal pathological changes and progressive kidney function decline even if urinary albumin levels are in the normal range, indicating that albuminuria is not the perfect marker for the early detection of DN. The present article provides an overview of the literature reporting some relevant biomarkers that have been found to be associated with DN and that potentially may be used to predict the onset and/or monitor the progression of nephropathy. In particular, biomarkers of renal damage, inflammation, and oxidative stress may be useful tools for detection at an early stage or prediction of DN. Proteomic-based biomarker discovery represents a novel strategy to improve diagnosis, prognosis and treatment of DN; however, proteomics-based approaches are not yet available in most of the clinical chemistry laboratories. The use of a panel with a combination of biomarkers instead of urinary albumin alone seems to be an interesting approach for early detection of DN, including markers of glomerular damage (e.g., albumin), tubular damage (e.g., NAG and KIM-1), inflammation (e.g., TNF-α) and oxidative stress (e.g., 8-OHdG) because these mechanisms contribute to the development and outcomes of this disease.
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Affiliation(s)
- Rafael N Moresco
- Laboratório de Pesquisa em Bioquímica Clínica, Departamento de Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
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Urinary beta-2 microglobulin and alpha-1 microglobulin are useful screening markers for tenofovir-induced kidney tubulopathy in patients with HIV-1 infection: a diagnostic accuracy study. J Infect Chemother 2013; 19:850-7. [DOI: 10.1007/s10156-013-0576-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/14/2013] [Indexed: 12/25/2022]
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Spasovski D, Latifi A, Marina N, Calovski J, Kafedziska I, Božinovski G, Percinkova S, Slaninka-Micevska M, Balkanov T, Dejanova B, Alabakovska S, Krstevska-Balkanov S, Spasovski G, Spasovski D. Symmetric dimethyl arginine and N-acetyl-β-D-glucosaminidase lysozimuria of proximal renal tubules as a target for nephrotoxicity in patients with rheumatoid arthritis treated with disease modifying antirheumatic drugs. J Nephropathol 2013; 2:36-52. [PMID: 24475424 DOI: 10.5812/nephropathol.8989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 09/30/2012] [Accepted: 09/20/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the effect of initial therapy with some disease modifying antirheumatic drugs (DMARDs) (Methotrexate and Ketoprofen) on glomerular and tubular integrity in patients with Rheumatoid arthritis (RA). OBJECTIVES OBJECTIVES To determine whether there is a change in clinical and laboratory indicators of renal function in course of the follow up of treatment and whether that change correlates with the dynamics of the quantity of enzymes excreted in urine and reactants of the acute phase. MATERIALS AND METHODS Using colorimetric method for determination of NAG, samples of 70 participants were examined (35 RA patients treated with Ketoprofen only, 35 RA patients treated with combined use of Methotrexate and Ketoprofen). The follow up was 5 time-intervals in the course of 24 weeks. RESULTS There was moderate correlation between NAG and microalbuminuria (r=0,34) in the group of patients treated with Ketoprofen only, while statistically significant correlation (r=0,21) was seen in group of patients with combined use of Methotrexate and Ketoprofen. NAG enzymuria in size, number of patients registered, and time of appearance were greater and appears earlier in the group with the combined use of Methotrexate and Ketoprofen compared with the mono-therapy with Ketoprofen. Mean urinary NAG induction was increasing with the concomitant use of Methotrexate and Ketoprofen. CONCLUSIONS Methotrexate is more potent NAG inductor than Ketoprofen and provokes greater tubular enzymuria than Ketoprofen.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Dejan Spasovski
- Department of Rheumatology, University Clinical Centre, Skopje, Republic of Macedonia
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Increased urinary excretion of albumin, hemopexin, transferrin and VDBP correlates with chronic sensitization to gentamicin nephrotoxicity in rats. Toxicology 2012; 304:83-91. [PMID: 23261757 DOI: 10.1016/j.tox.2012.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 02/06/2023]
Abstract
Drug nephrotoxicity is a serious health and economic problem worldwide. Rats can be acutely sensitized to acute kidney injury (AKI) by subnephrotoxic treatments with potentially nephrotoxic drugs. Acquired sensitization to AKI poses a silent risk impossible to diagnose pre-emptively with the technology available at the clinical level. Herein, we hypothesized whether a chronic, subnephrotoxic insult to the kidneys might result in chronically acquired sensitization to AKI, and whether chronic sensitization might be detected through specific urinary markers. To this end, rats were treated with a subtoxic dosage of the experimental nephrotoxin uranyl nitrate (UN) in the drinking water for 21 weeks, or plain water (as control), and then with low-dose gentamicin for 7 days. Renal function and renal tissue damage were evaluated through the experiment. The mild renal damage caused by gentamicin was markedly magnified in rats having received UN chronically, which was evident both at the functional and histological level. Four proteins, namely albumin, hemopexin, transferrin and vitamin D binding protein were increased in the urine in temporal association with the appearance of chronic predisposition. Although further studies are necessary, our results suggest that these proteins might be potentially used as markers of hidden, chronic predisposition to gentamicin nephrotoxicity, in order to appropriately and pre-emptively stratify and handle individuals according to their specific risk in the long term, and to conveniently optimize their life conditions or additional clinical procedures or treatments that might trigger the disease. This might reduce AKI incidence and severity and the associated costs.
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Choi SA, Yun JW, Park HS, Choi JW. Hypoglycemic dipeptide cyclo (His-Pro) significantly altered plasma proteome in streptozocin-induced diabetic rats and genetically-diabetic (ob/ob) mice. Mol Biol Rep 2012; 40:1753-65. [DOI: 10.1007/s11033-012-2229-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022]
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Delineating the degree of association between biomarkers of arsenic exposure and type-2 diabetes mellitus. Int J Hyg Environ Health 2012; 216:35-49. [PMID: 22920650 DOI: 10.1016/j.ijheh.2012.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/01/2012] [Accepted: 07/04/2012] [Indexed: 01/18/2023]
Abstract
Non-carcinogenic effects in low-level (< 100 μgL(-1)) arsenic (As)-impacted populations, such as the development and progression of type-2 diabetes mellitus (T2DM), are often neglected given the primary emphasis of public health authorities on As carcinogenicity. We gathered studies reporting urinary biomarkers of As exposure (U-As) and biomarkers associated with T2DM and its complications (U-T2DM), such as renal damage, oxidation stress, low-grade inflammation, and endothelial damage. Studied U-T2DM biomarkers were: 8-hydroxy-2'deoxyguanosine, N-acetyl-β-d-glucosaminidase, β2-microglobulin, and albumin. Data was expressed as: either arithmetic means and standard deviations, or geometric means and geometric standard deviations, or correlation coefficients of U-As and U-T2DM. Urinary As concentrations were consistently associated with the aforementioned biomarkers of T2DM pathologic complications. Despite the limited selectivity of the selected T2DM biomarkers, a per unit change in As exposure level was reflected in the corresponding T2DM biomarker urinary concentrations. Our systematic review provides new evidence on the role of environmental As exposures influencing the T2DM disease process. Additional epidemiologic studies onto the association between As and T2DM should incorporate both urinary As and T2DM biomarkers, as suggested in this study, in order to evaluate subclinical effects of low-level As exposures.
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Stødkilde L, Madsen MG, Palmfeldt J, Topcu SO, Nørregaard R, Olsen LH, Jørgensen TM, Frøkiær J. Urinary proteome analysis in congenital bilateral hydronephrosis. Scand J Urol 2012; 47:43-51. [PMID: 22891811 DOI: 10.3109/00365599.2012.708669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A proteomics strategy was applied to map protein changes in urine after relief of congenital bilateral hydronephrosis to identify proteins correlated with the pathophysiological processes in congenital obstructive nephropathy as potential urinary biomarkers. MATERIAL AND METHODS Urine samples from 10 infants with bilateral abnormal drainage from the kidneys were collected at the time of relief from obstruction, and after 2 and 4 weeks. Proteomics techniques were used on samples from three patients for identification of protein changes between the three time-points, and enzyme-linked immunosorbent assay (ELISA) was used on samples from all 10 patients for validation of five selected proteins. RESULTS Mass spectrometry quantified 315 protein hits, out of which 33 proteins showed significantly changed urinary excretion between the time-points. Validation by ELISA showed high urinary excretion of fibrinogen, plasminogen, transthyretin and transferrin at the time of relief from obstruction, followed by a significant reduction. In contrast, Tamm-Horsfall protein exhibited the reverse pattern. CONCLUSION Using a mass spectrometry-based proteomics approach, this study identified 33 proteins related to congenital bilateral hydronephrosis, and pinpointed a panel of five proteins consistently linked to this congenital kidney disorder as potential urinary biomarkers.
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Affiliation(s)
- Lene Stødkilde
- The Water and Salt Research Center, Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Korrapati MC, Shaner BE, Neely BA, Alge JL, Arthur JM, Schnellmann RG. Diabetes-induced renal injury in rats is attenuated by suramin. J Pharmacol Exp Ther 2012; 343:34-43. [PMID: 22736507 DOI: 10.1124/jpet.112.196964] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Progression of hyperglycemia-induced renal injury is a contributing factor for diabetic nephropathy (DN)-induced end-stage renal disease (ESRD), and development of novel therapeutic strategies that act early to prevent progression of DN and ESRD are important. We examined the efficacy and mechanism(s) of suramin on hyperglycemia-induced renal injury before development of overt histological damage. Two groups of male Sprague-Dawley rats received streptozotocin (STZ) and one group received saline. Three weeks later, one STZ group received suramin (10 mg/kg). All animals were euthanized 1 week later (4 weeks). Although there was a decrease in creatinine clearance between control and STZ ± suramin rats, there was no difference in creatinine clearance between STZ rats ± suramin intervention. Liquid chromatography-tandem mass spectroscopy-based analysis revealed increases in urinary proteins that are early indicators of DN (e.g., cystatin C, clusterin, cathepsin B, retinol binding protein 4, and peroxiredoxin-1) in the STZ group, which were blocked by suramin. Endothelial intracellular adhesion molecule-1 (ICAM-1) activation, leukocyte infiltration, and inflammation; transforming growth factor-β1 (TGF-β1) signaling; TGF-β1/SMAD-3-activated fibrogenic markers fibronectin-1, α-smooth muscle actin, and collagen 1A2; activation of proinflammatory and profibrotic transcription factors nuclear factor-κB (NF-κB) and signal transducer and activator of transcription factor-3 (STAT-3), respectively, were all increased in STZ rats and suramin blocked these changes. In conclusion, delayed administration of suramin attenuated 1) urinary markers of DN, 2) inflammation by blocking NF-κB activation and ICAM-1-mediated leukocyte infiltration, and 3) fibrosis by blocking STAT-3 and TGF-β1/SMAD-3 signaling. These results support the potential use of suramin in DN.
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Affiliation(s)
- Midhun C Korrapati
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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Urinary markers of glomerular injury in diabetic nephropathy. Int J Nephrol 2012; 2012:146987. [PMID: 22645683 PMCID: PMC3356892 DOI: 10.1155/2012/146987] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 02/20/2012] [Indexed: 12/15/2022] Open
Abstract
Diabetic nephropathy, the leading cause of renal failure worldwide, affects approximately one-third of all people with diabetes. Microalbuminuria is considered the first sign and the best predictor of progression to renal failure and cardiovascular events. However, albuminuria has several limitations. Therefore, earlier, more sensitive and specific biomarkers with greater predictability are needed. The aim of this paper is to discuss the current literature on biomarkers of glomerular injury that have been implicated in diabetic kidney disease.
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Differential proteome profiling using iTRAQ in microalbuminuric and normoalbuminuric type 2 diabetic patients. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:168602. [PMID: 22536212 PMCID: PMC3318901 DOI: 10.1155/2012/168602] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 10/27/2011] [Accepted: 11/22/2011] [Indexed: 11/17/2022]
Abstract
Diabetic nephropathy (DN) is a long-term complication of diabetes mellitus that leads to end-stage renal disease. Microalbuminuria is used for the early detection of diabetic renal damage, but such levels do not reflect the state of incipient DN precisely in type 2 diabetic patients because microalbuminuria develops in other diseases, necessitating more accurate biomarkers that detect incipient DN. Isobaric tags for relative and absolute quantification (iTRAQ) were used to identify urinary proteins that were differentially excreted in normoalbuminuric and microalbuminuric patients with type 2 diabetes where 710 and 196 proteins were identified and quantified, respectively. Some candidates were confirmed by 2-DE analysis, or validated by Western blot and multiple reaction monitoring (MRM). Specifically, some differentially expressed proteins were verified by MRM in urine from normoalbuminuric and microalbuminuric patients with type 2 diabetes, wherein alpha-1-antitrypsin, alpha-1-acid glycoprotein 1, and prostate stem cell antigen had excellent AUC values (0.849, 0.873, and 0.825, resp.). Moreover, we performed a multiplex assay using these biomarker candidates, resulting in a merged AUC value of 0.921. Although the differentially expressed proteins in this iTRAQ study require further validation in larger and categorized sample groups, they constitute baseline data on preliminary biomarker candidates that can be used to discover novel biomarkers for incipient DN.
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Hassan SB, Hanna MOF. Urinary κ and λ immunoglobulin light chains in normoalbuminuric type 2 diabetes mellitus patients. J Clin Lab Anal 2012; 25:229-32. [PMID: 21786323 DOI: 10.1002/jcla.20463] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIM Kidney disease is one of the major chronic microvascular complications of diabetes. Tubular involvement may precede glomerular involvement and the appearance of microalbuminuria. The aim of the study was to evaluate quantitatively immunoglobulin light chains (IgLCs), kappa and lambda excretion in the urine of patients with type 2 diabetes mellitus with normoalbuminuria and with microalbuminuria compared to control group. RESULTS Urinary IgLCs levels of the control group were significantly lower than diabetic patients with normoalbuminuria and diabetic patients with albuminuria. IgLCs were significantly associated with the duration of disease and negatively with estimated glomerular filtration rate. CONCLUSION Type 2 diabetic patients can have significantly raised concentrations of urinary IgLCs before microalbuminuria or renal disease occurs. Further investigations are recommended to assess LC evaluation in the early management of diabetic renal disease.
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Affiliation(s)
- S B Hassan
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wu R, Yeung WSB, Fung YS. 2-D t-ITP/CZE determination of clinical urinary proteins using a microfluidic-chip capillary electrophoresis device. Electrophoresis 2011; 32:3406-14. [DOI: 10.1002/elps.201100214] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Proteomic identification of vanin-1 as a marker of kidney damage in a rat model of type 1 diabetic nephropathy. Kidney Int 2011; 80:272-81. [DOI: 10.1038/ki.2011.116] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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