Early Markers for Diabetic Nephropathy in Urine of Type 2 Diabeticsin Southern Gaza Strip

Abstract

Diabetic nephropathy represents one of the major problems developed in Diabetics that eventually lead to renal failure. By time the kidneys performs dysfunctional progression from hyperfiltration to micro-to macroalbuminuria to renal failure, hence the onset of diabetic nephropathy can be predicted by detection of alterations in release of enzymes or albumin in the urine. The aim of this study is to detect and asses some urinary enzymes and microalbuminuria in urine of diabetic patients and healthy subjects. It also aims to find relationship between these bio-markers and the progression of diabetic nephropathy as suitable noninvasive assay for early detection of DNP in type-2 DM patients in Gaza Strip. Random 61 urine samples of diabetics (33 females and 28 males) and 53 healthy subjects (23 females and 30 males) that matched the diabetic case in sex and age were collected. Samples were tested for microalbuminuria (MAU), alkaline phosphatase (ALP), alanine aminopeptidase (AAP), acid phosphatase (ACP) and creatinine (Cr) using Hitachi 902 (Roche) auto analyzer and Biosystems BTS-310 spectrophotometer. Turbidimetric bio-systems kits for MAU were used while the other biomarkers measured spectrophotometry using Far-diagnostic kit. Data were collected and analyzed using SPSS (version15.0). The means of the markers in patients group were: MAU 28.6 mg/L, ALP 15.8 U/L, AAP 13.0 U/L, ACP 418.2 U/L and Cr 82.5 mg/dl, and in control group they were: 10.8 mg/L, 7.4 U/L, 6.2 U/L, 178.3 U/L and 158.6 mg/dl, respectively. Comparison of the markers means among males in patient and control groups showed significant difference (P= 0.000 for each marker), and among females in both groups showed P-values of 0.000, 0.002, 0.000, 0.000 and 0.001 for MAU, ALP, AAP, ACP and Cr, respectively. Comparison between the means of the markers ratios in patient and control showed significant difference (P= 0.000) for both males and females. The results of the study also showed that 49% of the DM population (30 subjects; 15 males and 15 females) had microalbuminuria and 60.6% had elevated level of tested enzymes (37 subjects; 19 malesí and18 females) while the control group showed normal results. The results also showed positive correlation, and a significant relationship between markers and markers ratios and each of body mass index (BMI), duration of DM and blood pressure p-values: 0.016, 0.000 and 0.001, respectively. Furthermore this study shows that more attention should be taken by diabetics concerning lifestyle and food quality. In conclusion, these markers and their ratios may be used as noninvasive early indicators for renal deterioration in DM patients.