ABSTRACT
Background: Diabetic nephropathy is a major cause of premature morbidity and mortality in type 1 and type 2 diabetes mellitus (T2DM) and hence new markers with better sensitivities are being investigated. The study was taken up to investigate whether urinary activities of N-acetyl-β-D-glycosaminidase (NAG), alkaline phosphatase (ALP), lactate dehydrogenase LDH) and Gamma glutamyl transferase (γ-GT) can be used as screening markers of renal dysfunction in patients suffering from T2DM.Methods: One hundred and four patients with T2DM along with 30 age- and gender-matched healthy individuals were included in the study. Patients were divided into three groups based on their u-MA levels i.e. normoalbuminuric (group1), micro albuminuric (group 2) and macroalbuminuric (group 3).Results: Urinary enzymes activity was significantly higher in patients with T2DM compared to controls (p<0.05). NAG, ALP, LDH, and GGT were significantly higher in group 3 compared to group1 and group 2 (p<0.0001). NAG, ALP, LDH and GGT showed significant positive correlation with MA (p=0.0001, r=0.308; p=0.0001, r=0.369; p=0.002, r=0.304, p=0.044, r=0.202 respectively). GGT and LDH showed highest sensitivity (86.21%, 84.00% respectively) and specificity (78.57%,53.49% respectively) for diagnosing renal dysfunction in patients with normoalbuminuria.Conclusions: The study suggests that u-GGT and LDH can be useful markers for assessing renal dysfunction in T2DM patients even before microalbuminuria manifests.
ABSTRACT
Background: Atherogenic lipid profile is reported to become pronounced with onset of nephropathy. Lipid ratios also indicate atherogenic dyslipidemia. Lipoprotein (a) [(Lp(a)] considered as an independent risk factor for cardiovascular diseases (CVD), may play an important role in development and progression of nephropathy in type 2 diabetes mellitus (T2DM). The present study aimed to assess atherogenic dyslipidemia in T2DM and diabetic nephropathy patients. Methods: Total cholesterol (TC), triglycerides(Tgl), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), Lp(a), lipid ratios: TC/HDL, Tgl/HDL, LDL/HDL, non-HDL cholesterol and atherogenic index (AI) was assessed in T2DM (n=35), diabetic nephropathy (n=30) and healthy individuals (n=30). Means of biochemical parameters were compared by ANOVA (analysis of variance). Pearson correlation was performed to study the association between parameters. Receiver operating characteristics (ROC) curve analysis was done to assess the predictive ability of the variables. Results: Atherogenic dyslipidemia with elevated Lp(a), TC, Tgl, VLDL, LDL, non-HDL cholesterol, lipid ratios, AI and low HDL levels were observed in both T2DM patients with and without nephropathy when compared to controls. Significantly high Tgl/HDL, TC/HDL and AI were observed in diabetic nephropathy when compared to T2DM. Conclusion: T2DM and diabetic nephropathy are associated with dyslipidemia which was more pronounced in diabetic nephropathy. Elevated Lp(a) levels may be considered as an independent CVD risk marker in T2DM and diabetic nephropathy patients along with atherogenic lipid ratio indicators.