RESUMEN
Diabetes mellitus is a major health problem in large areas of the world. Diabetic nephropathy has become the major cause of end-stage renal disease [ESRD] [Kikkawa R. et al., 2003]. In this work, we study the role of measuring of TNF- alpha and fibronectin for possible early detection of diabetic nephropathy. This study was carried out on 45 individuals. It included 15 apparently normal healthy individuals [group I], 15 patients with NIDDM less than 5 years duration [group II], 1.5 patients with NIDDM more than 10 years duration [group III]. All individuals were thoroughly examined clinically including careful general, heart, chest and abdominal examination as well as neurological examination, fundus examination. ECG and US examination was done for all patients. All individuals were investigated with complete urine analysis, urine culture, fasting and 2 hrs postprandial blood glucose, kidney function tests, glycated hemoglobin [HbA1c], microalbumin [Albumin / creatinine ratio [ACR]]. Plasma fibronectin and TNF- alpha were done for all patients, fibronectin and TNF-alpha were markedly elevated in group III. We concluded that measurement of plasma fibronectin and TNF-alpha level may be used as marker for follow-up reflecting vascular endothelial changes in the course of diabetic nephropathy