RESUMEN
Increased albumin excretion in diabetes is known to be an early marker of diabetic nephropathy, which mostly progress to renal failure. Early start of treatment is important to delay or prevent late complications. Early markers are important in case of diabetic nephropathy. In this study we investigate urinary collagen type IV [u c IV], matrix metalloproteinase 9 [MMP-9] and urinary podocytes as indicators of incipient [early] diabetic nephropathy and their role as a prognostic factors for deterioration in renal function. The study is a cross sectional case control study. It was carried out on 60 diabetic patients classified into three equal groups according to urinary albumin. The fourth group was 20 healthy control subjects. for all groups in addition to history and clinical examination urinary albumin and creatinine clearance, the level of urinary collagen type IV using immunoassay, plasma MMP-9 using enzyme immunoassay, and urinary podocytes was measured. The diabetic groups were compared with each other and with the control group. Plasma MMP-9 and urinary collagen type IV are significantly higher [p<0.001 for each] in diabetic normoalbuminuric group than healthy control group. Level of both markers increase significantly with the progress of albuminurea. Urinary podocytes is absent in normoalbuminuric diabetics and in healthy control group and its level increases with the progress of proteinurea. MMP-9, Collagen IV excretion and urinary podocytes showed a significant correlation [p <0.001, p <0.001, p =0.002 respectively] with the urinary albumin excretion. ROC curve study showed that MMP-9, Collagen IV excretion but not urinary podocytes can predict [sensitivity 100%, 100%, 33.3% respectively] a decline in creatinine clearance. Because not all patients with microalbuminuria progress to declining renal function and some patients who develop nephropathy do not manifest albuminuria. The findings in this cross-sectional analysis suggest that measurement of urine collagen IV, plasma MMP-9, may be a useful noninvasive indicator to detect diabetic renal disease before the stage of microalbuminuria, and can predicts patients liable to enter a phase of compromised renal function