Clinical significance of urinary Monocyte Chemoattractant Protein-1 [uMCP-1] in Indian type 2 diabetic patients at different stages of diabetic nephropathy

Monocyte Chemoattractant Protein-1 [MCP-1] is the strongest known chemotactic factor for monocytes and is upregulated in diabetic nephropathy. So measuring urinary MCP-1 is of great significance in the diagnosis and intervention of early diabetic nephropathy. This study aims at determining the levels of urinary MCP-1 [uMCP-1] at different stages of diabetic nephropathy and to see its correlation with other parameters in Indian type2 diabetic subjects. A total of 64 [M:F; 40:24] type 2 diabetic subjects were divided into three groups based on their renal function and were compared with non-diabetic controls [Group 1] n = 20 [M:F; 13:7]. The study groups were Group 2 [normoalbuminuria] n = 16, Group 3 [microalbuminuria] n = 23 and Group 4 [macroalbuminuria] n = 25. Demographic, anthropometric and biochemical details were recorded for all the subjects. Urinary MCP-1 levels were measured by using solid phase ELISA method. Mean levels of uMCP-1 in subjects with type 2 diabetes were significantly higher than in controls [p < 0.05]. The levels of uMCP-1 in type 2 diabetic subjects increased gradually with deteriorating renal function [p = 0.006]. There was a significant difference in urinary MCP-1 levels between Group 2 and Group 1 [p < 0.001]. Levels of uMCP-1 were significantly higher in subjects with eGFR <60 ml/min compared to eGFR >60 ml/min [p = 0.008]. uMCP-1 levels correlated positively with uACR or uPCR [r = 0.551, p< 0.0001], urea [r = 0.43, p< 0.0001] and creatinine [r= 0.478, p< 0.0001]. A negative correlation between uMCP-1 and eGFR [r = -0.338, p = 0.006] was noted. Our study demonstrated that urinary MCP-1 levels increased gradually in type 2 diabetic subjects with deteriorating renal function. It is significantly associated with the other risk factors of diabetic nephropathy

Levels of glycated albumin at different stages of diabetic nephropathy in India

Glycated haemoglobin [HbAlc] which is an index of long term glycaemic control in diabetic patients is measured in majority of patients worldwide. Glycated albumin [GA] is useful for the evaluation of short term glycaemic control [2 weeks] in patients with diabetes. The aim of this study was to assess the GA levels at different stages of diabetic nephropathy in Indian population. A total of 147 subjects [M:F; 95:52] were selected for this study and were divided into three groups based on their renal function and compared with a non diabetic control group [n = 50, M:F; 14:36]. The groups were as follows; group1 [control] n = 50, group2 [normoalbuminuria] n = 42, group 3 [microalbuminuria] n = 55, group 4 [proteinuria] n = 50. GA was measured by enzymatic procedure using the Lucica GA - L kit [Asahi Kasei Pharma Corp, Japan]. The normal cutoff value for GA was derived using control group and it was found to be 15% [range 7-17%]. GA was significantly higher in diabetic patients at different stages of diabetic nephropathy compared to non diabetic control group [cont: 12.9 +/- 1.8, normo: 20.8 +/- 5.8, micro: 26.1 +/- 8.6, macro: 23.5 +/- 8.3]. Microalbuminuric patients had significantly higher GA levels than normoalbuminuric patients [p< 0.05]. Proteinuric subjects had slightly lower GA levels compared to microalbuminuric group but it was not statistically significant. GA was found to be a better marker for evaluating short term glycaemic status among diabetic patients with different degree of renal impairment prior to ESRD