Feasibility of Cystatin C Determination for Early Diagnosis of Kidney Damage in Patients with Type 2 Diabetes Combined with Nonalcoholic Fatty Liver Disease and Obesity Exposed to Covid-19 Infection in the Past

ABSTRACT

OBJECTIVE: The aim: To examine the diagnostic possibilities of determining the level of cystatin C in the blood serum in order to ascertain the functional status of the kidneys in patients with type 2 diabetes (those who recovered from COVID-19 infection) depending on the presence or absence of non-alcoholic fatty liver disease (further - NAFLD) and malnutrition. PATIENTS AND METHODS: Materials and methods: We investigated 18 patients with type 2 DM, who were included in the first group of the patients examined;group 2 consisted of 20 patients with type 2 DM and non-alcoholic fatty liver disease (NAFLD), namely with non-alcoholic steatohepatitis;and group 3 of the patients examined consisted of 30 patients with type 2 DM and obesity. RESULTS: Results: Renal damage in patients with metabolically associated diseases in the background of respiratory disease due to COVID-19 infection was also indicated by changes in urine test indicators, and namely - proteinuria and erythrocyturia, leukocyturia in urine sediment. The examination of cystatin C (Cys C) level indicates its statistically significant increase in patients of all examined groups, with the highest levels established in group 3 patients (with its increase up to 2.58 +/- 0.11 mg/L, compared with the norm of 0.75 +/- 0.04 mg/L in the control group - p < 0.01). The examination of GFR by calculation, where the Cys C index in serum was used, revealed a significant decrease in this parameter in all the examined groups of patients. At the same time, the maximum values were found in group 1 patients (65.7 +/- 1.4 ml/min per 1.73 m2 of the body surface), and the minimum values - in group 3 patients (48.3 +/- 2.7 ml/min per 1.73 m2 of the body surface). CONCLUSION: Conclusions: An increase in serum cystatin C levels was determined in type 2 diabetes patients, with the lowest level in group 1 patients (1.24 +/- 0.07 mg/L - p < 0.05), and the highest level in patients suffering from type 2 diabetes combined with NAFLD and obesity (2.58 +/- 0.11 mg/L - p < 0.01). A moderate to severe course of COVID-19 infection in patients with type 2 diabetes as well as with its combination with NAFLD and obesity contributes to the development of renal functional disorders in these patients. Moreover, an increase in serum Cys C levels is a more sensitive and earlier marker of renal damage development in comorbid pathology.