RESUMO
Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (ß2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary ß2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary ß2m was more frequent among the diabetics (52%, 95% CI: 42.1-61.8%) than among the controls (32%, 95% CI: 22.9-41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9-44.7%) than in the controls (15.5%, 95% CI: 8.4-22.6%). There was a positive correlation between urinary ß2m and UAC (rho = 0.38, p < 0.001). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05-1.45), eGFR (OR: 0.97, 95% CI: 0.94-0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32-11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary ß2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy.
RESUMO
This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150 mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy.
