Urinarni transferin kao rani marker dijabetesne nefropatije
Sažetak
Uvod/Cilj. Dijabetesna nefropatija predstavlja jedan od vodećih uzroka hronične bubrežne bolesti i terminalne bubrežne insuficijencije. Zastupljena je kod 20%–40% bolesnika sa dijabetes melitusom, a kao prvi znak dijabetesne nefropatije još uvek se smatra mikroalbuminurija. Niska senzitivnost i specifičnost mikroalbuminurije su doveli do ispitivanja novih urinarnih biomarkera koji bi mogli biti rani pokazatelji postojanja dijabetesne nefropatije. Ova studija spovedena je da bi se utvrdilo da li urinarni transferin može biti rani marker dijabetesne nefropatije. Metode. U našu studiju bilo je uključeno 80 bolesnika sa tipom 2 dijabetesa, podeljenih u dve grupe: grupa 1 – normoalbuminurični bolesnici (ekskrecija albumina do 30 mg/dan); grupa 2 – mikroalbuminurični (ekskrecija albumina od 30–300 mg/dan) i 10 zdravih osoba. Svi bolesnici bili su stariji od 18 godina, imali su dijabetes melitus duže od jedne godine i jačinu glomerulske filtracije veću od 60 mL/min/1,73 m2. Svim bolesnicima određivan je nivo serumskog kreatinina, glikozilovanog hemoglobina i transferina u urinu. Koncentracija transferina određivana je u 24 časovnom uzorku urina i u prvom jutarnjem urinu primenom visoko senzitivnog ELISA kita. Rezultati. Koncentracija urinarnog transferina bila je značajno veća kod bolesnika koji su imali mikroalbuminuriju u poređenju sa bolesnicima koji su bili normoalbuminurični i zdravim osobama, a Pearson-ov koeficijent korelacije bio je r = 0,584 (p < 0,001). Nismo dobili povezanost između nivoa urinarnog transferina i glikoregulacije, kao ni nivoa transferina i dužine trajanja dijabetesa. Zaključak. Rezultati ove studije pokazuju da bi urinarni transferin mogao biti rani marker dijabetesne nefropatije.
Reference
International Diabetes Federation (IDF). IDF Diabetes Atlas. 7th ed. 2015. Available from: https://www.idf.org/.../diabetes-atlas/13-diabetes-atlas-seventh-...
Tuttle KR, Bakris GL, Bilous RW, Chiang JL, Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care 2014; 37(10): 2864–83.
Saran R, Li Y, Robinson B, Abbott KC, Agodoa LY, Ayanian J, et al. US Renal Data System 2015 Annual Data Report: Epide-miology of Kidney Disease in the United States. Am J Kidney Dis 2016; 67(3 Suppl 1): Svii, S1–305.
Kramer A, Pippias M, Stel VS, Bonthuis M, Abad Diez JM, Afen-takis N, et al. Renal replacement therapy in Europe: A sum-mary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus. Clin Kidney J 2016; 9(3): 457–69.
Loeffler I. Pathophysiology of Diabetic Nephropathy. In: Wolf G, editor. Diabetes and Kidney Disease. Verlag: Wiley-Blackwell; 2013. p. 45–61.
Dragović T. Microalbuminuria in diabetes: definition, identifi-cation techniques, and the significance of early recognition. Vojnosanit Pregl 2006; 63(12): 1027–32. (Serbian)
Redon J. Measurement of microalbuminuria: What the neph-rologist should know. Nephrol Dial Transplant 2006; 21(3): 573–6.
Dwyer JP, Parving H, Hunsicker LG, Ravid M, Remuzzi G, Lewis JB. Renal Dysfunction in the Presence of Normoalbuminuria in Type 2 Diabetes: Results from the DEMAND Study. Car-diorenal Med 2012; 2(1): 1–10.
Perkins BA, Ficociello LH, Roshan B, Warram JH, Krolewski AS. In patients with type 1 diabetes and new-onset microalbumi-nuria the development of advanced chronic kidney disease may not require progression to proteinuria. Kidney Int 2010; 77(1): 57–64.
Moresco RN, Sangoi MB, de Carvalho JA, Tatsch E, Bochi GV. Diabetic nephropathy: Traditional to proteomic markers. Clin Chim Acta 2013; 421: 17–30.
Dragović T, Ajdinović B, Hrvacević R, Ilić V, Magić Z, Anđelković Z, et al. Angiotensin II type 1 receptor gene polymorphism could influence renoprotective response to losartan treatment in type 1 diabetic patients with high urinary albumin excretion rate. Vojnosanit Pregl 2010; 67(4): 273–8.
McCormick CP, Konen JC, Shihabi ZK. Microtransferrinuria and microalbuminuria. I. In the diabetic human. Clin Physiol Bio-chem 1990; 8(2): 53–8.
Narita T, Hosoba M, Kakei M, Ito S. Increased Urinary Excre-tions of Immunoglobulin G, Ceruloplasmin, and Transferrin Predict Development of Microalbuminuria in Patients With Type 2 Diabetes. Diabetes Care 2005; 29(1): 142–4.
Hellemons ME, Kerschbaum J, Bakker SJ, Neuwirt H, Mayer B, Mayer G, et al. Validity of biomarkers predicting onset or pro-gression of nephropathy in patients with Type 2 diabetes: A systematic review. Diabet Med 2012; 29(5): 567–77.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med 2009; 150(9): 604–12.
Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: The continuing saga. Diabetes Care 2014; 37(3): 867–75.
Chen C, Wang C, Hu C, Han Y, Zhao L, Zhu X, et al. Normoalbuminuric diabetic kidney disease. Front Med 2017; 11(3): 310–8.
Boronat M, García-Cantón C, Quevedo V, Lorenzo DL, López-Ríos L, Batista F, et al. Non-albuminuric renal disease among sub-jects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus. Ren Fail 2014; 36(2): 166–70.
Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. Clinical significance of nonalbuminuric renal impairment in type 2 diabetes. J Hypertens 2011; 29(9): 1802–9.
Kazumi T, Hozumi T, Ishida Y, Ikeda Y, Kishi K, Hayakawa M, et al. Increased urinary transferrin excretion predicts microal-buminuria in patients with type 2 diabetes. Diabetes Care 1999; 22(7): 1176–80.
Kanauchi M, Nishioka H, Hashimoto T, Dohi K. Diagnostic sig-nificance of urinary transferrin in diabetic nephropathy. Nihon Jinzo Gakkai Shi 1995; 37(11): 649–54.
Al-Rubeaan K, Siddiqui K, Al-Ghonaim MA, Youssef AM, Al-Sharqawi AH, AlNaqeb D. Assessment of the diagnostic value of different biomarkers in relation to various stages of diabetic nephropathy in type 2 diabetic patients. Sci Rep 2017; 7(1): 2684.
O’Donnell MJ, Watson J, Martin P, Chapman C, Barnett AH. Transferrinuria in Type 2 Diabetes: The Effect of Glycaemic Control. Ann Clin Biochem 1991; 28(Pt 2): 174–8.
Moriya T, Tanaka S, Kawasaki R, Ohashi Y, Akanuma Y, Yama-da N, et al. Diabetic Retinopathy and Microalbuminuria Can Predict Macroalbuminuria and Renal Function Decline in Jap-anese Type 2 Diabetic Patients: Japan Diabetes Complications Study. Diabetes Care 2013; 36(9): 2803–9.