الفهرس 
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Abstract
Diabetic nephropathy (DN) is common complication of diabetes mellitus, which has a major impact on patient morbidity and mortality, and therefore a profound impact on the delivery of healthcare. It is now the commonest cause of renal failure requiring renal replacement therapy worldwide.
Recently, tubular involvement has been proved to precede glomeruler involvement because several tubular proteins and enzymes are detectable even before the appearance of microalbuminuria and rise in serum urea and creatinin, such as Kidney injury molecule-1(KIM-1), B- N-acetylglucosaminidase (B- NAG), β2 microglobulin,and Retinol binding protein (RBP). If tubular lesion is early detected, diabetic nephropathy could be probably controlled by good glycemic control.
KIM-1 was believed to be an ideal biomarker of kidney injury: due to its marked up-regulation and insertion into the apical membrane of the proximal tubule; its persistence in the epithelial cell until the cell has completely recovered and the Urinary levels of KIM-1 increased prior to the appearance of casts in the urine making it more sensitive and specific than the measurement of blood urea nitrogen, creatinine and urinary albumin.
The present work aimed to determining Kidney injury molecule-1(KIM-1) level in the urine of patients with type 2 diabetes mellitus in order to evaluate it as an early diagnostic parameter for nephropathy in comparison to urinary albumin excretion.
The present study was performed on eighty subjects divided into two main categories. The control group (group I) included twenty apparently healthy subjects. The patients group included sixty diabetic patients. These patients were divided into 3 groups according to their urinary albumin/creatinine ratio: (group II) included twenty normoalbuminuric diabetics with albumin to creatinin ratio (ACR) less than 30 mg/g. (group III) included twenty microalbuminuric diabetics with albumin to creatinine ratio (ACR) ranging from 30-299 mg/g and (group IV) included twenty macroalbuminuric diabetics with albumin to creatinine ratio (ACR) equal to or more than 300 mg/g
According to the present study the following could be noticed:
Urinary KIM-1 was significantly increased in type 2 diabetic patients with microalbuminuria (group III) and type 2 diabetic patients with macroalbuminuria (group IV) when compared to Controls (group I).
Urinary KIM/1creatinine (KIM-1/Cr) ratio was more sensitive than KIM-1 as it was significantly increased in type 2 diabetic patients (the three groups II, III, IV) when compared to Controls (group I). Moreover, Urine (KIM-1/Cr) ratio was significantly increased in type 2 diabetic patients with macroalbuminuria (group IV) when compared to type 2 diabetic patients without albuminuria (group II).
No correlation was found between urinary KIM-1/Cr ratio and urinary albumin/creatinine (Alb/Cr) ratio in group I (controls), group III and group IV patients, but a positive correlation was found in type 2 diabetic patients without albuminuria (group II).
By studying the Clinical sensitivity, specificity of urinary KIM-1/creatinine ratio and urinary KIM-1, urinary KIM-1/Cr ratio (sensitivity 85%) was more sensitive than urinary KIM-1(sensitivity 67.5%), and urinary KIM-1/Cr Ratio (specificity 70%) was more specific than urinary KIM-1 (specificity 62.5%).
By drawing ROC curve for urinary KIM-1/creatinine ratio and urinary albumin/creatinine ratio, the area under the curve was the same for both (AUC 0.828) with p value highly significant (p <0.001).
Therefore, the following could be concluded:
Urinary KIM-1/Creatinine ratio may be a more promising early marker than UACR for detecting and predicting renal injury in Type 2 diabetes mellitus patients. However, Urinary KIM-1 couldn’t be considered as a predictor for early detection of nephropathy in patients with type 2 diabetes.