الفهرس 
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Abstract
Diabetes mellitus is a serious worldwide public health problem due to its frequency, chronic complications and its high associated costs. It is associated with microvascular and macrovascular complications.Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes. It is a leading cause of end-stage renal disease (ESRD), and its prevalence is progressively increasing worldwide.DN is diagnosed by persistent albuminuria which is associated with elevated blood pressure and decreased Glomerular Filtration Rate (GFR)Microalbuminuria is an early clinical marker of diabetic kidney disease (DKD) and useful to surrogate its outcome. Microalbuminuria occurs due to damage of glomerular filtration barrier, which compromises endothelial cells, glomerular basement membrane (GBM) and podocytes.Although microalbuminuria is considered to be the best prognostic, widely used method for development of end-stage renal disease, it has several limitations, such as lower sensitivity, larger variability and false positive results in conditions as short term pronounced hyperglycemia, uncontrolled hypertension, acute febrile illness, urinary tract infection, heavy exercise and cardiovascular decompensation.Thus earlier, more sensitive and specific markers of kidney damage might help diagnosis and treatment of DN at an earlier stage before the development of renal failure.Podocytes have been demonstrated to be functionally and structurally injured during DN. Podocytes are located outside the glomerular basement membrane (GBM). Because of the proximity of the apical region of podocytes to the urinary space, pathological events occurring in this region are expected to be more easily detectable in urine than those occurring in the basal or slit diaphragm regions of podocytes.So monitoring podocytes-specific proteins, such as podocalyxin can be used as a potential urinary marker for diagnosis of DKD. Podocalyxin is an integral membrane sialoprotein found on the foot processes of kidney podocytes.
The aim of the study is to investigate urinary podocalyxin (uPCX), as a marker for diabetic nephropathy in T2DM.The study was conducted on eighty five participants. They were divided into four groups: group A, Diabetics with normoalbuminuria (20 patients group B, Diabetics with microalbuminuria (20 patients) group C, Diabetics with microalbuminuria (20 patients) group D, Apparently healthy participants of matched age and gender (25 participants as control groupDiabetic patients in this study were subjected to the following: Thorough history taking Clinical examination (Stressing on signs and symptoms of DM) Vital signsGeneral examination : weight, height,body mass index (BMI) Neurological examination : peripheral neuropathy, stroke All subjects in this study performed 1. Body Mass Index (BMI). BMI=Weight(kg)/(〖Height〗^2 (m^2 ) <2. Blood pressure measurements <3. Laboratory investigations Complete urine analysis Urinary Podocalyxin /creatinine ratio(uPCX/CrUrinary albumin/creatinine ratio (ACR).
Serum Creatinine, serum urea
HbA1c, Fasting Blood Glucose (FBG), Post Prandial Glucose (PPG)
Lipid profile (serum triglycerides, cholesterol, high-density lipoprotein, low-density lipoprotein).
Estimated Glomerular Filtration Rate (eGFR) (ml/min/1.73m2)calculation, using the chronic Kidney Disease Epidemiology Collaboration (CKD-EPI formula).
The study showed the following results:
Age, gender, BMI and duration of DM, showed no statistically significant difference between the four studied groups.
There was no statistically significant difference between the four studied groups as regards blood pressure.
There was a statistically significant difference between the studied groups as regards serum urea, creatinine, eGFR .
There was a statistically significant difference between the studied groups as regards fasting blood glucose, post prandial glucose and HbA1c.
There was a statistically significant difference between the studied groups as regards serum cholesterol, triglycerides, LDL, HDL.
There was a statistically significant difference between the studied groups as regards urinary podocalyxin and uPCX/Cr.
A statistically significant positive correlation was detected between uPCX/Cr & ACR
A statistically significant positive correlation was detected between uPCX/Cr & HbA1c
A statistically significant negative correlation between uPCX/Cr and eGFR
We concluded that:
1. Age, gender ,BMI and duration of diabetes might not constitute a risk factor for the development of albuminuria in diabetic patients.
2. Progression of albuminuria in diabetic patients is associated with worsening of renal functions (as indicated by seum urea, creatinine and eGFR) and with elevation of cholesterol and TG levels.
3. In patients with T2DM, ACR constitutes a good indicator for the progression of microalbuminuria.
4. uPCX/Cr might be considered not only as an early marker for detection of DN, but also as a predictor of disease progression.
5. Elevated uPCX/Cr level is well correlated to the deterioration of renal function evidenced by diminished eGFR. In addition uPCX/Cr is correlated to poor glycemic control.
6. uPCX/Cr might distinguish between cases with DN and diabetics who are not yet complicated by nephropathy