الفهرس 
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Abstract
Diabetes mellitus (DM) is a complex metabolic syndrome characterized by chronic hyperglycemia resulting in complications affecting the peripheral nerves, kidneys, eyes, and micro- and macrovascular structures. Diabetic nephropathy (DN) is one of the microvascular complications of diabetes mellitus and is an important cause of end-stage renal disease, with high morbidity and mortality. The risk of progression of diabetic nephropathy has improved over the last several decades, largely due to vigorous glycemic control, more blood pressure reduction and the use of angiotensin converting enzyme inhibitors.
YKL-40 is an inflammatory glycoprotein. It is a 40-kDa heparin- and chitin-binding lectin and a member of the mammalian chitinase-like protein family, known as cartilage glycoprotein-39 or chitinase-3-like protein 1. YKL-40 is secreted by a variety of human cells.
Many studies found the relation between ACR in urine sample and with YKL-40 serum level but also other many studies positively correlate serum level of YKL-40 with measures of obesity as BMI.
The general objective of the present study was to reduce chronic kidney disease progression as a complication of type 2 diabetes mellitus to prevent end stage renal failure. This was achieved through studding which markers can be used for early detection of diabetic nephropathy.
The present study included 75 patients 39 males and 36 females ranged between 35 to 89 years and arranged to three groups, group 1 was from obese patients with diabetic nephropathy, group 2 was from non-obese subjects with diabetic nephropathy and the group 3 was from obese patients and all groups selected from inpatient department and outpatient clinics of the Internal Medicine Department, Menoufia University hospital from JULI 2017 TO FEBRUARY 2018. All patients were subjected to Full history taking, Clinical examination, Body mass index and labs such as CBC, Urea, Creatinine, ESR, AST, ALT, ACR, HBA1c, FBG, eGFR and serum YKL-40.
Excluded patients who had:
• A previous history of clinical macrovascular or cardiac heart disease (CHD).
• History of malignancy.
• Uncontrolled hypertension.
• History of Alcoholics intake.
• Active urinary tract infection.
• Other renal diseases.
• Active inflammatory disorders.
• Liver failure.
Results of this study revealed that:
• As regard sex: There was no a significant difference between studied groups.
• As regard age: There was no a significant difference between studied groups.
• There was no significant difference between the studied group as regard to AST, ALT, Urea, ESR and TLC.
• There was highly significant difference between studied groups as regard to HBA1c, ACR, Creatinine, BMI, eGFR, FBG and YKL-40.
• There was a significant correlation between YKL-40 level and ACR, Creatinine, HBA1c, eGFR, FBG and BMI.