الفهرس 
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Abstract
Summary
Diabetic nephropathy is a major microvascular complication of diabetes and it is the leading cause of end stage renal disease worldwide. It is characterized by increasing albuminuria and progressive decline in glomerular filtration rate.
Proteinuria is considered a hallmark of Diabetic nephropathy, and it is considered as a primary reflection of glomerular injury and increased glomerular permeability to macromolecules. Its diagnostic accuracy is not sufficient and is limited as structural damage of the kidney might precede albumin excretion. Therefore, there is a need for more reliable renal biomarkers with higher sensitivity and specificity for early prediction of the onset and monitoring of the progression of Diabetic nephropathy.
Studies have also stated that microalbuminuria may develop in non-diabetic patients with progressive chronic kidney disease so microalbuminuria is not specific for patients with Diabetic nephropathy alone. Also, not all diabetic patients with microalbuminuria progress to end stage renal diseases. Therefore, sensitive and specific biomarkers that can early predict susceptibility to diabetic nephropathy is needed.
Uromodulin is the most abundant protein in urine and is specifically synthesized and secreted by kidney tubular epithelial cells. Rare mutations in the UMOD gene have been described as a cause of hereditary autosomal-dominant tubulointerstitial diseases.
Well-known genome-wide association studies (GWAS) have successfully identified common variants in the UMOD gene as risk factors for CKD and hypertension in the general population.
Recently, some prospective studies showed that serum uromodulin levels were independently associated with the risk of cardiovascular event and mortality as well as decline in kidney function among patients referred to angiography. It is not yet known whether serum uromodulin was associated with outcomes of CKD patients.
In this study, we tried to investigate the correlation between urinary uromodulin excretion (UMOD) levels in diabetic nephropathy (DN), the degree of albuminuria in healthy subjects (A/C ratio) and patients with type 2 diabetes mellitus and the predictive value of urinary uromodulin in early diagnosis of diabetic nephropathy in type 2 diabetes mellitus (T2DM).
This study was a cross sectional study will be carried out at Beni-suef University Hospital, Outpatient Department Diabetic and Internal Medicine Clinic on 20 healthy subjects and 60 patients known to be of type 2 diabetes mellitus taking oral hypoglycemic and /or insulin therapy.
The main results of the study revealed that:
age was ranged from 35-72 years with mean of 51.3±8.8 years, there were 53.3% male and 46.7% females, more than half of them (58.3%) were obese
No statistical significant difference (p=0.3)between diabetic patients with different stages of diabetic nephropathy regarding their age, regarding their BMI obesity was higher among Macro albuminuric diabetic patients (70%) followed by patients with micro (60%) and normo albuminuri (45%)
No statistical significant difference between diabetic patients with different stages of diabetic nephropathy regarding their systolic and diastolic blood pressure.
The mean HA1-C level was significantly higher among patients with different diabetic nephropathy stages than controls (p= 0001*)
No significant difference between micro and macro albuminuric patients and controls regarding uromodulin level.
Significant difference between different diabetic nephropathy staging regarding uromodulin concentration.
In conclusion, Uromodulin can be considered as a relevant biomarker that has been found to be associated with DKD with significant difference between different diabetic nephropathy staging regarding uromodulin concentration and high predictability of early DN in patients with normoalbuminuria.
Finally, we recommend for further studies on large geographical scale and on larger sample size to emphasize our conclusion.