الفهرس 
Diabetic NephropathyOnly 14 pages are availabe for public view
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Abstract
Diabetic nephropathy (DN) is one of the most
common complications, which results in chronic kidney
disease in diabetic patients. It is also one of the causes of
increased cardiovascular mortality. However, a
considerable amount of significant diabetic renal structural
injury may occur in absolute clinical silence, which renders
diagnosis difficult. Currently, routine kidney biopsy for DN
is not permitted in clinical practice, as the procedure is
invasive. Microalbuminuria is considered as the best
available, non-invasive marker for DN risk, but certain
studies have shown it to have inadequate specificity and
sensitivity. Thus, additional studies are required, and
feasible measures for the diagnosis of DN prior to
advanced renal dysfunction are considered to be of clinical
importance with public health implications.
The aim of the present work was to assess urinary
level of urinary vitamin D binding protein as a biomarker
for diabetic nephropathy and to evaluate its clinical
significance in diagnosis as well as assessment of disease
activity.
The vitamin D binding protein (DBP), originally
known as the Group-specific component (Gc-globulin), is a 51–58kDa multifunctional serum glycoprotein synthesized
in large quantities by hepatic parenchymal cells and
secreted into the circulation as a monomeric mature peptide
of 458 residues and three structural domains.
In our study, recruited from the national institute of
nephrology and urology in Cairo, following quantitative
measurement of 45 urine sample with ELISA, Diabetic
patients were categorized into two groups depending on
their albumin /creatinine ratio and healthy control subjects.
Patients with infection, collagen disease,
decompensated heart failure, liver disease, oncogenic
disease, type 1 DM and GFR less than 60 ml/min. were
excluded from our study.
All study population (diabetic patients and healthy
control) were subjected to full history taken, clinical
examination and laboratory investigation which include
(parameters of kidney function, lipid profile, blood glucose
profile, ESR, ACR and UVDBP).
Our results showed that, eGFR was significantly
decreased in diabetic patients with microalbuminuria
compared to normoalbuminuria and significantly decreased
in patients with normoalbuminuria compared to healthy
control (p-value >0.01) (table 4).HBA1c was significantly increased in diabetic
patients with microalbuminuria compared to
normoalbuminuria and significantly increased in patients
with normoalbuminuria compared to healthy control (pvalue >0.01) (table 4).
ACR was significantly increased in diabetic patients
with microalbuminuria compared to normoalbuminuria and
significantly increased in patients with normoalbuminuria
compared to healthy control (p-value >0.01) (table 4).
Urinary vitamin D binding protein (UVDBP) was
significantly increased in diabetic patients with
microalbuminuria compared to normoalbuminuria and
significantly increased in patients with normoalbuminuria
compared to healthy control (p-value >0.01) (table 5).
UVDBP was correlated positively with age , DM
duration, HBA1c, PPBS, GFR and ACR, while it
correlated negatively with blood pressure, FBS, serum urea,
serum creatinine, cholesterol, HDL, LDL, TGs and ESR
(table 6).
Multivariate linear regression analysis including age,
DM duration, FBS, PPBS, HBA1c, creatinine, GFR, HDL,
ESR and ACR show that ACR level was independent
predictor to VDBP level and vice versa (table 9).