الفهرس 
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Abstract
Diabetes is one of the leading causes of mortality across the globe. According to the 10th edition of the international diabetes federation, it is confirmed that 537 million are affected with diabetes and the figures will rise up to 643 million by 2030 and 783 million by 2045 (IDF 2021).
from 1997–2017, diabetic nephropathy contributed to one third of the disability-adjusted life-years (DALY) of all chronic kidney disease patients throughout the world, and its incidence is increasing on a yearly basis (B. Bikbov et al., 2020). Renal and cardiovascular risk events are the greatest threat to DN patients (V.R. A/L B Vasanth Rao et ai., 2019).
Evidence suggests that strict glycemic and blood pressure control is an essential tool in the management of patients with diabetic nephropathy. In addition, microalbuminuria in diabetic patients has been recognized as being a predictor of DN progression and prognosis (N. Papadopoulou-Marketou et al., 2017).
Microalbuminuria is the earliest detectable marker of DKD and is defined as elevated levels of albumin in the urine (American Diabetes Association, 2019).
However, the diagnosis of DN may be more accurate by looking for markers that can characterize structural alterations. Recent literature reports that tubular damage appears in the early stages of DN and promotes the progression of renal disease (Zeni et al., 2017).
Netrin-1 is a member of the laminin-like protein family and was initially identified as a potent chemotactic molecule involved in axonal guidance and cell migration during embryonic development.
Additionally, the plasma netrin-1 level is significantly increased in patients with diabetes complicated with microalbuminuria and correlates with albuminuria and the estimated glomerular filtration rate, potentially suggesting that glomerular damage occurs in individuals with diabetic nephropathy (E. Ay et al., 2016).
In our study we tried to discuss the possibility of using serum netrin 1 level as a diagnostic tool in early detection of diabetic nephropathy and correlation between level of serum netrin 1 in different diabetic patient groups with and without albuminuria.
In this study, we aimed to investigate the effects of netrin-1 on type 2 diabetic kidney complications and possible associations between the presence of netrin-1 and the degree of albuminuria and evaluate the possibility of using plasma netrin 1 level as early predictor for diagnosis of diabetic nephropathy.
Our study enrolled 120 patients divided into four groups, healthy control group, a diabetic group with no proteinuria, a diabetic group with micro albuminuria and diabetic group with macro proteinuria. Each of them is 30 patients.
Comparisons between the four groups and between non nephropathic group (healthy control and diabetic not proteinuric) and nephropathic group (diabetic with micro albuminuria and diabetic with macro proteinuria) for the significant difference of level of plasma netrin 1 level in each group.
Our study concluded that there is strong evidence that plasma netrin 1 level is significantly elevated in patients with diabetic nephropathy whether micro or macro proteinuria and there is future hope for possibility of using netrin 1 as early predictor for diagnosis of diabetic nephropathy. However, further studies with a larger number of patients are needed to support our conclusions.