Prediction of Renal Injury Risk by Expressions of KIM-1 and NGAL in Type 2 Diabetic Nephropathy

Abstract

Background: About 10 to 40% Type 2 diabetes (T2DM) and 30% Type 1 diabetes (T1DM) suffer from kidney failure increases huge financial burden for care for patients [1]. Patients with uncontrolled diabetes prone to end-stage renal disease (ESRD) which required kidney transplantation, haemodialysis or peritoneal dialysis which adds psychological & financial burden. Early kidney injury can be prevented by evaluating gene expression (KIM1, NGAL) in T2DM with microalbuminuria. Methodology: This study includes 241 subjects (118 male, 123 women, and age ranges 30-70 years, distributed in two groups; 30-45 years and 45-70 years) were included after screening for T2DM by measurement of blood glucose in fasting, post-prandial, glycosylated haemoglobin and micro albumin in urine. Subjects were randomised after written consent; subject examined by physician and enrolled as per inclusion/exclusion criteria. Categorization of subjects in three study groups were done on the basis of T2DM duration 3-5 years, Glycosylated haemoglobin level (HbA1c) ≥ 7.0% with fasting blood glucose ≥126 mg/dl) and micro albuminuria in study group. Equal numbers of age and sex matched healthy volunteers enrolled in control group. Blood samples were processed for other renal parameters &rt-PCR to check expressions of KIM1 and NGAL. Results: In study groups all renal parameters are within normal range except albumin creatinine ratio (p<0.012) & e-GFR (p<0.000). Other parameters showed marginal significance within and between the groups. KIM-1 and NGAL showed high degree of significance (p<0.000). Conclusion: Biochemical renal parameters are not enough to identify risk of DN even in microalbuminuria. Early detection of gene expressions of   KIM1 and NGAL may help to evaluate the status of kidney functions which help to prevent morbidity & mortality of kidney due to diabetic nephropathy. Extensive study in large population size was recommended.