Abstract
Context
Diabetic nephropathy in type 2 diabetes mellitus is one of the most serious microvascular complications. Immunoglobulin G (IgG), with molecular weight of 150 kDa, is excreted in urine of normoalbuminuric diabetic patients.
Aims
The aim was to compare urinary IgG with microalbuminuria as an early indicator of diabetic nephropathy in patients with type 2 diabetes mellitus.
Settings and design
The study was conducted in Zagazig University Hospital.
Materials and methods
This case–control study was conducted on 88 type 2 diabetic adult patients who were divided into four groups. Group I: 22 patients with normal albumin creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), group II: 21 patients with normal ACR (<20 mg/g creatinine) and eGFR (>120 ml/min/1.73 m2), group III: 24 patients with ACR from 20 to 200 mg/g creatinine and eGFR ranging from 60.74 to 102.48 ml/min/1.73 m2, and group IV: 21 patients with ACR more than 200 mg/g creatinine and eGFR ranging from 17.16 to 85.27 ml/min/1.73m2. Patients were subjected to complete blood count, kidney function tests (KFT), urinary albumin/ creatinine ratio, urinary IgG/creatinine ratio, random blood sugar, and estimation of GFR by modification of diet in renal disease equation.
Statistical analysis
The data were analyzed using statistical package for the social science (SPSS), windows version 17. Description of qualitative variables was done by frequency and percentage. Description of quantitative variables was in the form of mean±SD. χ 2-Test, Student’s t-test, analysis of variance (F-test), and correlation analysis were used for analytical examination.
Results
High significant difference among the different groups was found regarding ACR (P <0.001) and immunoglobulin G creatinine ratio (IgGCR) (P <0.001). ACR and IgGCR are highly increased in groups III and IV in comparison with groups 1 and II. There was a significant positive correlation between IgGCR and age, diabetes mellitus (DM) duration, serum creatinine (P <0.001), blood urea nitrogen, ACR, and renal sonography, and negative correlation with eGFR (P <0.001), hemoglobin, and serum albumin.
Conclusion
IgG appears in urine in early stages of diabetic nephropathy even before microalbuminuria, so we recommend its use to define high-risk patients, allowing prompt interventions.
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References
Lotfy M, Adeghate J, Kalasz H, Singh J, Adeghate E. Chronic complications of diabetes mellitus: a mini review. Curr Diabetes Rev 2017; 13:3–10.
Hong CY, Chia KS. Markers of diabetic nephropathy. J Diabetes Complications 1998; 12:43–60.
Matheson A, Willcox MD, Flanagan J, Walsh BJ. Urinary biomarkers involved in type 2 diabetes: a review. Diabetes Metab Res Rev 2010; 26:150–171.
Ibrahim MA, Ahmed YS, El-Shinnawy HA, Maseeh IY, Makkeyah YM, Bichari WA. Value of urinary cystatin C in early detection of diabetic nephropathy in type 2 diabetes mellitus. Int J Adv Res Biol Sci 2015; 2: 211–223.
Nimmerjahn F, Ravetch JV. Anti-inflammatory actions of intravenous immunoglobulin. Annu Rev Immunol 2008; 26:513–533.
Tripathi YB, Yadav D. Diabetic nephropathy: causes and managements. Recent Pat Endocr Metab Immune Drug Discov 2013; 7:57–64.
Junqueira L, Jose C. Basic histology text & atlas. 9th ed. New York, New York: McGraw-Hill Professional (Pub); 2003.
Mohan S, Kalia K, Mannari J. Association between urinary IgG and relative risk for factors affecting proteinuria in type 2 diabetic patients. Indian J Clin Biochem 2012; 27:333–339.
Narita T, Hosoba M, Kakei M, Ito S. Increased urinary excretions of immunoglobulin G, ceruloplasmin, and transferrin predict development of microalbuminuria in patients with type 2 diabetes. Diabetes care 2006; 29:142–144.
Mistry K, Kalia K. Non enzymatic glycosylation of IgG and their urinary excretion in patients with diabetic nephropathy. Indian J Clin Biochem 2009; 24:159–165.
Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, et al. Urinary biomarkers in the assessment of early diabetic nephropathy. J Diabetes Res 2016; 2016:4626125.
Polanco N, Gutiérrez E, Covarsí A, Ariza F, Carreño A, Vigil A, et al. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. J Am Soc Nephrol 2010; 21:697–704.
Hotta O, Sugai H, Kitamura H, Yusa N, Taguma Y. Predictive value of urinary micro-cholesterol (mCHO) levels in patients with progressive glomerular disease. Kidney Int 2004; 66:2374–2381.
Amin EM, Saad EM, Allam HM, Zidan AA. Serum levels of adipocyte fatty acid binding protein 4 and retinol binding protein 4 as biomarkers for early detection of diabetic nephropathy in type 2 diabetes. Zagazig Univ Med J 2015; 20:1.
Kundu D, Roy A, Mandal T, Bandyopadhyay U, Ghosh E, Ray D. Relation of microalbuminuria to glycosylated hemoglobin and duration of type 2 diabetes. Niger J Clin Pract 2013; 16:216–220.
Yadav GS, Acharya GD, Rai M, Shrivastava A. Correlation of urinary markers and urine creatinine in glomerulopathy at the onset of type-II diabetic subjects. Int J Clin Biochem Res 2015; 2:130–139.
Assal HS, Tawfeek S, Rasheed EA, El-Lebedy D, Thabet EH. Serum cystatin C and tubular urinary enzymes as biomarkers of renal dysfunction in type 2 diabetes mellitus. Clin Med Insights Endocrinol Diabetes 2013; 6:7.
Aly MH, El-Antouny NG, Amr GE, Shaker GE. Urinary se-cadherin and plasma cystatin C as novel biomarkers of diabetic nephropathy. Zagazig Univ Med J 2015; 20:2.
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Kamal, N.M., Elsayed, A.M., Amin, E. et al. Urinary immunoglobulin G versus microalbuminuria as an indicator of diabetic nephropathy in type 2 diabetic patients. Egypt J Intern Med 30, 58–62 (2018). https://doi.org/10.4103/ejim.ejim_80_17
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DOI: https://doi.org/10.4103/ejim.ejim_80_17