Evaluation of urinary neutrophil gelatinase associated lipocalin as an early marker of nephropathy in type 1 diabetic adolescents

Background: Diabetic nephropathy (DN) is a major cause of morbidity and mortality among adolescents with type 1 diabetes. Clinical management and therapeutic intervention from early stage of DN is of major importance to prevent progression to end-stage renal disease. Renal tubulointerstitium plays an important role in the development and progression of diabetic nephropathy.
Aim: The aim of the present study was to assess and evaluate urinary Neutrophil Gelatinase-Associated lipocalin (uNGAL) as an early marker for diabetic nephropathy in type 1 diabetic adolescents.
Methodology: This is a case control study that included ninety adolescents. They were divided according to albumin/creatinine ratio (ACR) in urine into three groups: group I included thirty type 1 diabetic adolescents without microalbuminuria (<30 mcg/mg), group II included thirty type 1 diabetic adolescents with microalbuminuria (30–300 mcg/mg) and group III included thirty healthy controls. In addition to urinary NGAL, urine albumin/creatinine ratio, serum creatinine, estimated glomerular filtration rate (eGFR), fasting blood glucose (FBG), glycated hemoglobin (HbA1c) and other common biochemical parameters were measured according to standard methods and were assessed to correlate their values with urinary NGAL. Data analysis was done by using (SPSS) version 20.0. P value was set significant if < 0.05. All graphs were analyzed with graph pad version 17.0.
Results: Urinary NGAL was increased in diabetic patients compared to controls; interestingly, uNGAL was increased already in microalbuminuric patients (group II) and also in normoalbuminuric (group I) (p=0.000). It was increased proportionately to the severity of kidney function, poor glycemic control. Diabetic patients showed increased mean ACR values with respect to controls (p=0.000). Analysis of correlation revealed that urine NGAL was correlated with fasting blood glucose and blood pressure.
CONCLUSION: Urinary NGAL was significantly elevated in micro-albuminuric (group II) and some normo-albuminuric type 1 diabetes patients (GROUP I) compared with healthy controls (GROUP III) and it can predict diabetic nephropathy at early stage even before the development of microalbuminuria.