Abstract

Pre-albuminuria DN may be defined by the activation of the renin-angiotensin system and the development of tubulointerstitial injury. In non-hypertensive people with type 2 diabetes, we analyzed the ability of four urine biomarkers to predict the development of albuminuria: angiotensinogen (Angio), interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin (Cys). An indicator of nephropathy in persons with type 2 diabetes was a low albumin-to-creatinine ratio (ACR). The eGFR of these individuals was less than 120 ml/min.” At one year, they were split into three groups based on whether they had hyperfiltration, normoalbuminuria, or microalbuminuria. Fifty more T2DM patients who did not have nephropathy served as controls. All of them were also evaluated for ACR, HbA1 C, eGFR, and a panel of urine biomarkers (IL-18, cystatin-C, NGAL, and AGT). Both correlation and logistic regression were used to evaluate the accuracy of each diagnostic tool across subgroups. The results showed that IL-18/Cr, cystatin/Cr, and AGT/Cr were all elevated in the urine of those with hyperfiltration, normoalbuminuria, and microalbuminuria compared to controls, whereas NGAL/Cr remained unchanged. According to multivariate logistic regression, the chances ratio for developing nephropathy increased by a factor of eight with increasing log Angio/Cr ratios. Conclusions: Urinary AGT was more useful than ACR and eGFR, then IL-18 and cystatin, for identifying DN before albuminuria developed

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