Diagnostic Value of the Combined Measurement of Serum Hcy, Serum Cys C, and Urinary Microalbumin in Type 2 Diabetes Mellitus with Early Complicating Diabetic Nephropathy
Diabetic nephropathy (DN) is a major cause of end-stage kidney disease, and therefore early diagnosis and intervention may help reverse renal damage. One hundred and sixty-eight patients with T2DM and 56 healthy volunteers (control group) were enrolled at Shandong University Qilu Hospital between April 2010 and October 2012. All subjects underwent blood sampling for sera homocysteine (Hcy) and cystatin C (Cys C) assays and a urine microalbumin test. The patients were divided into three groups according to the urine microalbumin excretion rate (UMAER): the simple DM group (SDM group, ), the early-stage DN group (EDN group, ), and the clinical DN and renal failure group (CDN group, ). Correlation analysis was performed to examine the association between sera Hcy and Cys C levels with UMAER. Our findings showed that sera Hcy level, Cys C level, and UMAER increased significantly in the SDM group ( , ), the EDN group ( ), and the CDN group ( ) as compared with the control group. These three biochemical markers also increased significantly with DN progression ( ). Correlation analysis showed that sera Hcy and Cys C levels were positively correlated with UMAER ( , ; , ). In conclusion, our results showed that sera Hcy and Cys C levels increased consistently with the development and progression of DN as indicated by UMAER. Sera Hcy and Cys C are sensitive biomarkers for the detection of early-stage DN and monitoring its progression. 1. Introduction Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus. Renal damage may underlie early-stage DN, which, in most cases, is asymptomatic. Proteinuria is present in patients with advanced stage DN. Early detection and intervention in diabetic patients with DN will possibly reverse, or even eliminate, underlying renal damage. Therefore, the early diagnosis and treatment of DN are crucial [1, 2]. The urine microalbumin excretion rate (UMAER) is a traditional standard measure for evaluating glomerular filtration and is helpful for detecting early-stage DN and monitoring its progression. However, a combination of biomarkers is needed to improve the prediction of DN in clinical practice. Recent studies have suggested that DN is a chronic inflammatory disorder mediated by a series of cytokines, including interleukin-6, interleukin-8, and tumor necrosis factor-α as well as homocysteine (Hcy) and cystatin C (Cys C). Homocysteinemia is an independent risk factor for cardiovascular diseases [3] and has been reported in patients with chronic kidney diseases [4]. Hcy is thought to be associated with
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