Expression Of Nephrin In Early Diagnosis Of Diabetic Nephropathy

Background & Objectives: Diabetic nephropathy occurs as a result of proximal tubule dysfunction with podocyte damage due to increased advanced glycation end-products’ insult in diabetes. Nephrin, one of the three proteins that make up the podocyte architecture, is excreted foremost following renal damage. The aim of this study was to evaluate the efficiency and reliability of nephrin for an early biomarker of kidney damage in diabetic patients. Methods: Urine samples (78) were collected from diabetic center. Protein and glucose were determined by Dipstick. The patients were grouped on the basis of Albumin/creatinine ratio (UACR) as normoalbuminuric, Microalbuminuric and Macroalbuminuric with UACR less than 30 mg/g, from 30-300mg/g, and above 300mg/g respectively. ELISA KIT (Exocell USA) was used for Nephrin estimation. Statistical evaluation was done on SPSS version 20. Results: Nephrinuria was present in 70(89.7%) out of 78 diabetic patients including 35(81.4%) of 43(55.1%) normoalbuminurics, 5(6.4%) of 30(38.5%) microalbuminurics and all 5 of macroalbuminurics (p=0.027). Nephrinuria was found associated with duration of diabetes, 21(91.3%)/23 were positive with less than three years of disease, 24(92.3%)/26 with three to seven years and 25(86.2%)/29 in more than seven years (p=0.039). Nephrin levels were found increasing from normo- (0.86ug/ml) to Micro- (11.6μg/ml) to Macroalbuminuria group (47.6μg/ml), compared to 0.15 μg/ml in comparison group. Conclusion: The increase in Nephrin levels from 0.86μg/ml in patients with normal albuminuria to 47.6μg/ml in patients with macroalbuminuria suggests that Nephrin precedes albumin in urine predicting early signs of kidney damage. Nephrin biomarker can be used as predictor for early diagnosis of Nephropathy in diabetics. Key Words: Diabetic Nephropathy; Albuminuria; Podocytes