Early Diagnostic Markers in Diabetic Nephropathy Patients

摘要

Diabetes Mellitus is one of the most important causes of chronic complications of kidney diseases. Cystatin C could serve as an ideal marker of the glomerular filtration status. The ability to assess renal function in diabetic patients rapidly and early is of major importance for the possibility of preventing the development of nephropathy. Therefore, it is important to add a more sensitive or specific indicator for detecting early renal impairment in diabetic patients, so that corrective measure could be adopted to prevent the progression of kidney function impairment towards frank nephropathy.Aim: To evaluate the clinical advantage of serum cystatin C and creatinine level in predicting renal impairment in patients with Type 2 diabetes in Gujarat, India.Materials and Methods: A cross-sectional study was conducted from September 2015 to April 2017 in Pramukhswami Medical College (PSMC) and Shri Krishna Hospital, Karamsad, Anand-Gujarat. This study included a total of 170 participants classified into two groups; 85 patients with diabetic nephropathy and 85 patients without diabetic nephropathy. Serum samples were collected to measure cystatin C using immunoturbidimetric assay (On TURBODYNE TM SC). Glucose, Urea, Creatinine, HbA1c, Cholesterol, Triglycerides, and HDL-Cholesterol were estimated by using Automated Analyser (Siemens Dimensions RxL/Xpand). The data were computer analysed using SPSS 20. USA.Results: The results revealed that the mean cystatin C level was higher in diabetic nephropathy patients (1.87±0.51 mg/L) than diabetics without nephropathy (1.025±0.30 mg/L), and the difference was significant with p-value <0.001. The results showed a significant correlation between Cystatin C with age(r=0.214; p=0.005), Creatinine (r=0.55; p<0.001), Urea (r=0.66; p<0.001) and HbA1c (r=0.164; p=0.033). But no significant correlation with gender (r=0.075; p=0.33). The results also showed that the level of serum cystatin C was higher in some patients (28 out of 85 cases) with a normal level of creatinine. But the level of serum cystatin C was higher in all the patients who had an abnormally high serum creatinine level. This was significant with p=0.001.Conclusion: Cystatin C is a useful marker for early detection of diabetic nephropathy. The results of this study suggest that cystatin C measurement in serum is useful for the early detection of renal impairment in a way better than S. creatinine in the patients with diabetes.