Validity of Serum Uromodulin as Early Diagnosis Marker of Diabetic Nephropathy in T2DM
Abstract
Increased prevalence of DM is accompanied by increased in its various complications include diabetic nephropathy, which can lead to end stage renal disease (ESRD). Urinary albumin-creatinine ratio (uACR) is the gold standard for diabetic nephropathy; however, it has several limitations, including the inability to early diagnose due to the absence of increased level in uACR. Uromodulin is produced by thick ascending limb (TAL) at Henle’s loop and early distal tubule of nephron. Uromodulin will decrease when tubular atrophy occurs in early stage of renal impairment with normoalbuminuria. The aim of this study was to determine the validity of serum uromodulin in type 2 diabetes mellitus (T2DM) in identifying diabetic nephropathy by comparing it with uACR as gold standard. This study was a cross-sectional analytical observational study at Dr. Hasan Sadikin (RSHS) Bandung from June to August 2020. Subjects consisted of 62 patiens with T2DM. Results showed that the serum uromodulin level had a sensitivity of 93.3%, a specificity of 88.2%, a positive predictive value of 95.5%, a negative predictive value of 83.3%, and an accuracy of 91,9% and an AUC value of 0.975. The cut-off point of serum uromodulin in this study was 47.195 ng/mL. In conclusion, serum uromodulin, when compared to the uACR as the gold standard, has good sensitivity and specificity for identifying diabetic nephropathy.
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WHO. Classification of Diabetes Mellitus 2019. World Health Organization. 2019. p. 6–7.
Luiza M, Caramori A, Rossing P. Chapter 54 – Diabetic Nephropathy. Seventh Ed. Vol. 5, Endocrinology: Adult & Pediatric. Elsevier; 2018. 934–57.
Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, et al. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy. J Diabetes Res. 2016;1–13.
Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: Challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032–45.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1–163.
Chevalier RL. The proximal tubule is the primary target of injury and progression of kidney disease: Role of the glomerulotubular junction. Am J Physiol - Ren Physiol. 2016;311(1):145–61.
Tramonti G, Kanwar YS. Review and discussion of tubular biomarkers in the diagnosis and management of diabetic nephropathy. Endocrine. 2013;43(3):494–503.
Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci. 2017;54(5):326–42.
PERKENI. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Di Indonesia. PB. Perkeni; 2015. p. 1–79.
Devuyst O, Olinger E, Rampoldi L. Uromodulin: From physiology to rare and complex kidney disorders. Nat Rev Nephrol. 2017;13(9):525–44.
Halankar A, Shalia K. Uromodulin Levels in Chronic Kidney Disease. Int J Biomed Adv Res IJBAR Int J Biomed Adv Res J. 2016;8:383–7.
Vaidya SR. Chronic renal failure. Sci Basis Urol Second Ed. 2019;2:1–14.
AlFehaid A. Prevalence of microalbuminuria and its correlates among diabetic patients attending diabetic clinic at National Guard Hospital in Alhasa. J Fam Community Med. 2017;24(1):1.
George JA, Gounden V. Novel glomerular filtration markers. Adv Clin Chem. 2019;88:91–119.
El-Achkar TM, Wu XR. Uromodulin in kidney injury: An instigator, bystander, or protector? Am J Kidney Dis. 2012;59(3):452–61.
Steubl D, Block M, Herbst V, Nockher WA, Schlumberger W, Satanovskij R, et al. Plasma Uromodulin Correlates With Kidney Function and Identifies Early Stages in Chronic Kidney Disease Patients. Med J. 2016;95(10):1–9.
Ibrahim AA, Baban RS, Khudair MS. Clinical and biochemical association between serum and urin level of the uromodulin protein with albuminuria in patients with type-2 diabetes mellitus. Biochem Cell Arch. 2019;19:2367–70.
Prajczer S, Heidenreich U, Pfaller W, Kotanko P, Lhotta K, Jennings P. Evidence for a role of uromodulin in chronic kidney disease progression. Nephrol Dial Transplant. 2010;25:1896–903.
DOI: https://doi.org/10.15395/mkb.v53n2.2268
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