| Among diabetic microvessel complications, diabetic nephropathy (DN) is a major cause of mobility and mortality in diabetes mellitus. The DN patients with clinical proteinuria will irreversibly lead to end-stage renal disease (ESRD), and need renal substitution treatment. Diabetic nephropathy is the leading cause of ESRD. The diabetic pathological changes can be reversible if treated at an early stage of DN. Urinary albumin excretion rate (UAER) is an index in the early diagnosis of DN and mainly reflects the damage to the glomerular function, but it can not reflect the impaired tubular function.In the early course of DN, apart from urinary albumin, urinary excretion of immunoglobulip kappa light chain (KLC), transferrin (TRF), immunoglobulinG (IgG) and alpha 1 microglobulin (alMG) may increase. KLC can be freely filtered by the glomerulus, and then reabsorbed by the proximal tubule. Normally there is small amount of KLC in human urine. The urinary excretion of KLC will increase when people suffer from renal diseases or multiple myoloma. To study the change of urinary excretion of KLC in type 2 diabetic patients and the relationship among urinary KLC, UAER, TRF, IgG and a IMG, we measured the urinary excretion of KLC, albumin, TRF, IgG, and alMG in patients with type 2 diabetes mellitus and the urinary KLC and albumin in healthy control subjects. The aims of this study were: first, to investigate roles of urinary excretions of KLC in the early course of DN; second, to find a sensitive index in early detection of diabetic nephropathy; and third, to provide reference for early diagnosis and treatment of DN.MethodsA total of 123 cases of type 2 diabetic patients (DM) and 51 cases of normal controls (NC) were studied. All patients were defined in accordance with WHO criteria (1985) and were divided into 2 groups according to Mogensen's principle: DM1 group (UAER<20 ug/min, 75 cases) and DM2 group (20 ug/min^UAER<200 ug/min, 48 cases). DM1 group was further divided into three subgroups based on UAER: DM1.1 group (UAER<5 ug/min, 30 cases), DM1.2 group (5 ug/min^UAER< 10 ug/min, 33 cases) and DM1.3 group (10 ug/min.^ UAER<20 ug/min, 12 cases). Serum creatinine (SCr) andurea nitrogen (SBun) in patients were normal, and the urinary protein was negative. Those who were with acute metabolic syndrome, acute infectious diseases, rumors and severe cardiac, pulmonary or hepatic diseases, non-diabetic related renal diseases were excluded.Urine of 24 hours and urina sanguinis were collected. The urinary concentrations of KLC, TRF, IgG and a IMG in urina sanguinis were measured by rate nephelometry with American Beckman-Array 3.6 Specific Protein Analyzers (KLC, TRF, IgG and a IMG reagents purchased from Beckman Instrument, Inc.). The urinary concentration of albumin was determined by RIA with XH-6010 y Radical Immunity examinational machine(Kits purchased from Chinese Research Institute of Atomic Energy Science in Beijing). HbAlc, FPG, SBun, Scr, SBP, DBP et al were examined in all patients.Statistical analysis was carried out by SPSS 10.0 for Windows. Data of each group were logarithmically transformed. Significant differences between groups were measured by Independent Samples t Test and one way ANOVA. Multiple comparison was accomplished by LSD and Dunnett T3 Test. 95% confidence intervals (95%CI) of means in each group were computed. Chi-square test and the precision and accuracy of the clinical examination were performed to compared the two diagnostic indexes. Correlation analysis between parameters was conducted through Person correlative analysis.ResultsThe differences of age, course of disease and SBP between DM1 group and DM2 group were significant (p<0.05). There were no significant differences between DBF, HbAlc, FPG, SBnn and SCr of DM1 group and DM2 group. There were no significant differences among the clinical indexes of DM1 subgroups.The urinary excretion of KLC was significantly higher in DM group than that in NC group (5.06 ?.65 mg/dl vs 2.89 ?1.82 mg/dl, p |
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