| Purpose:The purpose of this study is to investigate the role of urinary DKK-3 and KIM-1 in the evaluation of tubular interstitial injury in type 2 diabetic nephropathy.Methods:We collected the clinical data of the patients with type 2 diabetes mellitus(T2DM)and diabetic kindey disease(DKD)who were hospitalized in the first Hospital of Jilin University.At the same time,we selected other persons check-up at physical examination center.The above results were analyzed to evaluate the relationship between urinary DKK-3,KIM-1 and tubule interstitial injury in patients with DKD.Results:1.According to the ratio of urinary albumin to urinary creatinine,the patients with type 2 diabetes and diabetic nephropathy were divided into four subgroups: DM normal albuminuria group(23 cases),DKD microalbuminuria group(17 cases),DKD macroalbuminuria group(93 cases)and NC group(17 cases).The biochemical indexes of the four groups were compared respectively.It was found that the levels of DKK-3 and KIM-1 in urine gradually increased with the progression of DKD.2.DKD patients were grouped according to renal tissue injury score,and biochemical indexes were compared between groups.It was found that with the increase of IFTA score,the levels of DKK-3 and KIM-1 in urine gradually increased(p <0.001).Urine DKK-3 was positively correlated with IFTA(r=0.283,p=0.021).The ROC curve indicated that urine DKK-3 could effectively evaluate the severity of renal tubule interstitial injury,and the area under the curve(AUC=0.690)was higher than urine KIM-1(AUC=0.522).The optimal cut-off value was 196.68ug/mmol Cr,and the sensitivity to evaluate DKD tubule interstitial injury was 51.5%.The specificity was 69.7%.3.We analyzed the correlation between urinary DKK-3 and KIM-1 and renal function indexes and the decline of renal function.The results indicated that the levels of urinary DKK-3 and KIM-1 in DKD patients were negatively correlated with e GFR,positively correlated with serum creatinine,urinary protein quantization and urinary microalbumin,and negatively correlated with renal function decline.In DKD patients who were followed up for 6 months,we found that urinary KIM-1 level was strongly correlated with renal function decline(r=-0.476,P < 0.001).Conclusions:1.The levels of DKK-3 and KIM-1 in patients with type 2 diabetic nephropathy were significantly higher than those in normal control group,and gradually increased with the progression of diabetic nephropathy,renal interstitial fibrosis and renal tubular atrophy scores.2.Urinary DKK-3 level is associated with tubulointerstitial injury and renal function decline in patients with type 2 diabetic nephropathy,and can be used as a biomarker of tubulointerstitial injury in diabetic nephropathy.Urinary KIM-1 level is associated with progression of diabetic nephropathy and can be used as a biomarker to predict short-term renal function decline in diabetic nephropathy patients. |
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