The Value Of Urinary Protein Markers In The Diagnosis,Progression And Prognosis Of Diabetic Kidney Disease

Aim of the study:Through the detection of biomarkers in urine of diabetic kidney disease(DKD)patients,which reflects the injuries in each nephron segment,the renal inflammation and the activity ofintra-renal complement system,we studyed the changes of these biomarkers in various stages of disease progression in DKD,and the correlation between it and traditional evaluation indexes of renal function to explore the prognostic significance of these markers in DKD progression and evaluation of renal function assessment.Methods:This study is an observational cross-sectional study.DKD patients who were hospitalized or outpatient follow-up from April 2014 to June 2017 were selected.The medical history was collected,the general situation and the results of laboratory examination were recorded.According to the admittance standard,the patients who meet the access conditions are included in the study.The morning urine samples from the middle section of the empty stomach were collected.Enzyme-linked immunosorbent assay(ELISA),turbidimetry and turbidimetry were used to detect the concentration of various urinary biomarkers.The corresponding normal people were matched from the health check-up center as the control.The urine biomarkers included in the study include three types.The markers for glomerular damage:urinary albumin,urinary transferrin(TRF),urinary immunoglobulin G(IgG);tubular injury biomarkers: urine kidney injury molecule-1(KIM-1),liver fatty acid binding protein(L-FABP),neutrophil gelatinase-associated lipocalin(NGAL)and retinol binding protein(RBP),urine alpha 1-microglobulin(alpha 1-MG);inflammation index: urinary monocyte chemoattractant protein-1(MCP-1);complement index: urinary complement factor B(CFB).These results was used in Statistical analysis is standardized by urinary creatinine values(X/Cr).Results:In DKD patients,there is significant correlation between urinary TRF,IgG,KIM-1,L-FABP,NGAL,RBP,1-MG,MCP-1,CFB level and traditional kidney evaluation indexes eGFR and ACR,(P < 0.001)?These indicators show a negative correlation with eGFR,with the decline in the eGFR,which showed an increasing trend,among which NGAL,alpha 1-MG,correlation coefficient absolute value is larger,respectively-0.707,-0.728,-0.707;positive correlation with ACR,namely with the increase of ACR,which showed the same trend to rise.The IgG and urinary TRF absolute value of correlation coefficient is larger,respectively 0.841,0.883,0.824,0.812.Urine TRF,IgG,KIM-1,L-FABP,NGAL,RBP,alpha 1-MG,MCP-1,CFB were significantly correlated with traditional risk stratification.(p < 0.001),which was statistically significant.The correlation of TRF,IgG,alpha 1-MG,L-FABP and CFB was more significant.Conclusions:In patients with DKD,urine TRF,IgG,KIM-1,L-FABP,NGAL,RBP,alpha 1-MG,MCP-1 and CFB were significantly correlated with traditional kidney evaluation index eGFR and ACR.The correlation between TRF,IgG,alpha 1-MG,L-FABP,CFB and the traditional risk stratification is significant,which is helpful to evaluate the prognosis of DKD.As a result,these urinary protein markers are useful in assisting traditional indicators to determine whether the kidney is involved,to evaluate the degree of renal disease,and to predict the prognosis.These markers did not increase most significantly in group DKD,and were not significantly different from those in other groups.So they have no value of differential diagnosis.TRF is of value to diagnosis MN,MCP-1 is of value to diagnosis LN.