Assessment of Some Biochemical Parameters, Neutrophil Gelatinase Lipocalin, And Kidney Injury Molecule-1 in Type 2 Diabetic Patients with Chronic Kidney Disease

Abstract

Diabetic kidney disease (DKD), often referred to as diabetic nephropathy (DN), is a microvascular complication of diabetes that may progress to end-stage renal disease (ESRD), a condition associated with high rates of morbidity and mortality. The principal etiological factors contributing to the development of DKD include glomerulocapillary angiopathy and prolonged duration of diabetes, both of which are major contributors to morbidity and mortality in patients with type 2 diabetes mellitus (T2DM).

This study aimed to evaluate the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) as early biochemical markers of DKD by determining their sensitivity and specificity in Iraqi patients with T2DM.

This cross-sectional study included 170 participants divided into three groups: Group I consisted of 50 healthy control subjects with an estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m²; Group II included 60 patients with T2DM and chronic kidney disease (CKD); and Group III comprised 60 patients with T2DM without CKD. All participants underwent fasting blood sampling for the assessment of glycated hemoglobin (HbA1c), serum creatinine (SCr), blood urea nitrogen (BUN), fasting blood sugar (FBS), serum electrolytes, NGAL, and KIM-1.

The results demonstrated that patients with DKD had significantly elevated levels of urea, creatinine, HbA1c, and FBS, along with highly significant alterations in serum electrolytes, particularly calcium and phosphorus. Serum levels of NGAL and KIM-1 were significantly higher in the DKD group, with a strong positive correlation observed between the two biomarkers. Serum NGAL and KIM-1 levels increased progressively from the control group (168.68 ± 3.63 ng/mL; 79.39 ± 3.06 pg/mL) to diabetic patients without CKD (352.52 ± 6.56 ng/mL; 104.47 ± 1.88 pg/mL), and were highest in diabetic patients with CKD (935.50 ± 36.51 ng/mL; 309.15 ± 12.97 pg/mL). Receiver operating characteristic (ROC) curve analysis revealed a cutoff value of >421.76 ng/mL for NGAL and >134.91 pg/mL for KIM-1.

Conclusion: Serum NGAL and KIM-1 levels, in combination with eGFR and other renal function parameters indicative of declining kidney function, may be considered reliable early biomarkers for the detection of diabetic kidney disease.