ESPE Abstracts

Introduction: Diabetic nephropathy (DN) is one of the most frequent and severe complications of diabetes mellitus and a leading etiological cause of chronic kidney disease. Early diagnosis and treatment are essential to prevent further deterioration of kidney function. Albuminuria has been considered to be the clinical hallmark of diabetic kidney disease and is used for its diagnosis and follow-up. Although microalbuminuria is a marker established in the clinical practice, there are number of imperfections in its specificity and predictive value, necessitating the search for earlier and more specific diagnostic tests. Some of the most promising new markers are urinary tumor necrosis factor (TNF)-alpha and urinary transferrin.

Objectives: To evaluate the relevance and applicability of urinary TNF-alpha and transferrin as an earlier and more specific markers for the diagnosis of DN.

Materials and methods: The study enrolled 122 patients with type 1 diabetes mellitus with a mean age of 14.10 (±2.55) years and 19 controls with a mean age of 12.00 (±2.98) years. Urinary TNF-alpha, transferrin and creatinine were measured in all participants in first morning urine. TNF-alpha/creatinine and transferrin/creatinine ratios were calculated. Microalbuminuria (MAU) was assessed in diabetic patients by measurement in 24-hour urine collection. Glycated hemoglobin (HbA1c) and GFR were also assessed. Patients were divided into 3 groups according to glycemic control: HbA1c<7%; HbA1c 7-9% and HbA1c>9%. According to the presence of MAU, 2 groups were formed: with and without MAU. According to GFR, patients were divided into 3 groups: GFR<90; 90-140 and >140ml/min/1.73m2. The mean values of TNF-alpha/creatinine ratios in different groups were compared.

Results: Statistically significant difference was found when comparing TNF-alpha/creatinine and transferrin/creatinine ratios between patients and controls. Significant difference was also found when the mean values of the ratios were compared according to the glycemic control, with positive correlation to HbA1c. When comparing transferrin/creatinine ratio there was a significant difference between the groups with and without MAU. Tsdahe TNF-alpha/creatinine ratio of the MAU group was higher than the non-MAU group, but there was no statistically significant difference. There was also no significant difference between groups divided by GFR.

Conclusion: Urinary TNF-alpha and transferrin showed significant potential as an early marker for the diagnosis and follow-up of diabetic nephropathy in children with type 1 diabetes.