ESPE Abstracts

Background: Diabetic nephropathy (DN) is the leading contributor to high morbidity and mortality in patients with type 1 Diabetes (T1D). Abuminuria, the gold standard marker of renal damage in diabetic nephropathy, lacks the sensitivity to detect the earliest changes in renal function; as renal histopathological changes were reported to be found before the onset of albuminuria

Aim of the work: To assess the diagnostic role of urinary neutrophil gelatinase- associated lipocalin (uNGAL) levels as an early marker of diabetic nephropathy.

Methods: A cross-sectional study included 84 children with type1 Diabetes aged 2-18 years. Albumin/creatinine ratio as well as u NGAL levels were assessed. Children with albuminuria were compared with those with normal albumin creatinine ratio (ACR)

Results: Mean value of uNGAL was statistically significantly higher in albumiuric group (164.3± 21.5 ng/ml) than in each of the normoalbuminuric group (127.27± 17.58 ng/ml) and the control group (103.91± 33.88 ng/ml), (p-value <0.0001) for each. There was statistically significant positive correlation as regard A/C ratio with duration of DM, systolic and diastolic blood pressure, HbA1c, serum creatinine and micro albumin in urine. Receiver operator characteristic (ROC) curves showed better diagnostic accuracy of urinary NGAL than serum creatinine in detecting albuminuria in diabetic patients. The sensitivity and specificity of serum creatinne, microalbumin in urine and uNGAL were estimated via ROC curves. The area under the curves (AUC) was 0.916: for uNGAL, 0.663 for serum creatinine and 0.777: for microalbumin in urine. The AUC was significantly higher for uNGAL with P-value < 0.0001, but not for serum creatinine with P-value = 0.038 and microalbumin in urine with p-value <0.0001: The sensitivity and specificity of uNGAL were 100% and 63%, respectively with the upper reference limit as the cut-off.

Conclusion: High urinary levels of NGAL have been found in diabetic children compared to controls, and also levels were found to be higher in diabetic patients with microalbuminuria than in those with normoalbuminuria, So, urinary NGAL measurement might become an early, useful, sensitive, practical and noninvasive accurate tool for early detection of diabetic kidney injury in children and adolescents, which allows early intervention and treatment. Larger studies are needed to establish urinary neutrophil gelatinase-associated lipocalin level and to detect the association between urinary neutrophil gelatinase-associated lipocalin and other factors that might affect its level.