Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Dec 25, 2024; 13(4): 98880
Published online Dec 25, 2024. doi: 10.5527/wjn.v13.i4.98880
Neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and periostin: Novel urinary biomarkers in diabetic nephropathy
Sakthivadivel Varatharajan, Vishakha Jain, Anand K Pyati, Charan Neeradi, Kotha Sugunakar Reddy, Janardhana Reddy Pallavali, Ilakkiya Priya Pandiyaraj, Archana Gaur
Sakthivadivel Varatharajan, Vishakha Jain, Charan Neeradi, Janardhana Reddy Pallavali, Ilakkiya Priya Pandiyaraj, Department of General Medicine, All India Institute of Medical Sciences-Bibinagar, Hyderabad 508126, Telangana, India
Anand K Pyati, Department of Biochemistry, All India Institute of Medical Sciences-Bibinagar, Hyderabad 508126, Telangana, India
Kotha Sugunakar Reddy, Department of General Medicine, Neelima Institute of Medical Sciences, Hyderabad 500088, Telangana, India
Archana Gaur, Department of Physiology, All India Institute of Medical Sciences-Bibinagar, Hyderabad 508126, Telangana, India
Author contributions: Varatharajan S conceived, designed, and coordinated the study, participated in the acquisition and interpretation of data, and drafted the manuscript; Jain V, Pyati AK, Neeradi C, and Reddy KS participated in the acquisition, interpretation of the data, and drafted the initial manuscript; Pallavali JR, Pandiyaraj IP, and Gaur A participated in the analysis, interpretation of the data and revised the article critically for important intellectual content; all of the authors read and approved the final version of the manuscript to be published.
Supported by All India Institute of Medical Sciences-Bibinagar, No: AIIMS/BBN/Research/IM-F/2022/20.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of All India Institute of Medical Sciences-Bibinagar Institutional Review Board, No. AIIMS/BBN/IEC/SEP/2021/93-A.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at vsakthivadivel28@gmail.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items-and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sakthivadivel Varatharajan, MD, Additional Professor, Department of General Medicine, All India Institute of Medical Sciences-Bibinagar, Bibinagar, Hyderabad 508126, Telangana, India. vsakthivadivel28@gmail.com
Received: July 8, 2024
Revised: September 25, 2024
Accepted: October 20, 2024
Published online: December 25, 2024
Processing time: 122 Days and 0.3 Hours
Abstract
BACKGROUND

Globally, diabetic nephropathy (DN) is the primary cause of chronic kidney disease. Currently, renal function is monitored indirectly using measures of serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria. Novel urinary biomarkers utilized in the early stages of DN have been described; these indicators can be used in the early identification of the disease, which is important for initiating treatment to halt or impediment the advance of diabetic nephropathy.

AIM

To estimate neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and periostin (POSTN) levels as novel urinary biomarkers in DN.

METHODS

In this hospital based cross-sectional study, a total of 160 patients of both genders aged 18 years or more; 40 healthy participants and 120 patients with diabetes mellitus (DM) were included. Patients with DM were divided into normoalbuminuria (n = 40), microalbuminuria (n = 40), and macroalbuminuria (n = 40) groups as per urine albumin creatinine ratio (uACR). Blood urea, serum creatinine, uACR were measured. Urine NGAL, KIM-1, and POSTN were measured by enzyme linked immunosorbent assay. The eGFR was calculated and compared with urinary markers.

RESULTS

NGAL, KIM-1, and POSTN levels increased significantly in normo, micro, and macroalbuminuria with the highest in the macroalbuminuria group. Albumin creatinine ratio (ACR) showed a positive correlation with NGAL, KIM-1, and POSTN levels. The eGFR showed a weak negative correlation with ACR, NGAL, KIM-1, and POSTN. NGAL was significantly lower in stage 1 compared to stage 2, 3, and 4 kidney disease. KIM-1 was significantly decreased in stage 1 compared to stage 4 kidney disease. POSTN was significantly decreased in stage 1 compared to stage 3 and 4 kidney disease. The receiver operator curve analysis of ACR, NGAL, KIM-1, and POSTN showed good sensitivity of 80%, 75.8%, 63.3%, and 80 % respectively with a cut-off of 12.5 mg/g, 4.5 μg/L, 1.5 ng/mL, and 37.5 ng/mL.

CONCLUSION

Urinary NGAL and POSTN are independent markers of DN.

Keywords: Diabetic nephropathy; Neutrophil gelatinase-associated lipocalin; Kidney injury molecule-1; Periostin; Urinary marker

Core Tip: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease. Novel urinary biomarkers are useful for detecting DN at an early stage, facilitating timely intervention. Among these, Neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and periostin have shown promise as early detection markers for DN.