Desempenho de novos biomarcadores no diagnóstico e classificação da nefropatia diabética em pacientes com diabetes mellitus tipo 1

Abstract

Diabetic nephropathy is a chronic complication of diabetes mellitus that affects approximately 35% of type 1 diabetics and is the leading cause of chronic kidney disease in the most countries. Moreover, it is associated with high morbidity and mortality, as well as considerable medical expenses. Therefore, early and accurate diagnosis of this complication, as well as its adequate monitoring is essential to ensure the establishment of protective and therapeutic measures that allow prevent and slow its progression. However, tests traditionally employed in the diagnosis and monitoring of diabetic nephropathy urinary albumin excretion and glomerular filtration rate have significant limitations. In this context, it becomes necessary to search and evaluation of the performance of new biomarkers. From this perspective, the objective of this study was evaluate the performance of some emerging biomarkers in the diagnosis of diabetic nephropathy in patients with type 1 diabetes mellitus. Then, cystatin C, alkaline phosphatase and gammaglutamyltransferase were determined in plasma and urine of patients with type 1 diabetes mellitus with and without diabetic nephropathy. The new biomarkers showed no significant differences regarding gender, body mass index and smoking. Furthermore, they correlated with each other, with classic markers of renal function (urea and creatinine) and the parameters used in the diagnosis of diabetic nephropathy. The evaluated biomarkers were able to differentiate healthy individuals from diabetics, diabetics without nephropathy from diabetics with nephropathy and the stages of albuminuria. Among the new biomarkers stands out cystatin C, as well as better monitor the progression of albuminuria, I had the best performance, below the urinary albumin/creatinine ratio, in the diagnosis of diabetic nephropathy. The new biomarkers thus, especially its plasma determination, in particular cystatin C, may be useful in the assessment and monitoring of the renal function and in the diagnosis of diabetic nephropathy in patients with type 1 diabetes mellitus.