A novel diabetic nephropathy score based on urinary proteomic change is associated metabolic control status in subjects with type 2 diabetes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 818-841-Diabetes Pathophysiology & Complications
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-821
Tzu-Ling Tseng*1, Tien-Chun Chang2, Wei-Ya Lin1, Pei-Fen Kuo1, Yen-Peng Li1, Huang-Yuan Li2 and Lee-Ming Chuang2
1Industrial Technology Research Institute, Taiwan, 2Coll of Med - NTU, Taipei, Taiwan
Diabetic nephropathy is a major complication of diabetes. It causes a huge burden in management of diabetes in the world. Although appearance of microalbuminuria and progressive decline of glomerular filtration rate are the early signs during development of diabetic nephropathy that might lead to end-stage renal failure, pathology of the kidney remains gold standard for diagnosis of diabetic nephropathy. To provide a thorough understanding of urine proteomic changes despite of albumin excretion rate as a clinical routine test, we developed a scoring system for diabetic nephropathy, ITRI_DN score, based on systemic profiling of urinary proteomic changes in normal, diabetes, and those with nephropathies. In this study, we tested the relation of the novel ITRI_DN scores with albumin excretion (by albumin creatinine ratio, ACR) and estimated glomerular filtration rate (eGFR) in a group of 248 subjects with type 2 diabetes, 143 male and 105 female, with a mean age of 59.88 (±9.63). We excluded patients with a high normal level of creatinine (1.4 mg/dl for males, 1.3 mg/dl for females) and presence of high level of microalbuminuria (ACR > 200 mg/g). We also evaluated the correlation of these 3 parameters of diabetic kidney disease with various clinical and metabolic variables. In patients with minimal signs of nephropathy, we documented that there was a poor correlation between CKD stages and absence/presence of microalbuminuria. ITRI_DN score appeared to be discriminative between absence and presence of microalbuminuria, but not among CKD stages from stage 1 to stage 3. More importantly, ITRI_DN score and ACR, but not eGFR, were more closely correlated with metabolic variables including plasma glucose, HbA1C, blood pressure, and triglycerides. After adjusting those confounding variables, ACR was independent of ITRI_DN and vise versa. Taken together, ITRI_DN serves a novel biomarker panel that is influenced by metabolic control of diabetes in addition to those explained only partially by ACR. Long term outcome study will be necessary to establish the predictive role of ITRI_DN on the development and progression of diabetic nephropathy.

Nothing to Disclose: TLT, TCC, WYL, PFK, YPL, HYL, LMC

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