Urinary cyclophilin A in Egyptian patients with type 2 diabetes and diabetic nephropathy: correlation with urine albumin/creatinine ratio

Abstract

Introduction Albuminuria is commonly used to predict the onset and to follow the progression of diabetic nephropathy (DN), but it lacks both sensitivity and specificity in early stages. Aim We assessed urinary cyclophilin A (CypA) as a biomarker for the diagnosis of DN in Egyptian patients with type 2 diabetes. Patients and methods The study was conducted on 150 Egyptian participants aged 30–65 years; 125 (58 male individuals and 67 female individuals) patients with type 2 diabetes mellitus (diabetes duration>5 years) in different stages of DN and 25 age-matched and sex-matched healthy control participants comprised the study cohort. Estimated glomerular filtration rate and urine albumin/creatinine ratio (ACR) were assessed in all participants. Urinary CypA was measured in the morning specimen. Results Urinary CypA was significantly higher in patients with stage 2 DN, as compared with stage 1 patients (P=0.02) and the control group (P=0.017), with no significant change in urine ACR between stages 1 and 2 (P=0.809). Urinary CypA also showed a steady rise in DN stages 3, 4 and 5 (P<0.001). Urinary CypA had strong positive correlations with creatinine and urine ACR and a strong negative correlation with estimated glomerular filtration rate in patients with DN (P<0.001 for all). Conclusion We suggest that urinary CypA is a good biomarker for early detection of DN in patients with type 2 diabetes. It starts to rise before urine ACR. It also correlates well with the progression of DN. A larger study is needed to confirm its superiority over urine ACR in the early stages of DN.

Keywords

• albumin/creatinine ratio
• diabetic nephropathy
• type 2 diabetes
• urinarycyclophilin a