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Abstract
Background: Diabetes mellitus is defined as a state of chronic hyperglycaemia, i.e. an excessive concentration of glucose in the blood. There are two forms of human diabetes mellitus: non-insulin-dependent diabetes (NIDDM), also referred to as type II, maturity onset, or non-ketotic diabetes; and insulin dependent diabetes mellitus (IDDM), also referred to as type I, juvenile onset, ketosis-prone diabetes.
Objective: The aim of the present study is to detect early renal involvement in type 2 diabetic patients. This will be done by measurement of serum sialic acid and urinary N-Acetyl-b-glucosaminidase (NAG) and assessment its relation to microalbuminuria and duration of diabetes.
Methods: The present study was carried out at Medical Biochemistry Department, Diabetic Outpatients Clinic and Internal Medicine Department, Faculty of Medicine, Zagazig University. Our study included 45 patients of type 2 DM and 15 control persons, and they were classified into 4 groups: Group I (control): comprising 15 healthy male subjects not suffering from any disease interfering with our study. Group II: Including 15patients with type 2 DM with disease duration from 3 to 5 years. Group III: Including 15patients with type 2 DM with disease duration from 5 to 10years. Group IV: Including 15 patients with type 2 DM with disease duration more than 10 years.
Results: There were significant increase in urinary NAG in all diabetic patients than that of controls. There was no correlation between urinary NAG and microalbuminuria in group II (type 2 DM patients between 3-5 years duration). There were significant positive correlation between urinary NAG and microalbuminuria in group III, IV (patients 5-10 years duration and patients more than 10 years duration). The mean values of urinary excretion of NAG showed gradual increase during the progress of the disease at different duration periods. There were significant increase in serum sialic acid in group III, IV (patients 5-10 years duration and patients more than 10 years duration) than that of controls. There was no correlation between serum sialic acid and microalbuminuria in group II (type 2 DM patients between 3-5 years duration). There were significant positive correlation between serum sialic acid and microalbuminuria in group III, IV (patients 5-10 years duration and patients more than 10 years duration). The mean values of serum sialic acid showed gradual increase during the progress of the disease at different duration periods.
Conclusion: Results of the present study demonstrated that renal proximal tubular cell dysfunction occurs in the early stage of diabetic nephropathy even earlier than glomerular damage (i.e.microalbuminuria). Serum sialic acid elevation occurs in the early stage of diabetic nephropathy even earliar than microalbuminuria. This study indicates that urinary NAG and serum sialic acid measurement is a sensitive non-invasive test for early detection of diabetic patients at risk of developing diabetic nephropathy in type 2 DM patients.