الفهرس | Only 14 pages are availabe for public view |
Abstract Type 1 diabetes mellitus (T1DM) is a chronic, lifelong disorder of glucose homeostasis characterized by autoimmune destruction of the insulin-producing pancreatic b-cell, leading progressively to insulin deficiency and resultant hyperglycemia. Its incidence continues to increase worldwide and it has serious short-term and long-term implications. These complications consist of microvascular and macrovascular disease, which account for the major morbidity and mortality associated with T1DM. Screening provides an opportunity to detect uNGAL early to initiate therapy, and to encourage meticulous attention to achieving glycemic goals during the reversible phase of diabetic nephropathy which is the single leading cause of end-stage renal disease and the need for renal replacement therapy and considered one of the most severe microvascular complications in patients with type 1 diabetes. Urinary NGAL is currently considered as one of the most promising biomarkers in clinical nephrology and has been extensively studied in acute kidney disease. Acute kidney disease is closely related to high morbidity and mortality. Therefore, researchers had aggressively searched for a new biomarker and uNGAL has been found to improve the accuracy of the current biomarkers used toThe aim of this case control study was to assess urinary neutrophil gelatinase-associated lipocalin (uNGAL) in type 1 diabetic adolescents and to evaluate urinary NGAL as an early marker for diabetic nephropathy on 90 adolescents (44 males and 46 females) divided into three groups: group I included 30 of type 1 diabetic adolescents with microalbuminuria, group II included 30 of type 1 diabetic adolescents without microalbuminuria and group III included 30 of apparently healthy age and sex matched adolescents as a control group. All patients and controls were subjected to full history taking, growth assessment using Egyptian growth curves, vital signs including blood pressure (BP), head and neck examination, systemic examination and laboratory investigations (complete urine analysis with culture, serum urea and serum creatinine, albumin/creatinine ratio will, glycosylated hemoglobin (HbA1c) and Urinary NGAL concentration. Our results showed that; There was no significant difference between three groups for the gender, BMI, height, age and age on set between three groups but there was a significant longer duration in group II than group I (p=0.003). Also, there was a significant difference between group I and group II for SBP and DBP as it was higher in group I (p=0.000).The present study showed the statistical difference between the diabetic patient groups I or II and the control group as regards glycosylated hemoglobin (HbA1c) and FBG as it was higher in group II (p=0.000). Also, there was a highly statistically significant difference in the mean±SD between the collective patient groups I and II for Insulin Dose u/kg/day (p=.031). Liver enzymes have been tested for all groups to ensure that they have not liver disease. According to ALT and AST results, the patients with highly ALT and AST were excluded from this study so that there is no significant difference between patients group I, group II and Group III normal control. This study showed the statistical difference between the diabetic patient groups and the healthy group as regards lipid profile as there was a statistically significant difference in the mean±SD of Total cholesterol was significantly higher in group II the patients groups compared the group III. Also, there was a significant difference between mean±SD of HDL, LDL and triglycerides for T1DM group II compare to group III healthy control. On the other hand, there was a significant difference between mean±SD of triglycerides for T1DM group I compare to group III and between HDL-C for T1DM group I compare to group II. Our study showed there was a highly statistically significant difference in the mean±SD of creatinine and eGFR between T1DM with nephropathy patient groups and control. On the other hand, there was no a significant difference between the diabetic patient groups and the healthy group in the mean±SD urea or between patient’s groups. This study showed there was a highly statistically significant increase in the mean±SD Albumin Creatinine Ratio (ACR) in group II T1DM with nephropathy patient groups compared to controls. Current study showed there was a highly statistically significant increase in the mean±SD Albumin Creatinine Ratio and uNGAL in group II T1DM with nephropathy patient groups compared to controls. The mean value of uNGAL was higher in diabetics with positive family history of diabetes mellitus than in group I and group II diabetics with negative family history of diabetes and the difference was statistically significant. The mean value of uNGAL was higher in diabetics with positive family history of Cardiovascular disease than in group I and group II diabetics with negative family history of diabetes and the difference was statistically significant. The mean value of uNGAL was higher in diabetics with positive family history of Renal disease than in Group I and group II diabetics with negative family history of diabetes and the difference was statistically significant The mean value of ACR was lower in diabetics with positive family history of Cardiovascular disease than in group I and group II diabetics with negative family history of diabetes and the difference was statistically nonsignificant. The mean value of ACR was higher in diabetics with positive family history of Renal disease than in group I and group II diabetics with negative family history of diabetes and the difference was statistically significant. There was a significant positive correlation of SBP, DBP, Triglycerides and uNGAL. On the other hands, there was non-significant positive correlation between Urea and uNGAL and negative non-significant correlation between Liver Function, eGFR and uNGAL. detect kidney damage. |