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The Egyptian Journal of Internal Medicine
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Urinary albumin excretion and progression of renal disease with impaired fibrinolytic activity in type 2 diabetes mellitus

The Egyptian Journal of Internal Medicine volume 27, pages 108–114 (2015)Cite this article

Abstract

Background

Diabetic nephropathy is one of the major causes of end-stage renal disease. As impaired fibrinolysis can increase renal fibrosis, we investigated the relationship of impaired fibrinolysis, as assessed by the ratio of plasminogen activator inhibitor-1 ( PAI-1) to tissue-type plasminogen activator (t-PA) with urinary albumin excretion ( UAE) and renal disease progression in type 2 diabetes.

Patients and methods

A total of 50 patients with type 2 diabetes and 10 healthy control individuals were included in the study. Participants were subdivided according to UAE. Group 1 (G1) represented control individuals. Group 2 (G2) included patients without albuminuria. Group 3 (G3) included patients with microalbuminuria. Group 4 (G4) included patients with macroalbuminuria. Creatinine clearance and UAE were calculated. PAI-1 and t-PA were measured using an enzyme-linked immunosorbent assay kit, and the PAI-1/t-PA ratio was calculated as an index of impaired fibrinolysis.

Results

PAI-1 was highly elevated significantly in G4 when compared with the other groups, with a mean of 87.40 ± 17.03 IU/ml against 28.00 ± 6.98 IU/ml in G1, 46.4 ± 7.99 IU/ml in G2, and 64.10 ± 18.26 IU/ml in G3 (P < 0.001). Also, the serum level of t-PA in G4 was highly elevated significantly when compared with G1 and G2 with means of 16.85 ± 5.63 IU/ml against 7.95 ± 1.91 IU/ml and 10.45 ± 2.63 IU/ml, respectively (P < 0.001). The ratio of PAI-1/t-PA in G4 was significantly higher when compared with G1 (mean of 5.94 ± 2.81 against 3.54 ± 0.43; P = 0.01). PAI-1 and t-PA showed a significant positive correlation with UAE. Receiver operating characteristics curve analysis revealed that only PAI-1 and t-PA were significant discriminated factors for microalbuminuria and macroalbuminuria (P < 0.001).

Conclusion

Serum levels of PAI-1 and t-PA and the PAI-1/t-PA ratio were significantly increased in diabetic patients with higher UAE. Impaired fibrinolysis and increased UAE were associated with renal disease progression.

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Authors and Affiliations

  1. Departments of Internal Medicine, Faculty of Medicine, Cairo University, 7 Al Mahrossa Street, Ahmed Orabi, Al Mohandeseen, App 3, 694 Giza, Cairo, Egypt

    Ebtessam Zakaria, Maha Hossam Al-Din, Nashwa S. Ghanem, Noha A. Sadik MD & Maha Assem

  2. Departments of Clinical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt

    Fatma Taha

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  1. Ebtessam Zakaria
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  2. Maha Hossam Al-Din
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  3. Nashwa S. Ghanem
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  4. Noha A. Sadik MD
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Corresponding author

Correspondence to Noha A. Sadik MD.

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Zakaria, E., Al-Din, M.H., Ghanem, N.S. et al. Urinary albumin excretion and progression of renal disease with impaired fibrinolytic activity in type 2 diabetes mellitus. Egypt J Intern Med 27, 108–114 (2015). https://doi.org/10.4103/1110-7782.165450

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  • DOI: https://doi.org/10.4103/1110-7782.165450

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