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Serum and urinary pentraxin-3 levels in type 2 diabetes and its relation to diabetic nephropathy
The Egyptian Journal of Internal Medicine volume 30, pages 182–190 (2018)
Abstract
Background
Diabetic nephropathy (DN) is the most common cause of end-stage renal disease. Microalbuminuria is the most popular method for detecting the early signs of DN. However, pathological changes occur before the onset of microalbuminuria. So, there is a need for another biomarkers that might provide a sensitive and fast means for identification of the progression of DN. Pentraxin 3 (PTX3) is an acute-phase glycoprotein and a soluble receptor acting as an opsonin. PTX3 protein is expressed in vascular endothelial cells and macrophages. Thereby, its levels may reflect more directly the inflammatory status of the vasculature.
Aim
Evaluation of the levels of serum and urinary PTX3 in type 2 diabetes mellitus (T2DM) patients and its relation to DN.
Patients and methods
Group A: 20 healthy volunteers (control group). Group B: 20 patients with normoalbuminuric T2DM. Group C: 20 patients with microalbuminuric T2DM. Group D: 20 patients with macroalbuminuric T2DM. Also all the participants divided into two subgroups: Group 1: 40 participants with no nephropathy (controls and normoalbuminuric patients). Group 2: 40 patients with nephropathy (microalbuminuric and macroalbuminuric patients).
Results
There was no significant difference among all studied groups with respect to age, sex, lipid profile, urinary PTX3, C-reactive protein, and liver function test. Whereas BMI, hemoglobin level, HBA1C, fasting blood sugar, postprandial blood sugar, serum creatinine, estimated glomerular filtration rate, and 24 h urinary albumin excretion; showed high significant difference among all studied groups.
Serum albumin and total protein levels were highly significantly decreased in macroalbumiuric group as a result of proteinuria compared to the other three groups Serum PTX3 showed high significant difference between nephropathic (micro and macroalbuminuric) group and non nephropathic group (control and normoalbuminuric).
There were highly significant positive correlations between serum PTX3 and (fasting blood sugar, postprandial blood sugar, HBA1C, and 24 h urinary albumin) significant positive correlation with serum creatinine, whereas there were highly significant negative correlations between serum PTX3 and serum total protein and serum albumin.
Conclusion
Serum PTX3 increased progressively with DN and may be a serum biomarker for early diagnosis of DN. Whereas urinary PTX3 has no relation to DN.
References
Matheson A, Willcox MD, Flanagan J, et al. Urinary biomarkers involved in type 2 diabetes: a review. Diabetes Metab Res Rev 2010; 26:150–171.
Parving HH. Nephrology forum: diabetic nephropathy: prevention and treatment. Kidney Int 2001; 60:2041–2055.
Lee YN. A report of the Malaysian dialysis registry of the national renal registry. Med J Malaysia 2008; 63 (C):5–8.
Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care 2014; 37:2864–2883.
Mora-Fernández C, DomÃnguezPimentel V, de Fuentes MM, et al. Diabetic kidney disease: from physiology to therapeutics. J Physiol 2014; 592:3997–4012.
Lutale JJ, Thordarson H, Vetvik K. Microalbuminuria among type 1 and type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania. BMC Nephrol 2007; 8:2.
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2003; 26:S33.
Fioretto P, Mauer M. Histopathology of diabetic nephropathy. Semin Nephrol 2007; 27:195–207.
International Diabetes Federation: diabetes complicationsb, 6th ed. IDF Diabetes Atlas; 2013. 24–26.
Stevens LA, Levey AS. Measurement of kidney function. Med Clin North Am 2005; 89:457–473.
Tramonti G, Kanwar YS. Review and discussion of tubular biomarkers in the diagnosis and management of diabetic nephropathy. Endocrine 2013; 43:494–503.
Ciéslik XXXX, Hrycek A. Long pentraxin 3 (PTX3) in the light of its structure, mechanism of action and clinical implications. Autoimmunity 2012; 45:119–128.
Garlanda C, Hirsch E, Bozza S, et al. Non-redundant role of the long pentraxin PTX3 in anti-fungal innate immune response. Nature 2002; 420:182–186.
Alberti L, Gilardini L, Zulian A, et al. Expression of long pentraxin PTX3 in human adipose tissue and its relation with cardiovascular risk factors. Atherosclerosis 2009; 202:455–460.
Napoleone E, Di Santo A, Bastone A, et al. Long pentraxin PTX3 upregulates tissue factor expression in human endothelial cells: a novel link between vascular inflammation and clotting activation. Arterioscler Thromb Vasc Biol 2002; 22:782–787.
Rusnati M, Camozzi M, Moroni E, et al. Selective recognition of fibroblast growth factor-2 by the long pentraxin PTX3 inhibits angiogenesis. Blood 2004; 104:92–99.
Introna M, Vidal Alles V, Castellano M, et al. Cloning of mouse PTX3, a new member of the pentraxin gene family expressed at extrahepatic sites. Blood 1996; 87:1862–1872.
Fazzini F, Peri G, Doni A, et al. PTX3 in smallvessel vasculitides: an independent indicator of disease activity produced at sites of inflammation. Arthritis Rheum 2001; 44:2841–2850.
Yilmaz MI. Effect of renin angiotensin system blockade on pentraxin 3 levels in type-2 diabetic patients with proteinuria. Clin J Am Soc Nephrol 2009; 4:535–541.
Carrero ML, Stenvinkel P. Recent insights in inflammation-associated wasting in patients with chronic kidney disease. Contrib Nephrol 2011; 171:120–126.
Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150:604–612.
Pichaiwong W, Hudkins KL, Wietecha T, et al. Reversibility of structural and functional damage in a model of advanced diabetic nephropathy. J Am Soc Nephrol 2013; 24:1088–1102.
Lin CL, Lee PH, Hsu YC, et al. MicroRNA-29a promotion of nephrin acetylation ameliorates hyperglycemia-induced podocyte dysfunction. J Am Soc Nephrol 2014; 25:1698–1709.
Suliman ME, Yilmaz MI, Carrero JJ, et al. Novel links between the long pentraxin 3, endothelial dysfunction, and albuminuria in early and advanced chronic kidney disease. Clin J Am Soc Nephrol 2008; 3:976–985.
Sun YM, Su Y, Li J, et al. Recent advances in understanding the biochemical and molecular mechanism of diabetic nephropathy. Biochem Biophys Res Commun 2015; 433:359–361.
Abu Seman N. Evaluation of the association of plasma pentraxin 3 levels with type 2 diabetes and diabetic nephropathyin a Malay population. J Diabet Res 2013; 2013:298019.
Yamasaki K, Kurimura M. Determination of physiological plasma pentraxin 3 (PTX3) levels in healthy populations. Clin Chem Lab Med 2009; 47:471–477.
Moloney A, Tunbridge WM, Ireland JT, et al. Mortality from diabetic nephropathy in the United Kingdom. Diabetologia 1983; 25:26–30.
Gu HF. SOX2 has gender-specific genetic effects on diabetic nephropathy in samples from patients with type 1 diabetes mellitus in the GoKinD study. Gender Med 2009; 6:555–564.
Idogun ES, Kasia BE. Assessment of microalbuminuria and glycated hemoglobin in type 2 diabetes mellitus complications. Asian Paicfic J Trop Dis 2011; 1:203–205.
Assal HS, Tawfeek S, Rasheed EA, et al. Serum cystatin C and tubular urinary enzymes as biomarkers of renal dysfunction in type 2 diabetes mellitus. Clin Med Insights Endocrinol Diabetes 2013; 6:7–13.
Kundu D, Roy A, Mandal T, et al. Relation of microalbuminuria to glycosylated hemoglobin and duration of type 2 diabetes. Niger J Clin Pract 2013; 16:216–220.
Sheikh SA, Baig JA, Iqbal T, et al. Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi. J Ayub Med Coll Abbottabad 2009; 21:83–86.
Hovind P, Tarnow L. Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ 2004; 328:1105.
Viswanathan V, Snehalatha C, Kumutha R, et al. Serum albumin levels in different stages of type 2 diabetic nephropathy. Indian J Nephrol 2004; 14:89–92.
Jeong J, Kwon SK, Kim HY. Effect of bicarbonate supplementation on renal function and nutritional indices in predialysis advanced chronic kidney disease. Electrolyte Blood Press 2014; 12:80–87.
Amr Abd El-Hady, Manal Aly, Alaa Mahmoud, et al. Study of plasma long pentraxin 3 as a marker of endothelial dysfunction in Egyptian patients with type 2 diabetes. Med J Cairo Univ 2012; 80:277–281.
Chae HW, Shin JI, Kwon AR, et al. Spot urine albumin to creatinine ratio and serum cystatin C are effective for detection of diabetic nephropathy in childhood diabetic patients. J Korean Med Sci 2012; 27:784–787.
Lu WN, Li H, Zheng FP, et al. Renal insufficiency and its associatedfactors in type 2 diabetic patients with normoalbuminuria. Zhonghua Nei Ke Za Zhi 2010; 49:24–27.
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, et al. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care 2004; 27:195–200.
Murussi M, Gross JL, Silveiro SP. Glomerular filtration rate changes in normoalbuminuric and microalbuminuric Type 2 diabetic patients and normal individuals A 10-year follow-up. J Diabetes Complications 2006; 20:210–215.
Tidman M, Sjöström P, Jones I. A Comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant 2008; 23:154–160.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2011; 34:S11–S61.
Reverter JL, Sentà M, Rubiés-Prat J, et al. Relationship between lipoprotein profile and urinary albumin excretion in type II diabetic patients with stable metabolic control. Diabetes Care 1994; 17:189–194.
Sigdel M, Rajbhandari N, Basnet S, et al. Micro-albuminuria among type 2 diabetes mellitus patients in Pokhara, Nepal. Nepal Med Coll J 2008; 10:242–245.
Suchitra MM, Sheshu Kumar M, Bitla AR, et al. Atherogenic dyslipidemia in diabetic nephropathy: lipoprotein (a), lipid ratios and atherogenic index. Int J Res Med Sci 2013; 1:455–459.
Joven J, Villabona C, Vilella E. Pattern of hyperlipoproteinemia in human nephrotic syndrome: influence of renal failure and diabetes mellitus. Nephron 1993; 64:565–569.
Dubin R. Racial differences in the association of pentraxin-3 with kidney dysfunction: the multi-ethnic study of atherosclerosis. Nephrol Dialysis Transplant 2011; 26:1903–1908.
Pang Y, Tan Y, Li Y, et al. Pentraxin 3 is closely associated with tubulointerstitial injury in lupus nephritis. Medicine (Baltimore) 2016; 95:e2520.
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Al-Barshomy, S.M., Mostafa, M.E.S., Shaker, G.E. et al. Serum and urinary pentraxin-3 levels in type 2 diabetes and its relation to diabetic nephropathy. Egypt J Intern Med 30, 182–190 (2018). https://doi.org/10.4103/ejim.ejim_9_18
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DOI: https://doi.org/10.4103/ejim.ejim_9_18