Determination of TNFR1 Level and its Association with ACR and eGFR in Iraqi Patients with Different Stages of Diabetic Nephropathy

Abstract

Background: recently, studies have been focused on diabetes complications, such as neuropathy, retinopathy and nephropathy. Attempts were conducted to diagnosis diabetic complication cases to determine the relevant proper markers that can be employed for early detection purposes to prevent the development and progression to final disease stage. The aim of this study is to determine TNFR1 in diabetic nephropathy and its relation with renal function under various stages of this disease.   Materials and Methods: 90 patients (45 male and 45 female) with T2DM, aged (40-60), who attend to Baghdad Teaching Hospital /Medical City, were classified into three groups according to albumin-creatinine ratio (ACR) in urine. The first patients group consists of 30 diabetic patients with ACR less than 30mg/g (normoalbuminuria). Whereas; the second patients group includes 30 diabetic patients with ACR range 30-300 mg/g (microalbuminuria). The third patients group comprises 30 diabetic patients with ACR more than 300 mg/g (macroalbuminuria).In addition to 30 healthy subjects as control group. Fasting blood glucose, serum creatinine and blood urea were assayed by enzymatic methods. Soluble TNFR1 was estimated by ELISA. Modification of diet in renal disease (MDRD) formula was used to calculate of eGFR. Results: There are significant differences between values of TNFR1, ACR and eGFR. A high significant increase of TNFR1 (p˂0.001) was noticed in macroalbuminuria patients group in comparison with normoalbuminuria and control groups. Also, there is a significant increase in ACR level in macroalbuminuria group than other studied groups. In contrast, a significant decrease in eGFR was recorded in macroalbuminuria group in comparison with other patient and control groups. A high significant increase in of both Creatinine and blood urea levels were recorded in macroalbuminuria patients group than other patient and control groups. Conclusion: sTNFR1 associates with renal function in the case of diabetic nephropathy. Consequently, it considers a better predictor of renal function for patients with diabetic nephropathy. 

Keywords: T2DM, Nephropathy, TNFR1, ACR, EGFR, Microalbuminuria, Macroalbuminuria.