Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy

Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy

Abstract Background Albuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients,...

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Published in:Journal of diabetes and its complications Vol. 26; no. 6; pp. 546 - 553
Main Authors: Titan, S.M, Vieira, J.M, Dominguez, W.V, Moreira, S.R.S, Pereira, A.B, Barros, R.T, Zatz, R
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-11-2012
Subjects:
Aged
Albuminuria - etiology
Albuminuria - physiopathology
Biomarkers - blood
Biomarkers - urine
Chemokine CCL2 - blood
Chemokine CCL2 - urine
Chronic kidney disease
Diabetic Nephropathies - blood
Diabetic Nephropathies - diagnosis
Diabetic Nephropathies - physiopathology
Diabetic Nephropathies - urine
Diabetic nephropathy
Disease Progression
Double-Blind Method
Endocrinology & Metabolism
Female
Follow-Up Studies
Humans
Kidney - physiopathology
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - etiology
Kidney Failure, Chronic - mortality
Longitudinal Studies
Male
MCP-1
Middle Aged
Prognosis
RBP
Retinol-Binding Proteins - urine
Sensitivity and Specificity
Severity of Illness Index
Survival Analysis
TGF-β
VEGF
RBP
Diabetic nephropathy
TGF-β
MCP-1
Chronic kidney disease
VEGF
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Summary:Abstract Background Albuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients, and the search for novel markers is intense. Methods We analyzed the role of urinary RBP and of serum and urinary cytokines (TGF-beta, MCP-1 and VEGF) as predictors of the risk of dialysis, doubling of serum creatinine or death (primary outcome, PO) in 56 type 2 diabetic patients with macroalbuminuric DN. Results Mean follow-up time was 30.7 ± 10 months. Urinary RBP and MCP-1 were significantly higher in patients presenting the PO, whereas no difference was shown for TGF-β or VEGF. In the Cox regression, urinary RBP, MCP-1 and VEGF were positively associated and serum VEGF was inversely related to the risk of the PO. However, after adjustments for creatinine clearance, proteinuria, and blood pressure only urinary RBP (OR 11.6; 95% CI 2.7–49.2, p = 0.001 for log RBP) and urinary MCP-1 (OR 11.0; 95% CI 1.6–76.4, p = 0.02 for log MCP-1) remained as significant independent predictors of the PO. Conclusion Urinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated.
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ISSN:1056-8727
1873-460X
DOI:10.1016/j.jdiacomp.2012.06.006