Abstract

ASSESSMENT OF TRANSFORMING GROWTH FACTOR-BETA (TGF- ?) AND ALBUMIN TO CREATININE RATIO (ACR) IN PATIENTS WITH TYPE 2 DIABETIC NEPHROPATHY

Hussein Saeed Abbas*, Shaymaa Zahraw Nada and Alaa Abbas Fadhel

ABSTRACT

Background: Diabetes mellitus is the leading cause of end stage renal disease worldwide. Diabetic nephropathy (DN) is one of the most common microvascular consequences of diabetes. Early identification of DN, on the other hand, is vital for better clinical treatment, and therapeutic intervention at an early stage of the disease is vital to avoid progression to ESRD and dialysis. Objective:- The aim of this study is to investigate the diagnostic utility of transforming growth factor-beta(TGF-β) as a biomarker for early detection of nephropathy in type 2 diabetes mellitus patients. Patient and Methods: The current study was designed as case control study, involved 120 individuals, 60 patients with type 2 diabetes mellitus (T2DM) group and 60 participants who are apparently healthy was used as control group. The patients group were subdivided into three equal groups according to their urinary albumin to creatinine ratio (ACR): 20 normoalbuminuric patients, 20 microalbuminuric patients, 20 macroalbuminuric patients. Results: Serum TGF-beta levels (Mean ±SD) in theT2DM with Normoalbuminuria, T2DM with Microalbuminuria, T2DM with Macroalbuminuria and control groups were (128.6±32.9), (331.4±101.0), (364.1±98.1), (109.1±14.8) respectively with highly significant difference P(<0.001). In addition, serum TGF-β showed a positive correlation with ACR (r=0.564, P=0.01) and urea (r=0.510, p=0.02) and a negative correlation with eGFR (r= -0.504, P=0.02). Receiver operating characteristic curves (ROC) revealed that for early detection of DN, A good diagnostic profile of serum TGF-B at the optimal cut off value for early detection of DN is 126.19 ng/l, with sensitivity of 80%, specificity of 95%, positive predictive value (PPV) of 97%, negative predictive value (NPV) of 61%, and accuracy of 83%. Conclusion: Increased levels of TGF-β play a role in the pathogenesis of diabetic nephropathy, the current study demonstrates that higher HbA1c and poor glycemic control are closely associated with a greater likelihood of increased levels of TGF-β and thus increased risks and complications of diabetic nephropathy in patients with type 2 diabetes mellitus.

Keywords: Diabetic nephropathy, Type 2 diabetes mellitus, transforming growth factor-beta.