Prediction of renal injury risk by gene expressions of KIM-1 and NGAL in Type II diabetic nephropathy

Introduction: About 10 to 40% Type 2 diabetes (T2DM) and 30% Type 1 diabetes (T1DM) suffer from kidney. Uncontrolled diabetes develops end stage renal disease (ESRD) which required kidney transplantation, haemodialysis or peritoneal dialysis. Early kidney injury can be prevented by evaluating gene expressions (KIM1, NGAL) in T2DM with microalbuinuria subjects. Kidney Injury Molecule (KIM1) is a glycoprotein appears at high levels after ischemic or toxic kidney injury. NGAL is a lipocalin protein, expressed in several human tissues, including kidney. Therefore KIM1 and NGAL expressions may help predict risk of kidney injury. Methodology: This study includes 241 subjects, including healthy control, recruited after screening forT2DM by measurement of FBS, PPBS, glycosylated haemoglobin and microalbumin. Subjects were randomised after ethical approval, written consent following inclusion/exclusion criteria. Categorization of subjects was done on the basis of T2DM duration 3-5 years, HbA1c [greater than or equal to] 7.0% with FBS >126 mg/dl and microalbuinuria. Blood samples were processed for other renal parameters & rt-PCR to check expressions of KIM1 and NGAL. Results: In study groups all renal parameters are within normal range except albumin creatinine ratio (p =.012) & e-GFR (p=.00). Other renal parameters showed marginal significance within and between the groups. KIM-1 and NGAL showed high degree of significance (p =.00). Conclusion: It was concluded that biochemical renal parameters are not enough to prevent DN even in microalbuinuria. Butgene expressions of KIM1 and NGAL helps to find out the status of kidney function & help to predict risk of diabetic nephropathy. Keywords: Type II Diabetes mellitus, diabetes nephropathy, gene expressions (KIM1 & NGAL), excretory renal parameters.