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Background: Studies in the past decade have reported many novel biomarkers for predicting the new-onset or progression risk of renal dysfunction in patients with type 2 diabetes (T2D) based on the genomic, metabolomic, and proteomic technologies. These novel predictive markers, however, are difficult to be widely used in clinical practice over the short term due to their high technology content, instability, and high cost. This study was aimed at evaluating the associations of clinical features and six traditional renal markers with the short-term risk of new-onset renal dysfunction in patients with T2D.Methods: This study involved 213 participants with T2D and normal renal function at baseline. The baseline levels of the albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), alpha-1-microglobulin-to-creatinine ratio (A1MCR), neutrophil gelatinase-associated lipocalin-to-creatinine ratio, transferrin-to-creatinine ratio (UTRF/Cr), and retinol-binding protein-to-creatinine ratio (URBP/Cr) were analyzed. Multivariate logistic models were established and validated.Results: During the two-year follow-up period, 23.01% participants progressed to renal dysfunction. The basal levels of ACR, A1MCR, UTRF/Cr, and URBP/Cr were the independent risk factors of new-onset renal dysfunction (P < 0.05). Several logistic models incorporating clinical characteristics and these renal markers were constructed for predicting the short-term risk of new-onset renal dysfunction. Comparatively, the model including age, glycated hemoglobin (HbA1c), hypertension, ACR, A1MCR, UTRF/Cr, and URBP/Cr levels at baseline had the highest potential (C - index = 0.785, P < 0.001). This model was validated using the K-fold cross-validation method; the accuracy was 0.815 ± 0.013 in training sets and 0.784 ± 0.019 in validation sets, indicating a good consistency for predicting the new-onset renal dysfunction risk. Finally, a nomogram based on this model was constructed to provide a quantitative tool to assess the individualized risk of short-term new-onset renal dysfunction.Conclusion: The model incorporating these markers and clinical features may have a high potential to predict the short-term risk of new-onset renal dysfunction. [ABSTRACT FROM AUTHOR]

Aim: Various studies have reported that urinary neutrophil gelatinase‐associated lipocalin (NGAL), an indicator of tubular damage, may be an effective biomarker of renal impairment in patients with diabetes. This study aimed to compare the ability of urinary alpha‐1‐microglobulin (a traditional tubular damage marker) with NGAL for evaluating renal insufficiency in patients with type‐2 diabetes. Methods: Urinary albumin‐to‐creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to determine whether 513 participants with type‐2 diabetes had renal dysfunction. Urinary alpha‐1‐microglobulin‐to‐creatinine ratio (A1MCR) and NGAL‐to‐creatinine ratio (NCR) were calculated. Results: Although both A1MCR and NCR were significantly higher among participants with renal insufficiency than among participants without renal damage, the difference in A1MCR values between participants with and without renal insufficiency was relatively greater than the difference in NCR values, especially among the male subjects. The correlation of ACR or eGFR with A1MCR was stronger than that of ACR or eGFR with NCR. A1MCR showed a good capability for detecting renal dysfunction (area under the curve = 0.80), its cut‐off value was 14.82 mg/g, corresponding to 71.4% sensitivity and 73.1% specificity. The diagnostic efficiency of A1MCR was significantly higher than that of NCR. Conclusion: The results indicated that the traditional tubular damage marker A1MCR was more significantly associated with renal insufficiency defined by ACR and/or eGFR and may have a higher diagnostic efficiency compared with the efficiency of NCR in patients with type‐2 diabetes. SUMMARY AT A GLANCE: Among 513 type 2 diabetics with impaired kidney function, the correlation of urinary albumin‐to‐creatinine ratio and estimated glomerular filtration rate decline with urinary alpha‐1‐microglobulin‐to‐creatinine ratio is stronger than with urinary neutrophil gelatinase‐associated lipocalin‐to‐creatinine ratio. Urinary alpha‐1‐microglobulin may therefore have a higher diagnostic utility than urinary neutrophil gelatinase‐associated lipocalin for kidney dysfunction among diabetic subjects. [ABSTRACT FROM AUTHOR]

Keywords: alpha-1-microglobulin to creatinine ratio; diabetes duration; normoalbuminuric renal impairment; type 2 diabetes EN alpha-1-microglobulin to creatinine ratio diabetes duration normoalbuminuric renal impairment type 2 diabetes 261 264 4 02/03/21 20210301 NES 210301 GLO:55QH/01mar21:jdb13131-toc-0001.jpg PHOTO (COLOR): . gl B Highlights b The level of urinary SB 1 sb -microglobulin to creatinine ratio (A1MCR) increases with longer diabetes duration. Moreover, the risk of abnormal A1MCR was noticeably more pronounced in male patients with diabetes duration >14 years, despite normoalbuminuria (OR = 4.02, I P i value for interaction =.021). Alpha-1-microglobulin to creatinine ratio, diabetes duration, normoalbuminuric renal impairment, type 2 diabetes. [Extracted from the article]

Background: Early screening of diabetic kidney disease (DKD) remains a major challenge. Our aim was to evaluate the value of urinary orosomucoid 1 protein (UORM1) in early renal impairment screening in type‐2 diabetes patients. Methods: The concentration of UORM1, the UORM1‐to‐creatinine ratio (UORM1CR), the urinary albumin‐to‐creatinine ratio (ACR), the alpha‐1‐microglobulin‐to‐creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were measured in 406 type‐2 diabetes patients. Any positive values for ACR, A1MCR and/or eGFR were considered as indicative of renal impairment. Results: On average, the levels of UORM1 and UORM1CR were about seven times higher in subjects with renal injury than in those without. Both UORM1 and UORM1CR, when adjusted via logarithm‐transformation, were significantly related to ACR, A1MCR and eGFR levels. The highest correlation was observed between UORM1CR and A1MCR (r = 0.85, P <.001). The cut‐off values for UORM1 (2.53 mg/L) and UORM1CR (3.69 mg/g) for the early diagnosis of kidney impairment were obtained from receiver operating characteristic curves. UORM1CR obviously had higher diagnostic efficiency corresponding to 83.26% sensitivity and 90.32% specificity than UORM1. Likewise, its sensitivity was higher than those of ACR, A1MCR and eGFR. Bad glycaemic control had the highest risk of increased UORM1CR (odds ratio [OR] = 2.81, P <.001), while high HDL‐C (high‐density lipoprotein cholesterol) decreased the risk of increased UORM1CR (OR = 0.38, P =.017). Conclusion: The UORM1CR (>3.69 mg/g) has the high diagnostic efficiency for the early screening of renal impairment in type‐2 diabetes patients. Furthermore, good glycaemic control and high HDL‐C might be protective factors against UORM1CR increase. SUMMARY AT A GLANCE: Urinary orosomucoid 1 protein could be an effective early biomarker to detect diabetic kidney disease in this cohort of 406 patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Several studies have indicated that high albuminuria is associated with renal function decline. However, the relationship between the urinary albumin-to-creatinine ratio (ACR) and risk of developing tubular injury remains unclear. Our aim was to investigate the association of ACR with the risk of developing tubular impairment in patients with type 2 diabetes.Methods: This longitudinal observational study compared baseline with follow-up data in 183 patients with type 2 diabetes. ACR, urinary alpha-1-microglobulin-to-creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were used to evaluate albuminuira, tubular injury and glomerular filtration function, respectively.Results: Levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and A1MCR were significantly different at the two-year follow-up compared with baseline levels. Among patients both with baseline ACR above and below 30 mg/g, the percentage with A1MCR > 15 mg/g clearly increased after follow-up (P < 0.05). The risk of A1MCR rising from normal ranges to >15 mg/g over the follow-up increased with increasing baseline ACR values lower baseline eGFR. Among the patients with baseline ACR > 63.10 mg/g, all showed increased A1MCR values at follow-up compared with baseline. In the multivariate regression analysis, the patients with baseline ACR > 63.10 mg/g had a strong risk of A1MCR rising from normal to >15 mg/g (odds ratio (OR) = 11.12, P = 0.001) over the follow-up, while the males had a 2.89-fold risk of A1MCR increasing from normal to >15 mg/g compared with females.Conclusion: Baseline ACR level is related to increased risk of developing renal tubular injury; in particular, this association is much stronger in patients with type 2 diabetes and baseline ACR > 63.10 mg/g. [ABSTRACT FROM AUTHOR]

Objectives: Numerous biomarkers have been shown to be associated with albuminuria. However, few of them are valuable separate predictors of albuminuria development. This study aimed to develop a model for predicting the short-term risk of new-onset albuminuria in normoalbuminuric patients with type 2 diabetes (T2D).Methods: 213 patients with T2D who were normoalbuminuric at the baseline were enrolled in this study. Basal levels of clinical characteristics and renal biomarkers including urinary orosomucoid (alpha-1-acid-glycoprotein, UORM), neutrophil gelatinase-associated lipocalin, retinol-binding protein, alpha-1-microglobulin, transferrin, and albumin-to-creatinine ratio (ACR) were utilized to analyze the association with the short-term risk of new-onset albuminuria.Results: 19.72% of normoalbuminuric subjects at baseline progressed to albuminuria over the 2-year follow-up period. Except for NGAL, the basal levels of the other five renal biomarkers were significantly associated with new-onset albuminuria risk in the univariate analysis. In the multivariate logistic regression analysis using Forward: LR method, a model incorporating UORM/Cr, ACR, and HbA1c was established. Comparatively, this model had a higher potential to predict new-onset albuminuria risk compared with the single use of renal markers. In the validation of this model performed by 5-fold cross-validation method, the accuracy of this model was 0.818 ± 0.008 in the training sets, 0.827 ± 0.062 in the test sets, indicating a good capability for assessing albuminuria risk. Finally, a nomogram based on this model was constructed to facilitate its use in clinical practice.Conclusion: The combined analysis of UORM/Cr, ACR and HbA1c may be of potential value for predicting the short-term risk of new-onset albuminuria in such patients. [ABSTRACT FROM AUTHOR]