الفهرس 
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Abstract
• Diabetic nephropathy is a major cause of morbidity and mortality among children and young adult with type 1 DM and one of important causes of ESRD in children, without DN the mortality in type 1 DM is similar to that in the general population. • The new ADA criteria for diagnosis of diabetic nephropathy is the existence of urinary albumin excretion ( UAE) more than 30 mg/24,and currently albumin excretion rate (AER) remains the best available noninvasive predictor for DN. • Although, it was found that some cases advance to nephropathy with no microalbuminuria, some cases with microalbuminuria regress with no treatment. • Accordingly, the need for a new biomarker that would act as a progression indicator of DN, either alone or complementary to urinary albumin is clearly required. • Urinary afamin was identified by multiple studies as novel urinary biomarker for diabetic nephropathy • A study was done in type 2 DM revealed that Afamin/creatinine ratio may be useful to predict patients with type 2 DM at high risk of nephropathy before the development of macro albuminuria or decline in kidney function. • So the aim of our work is to explore the role of urinary afamin and afamin/creatinine ratio as potential markers for detection of early diabetic nephropathy in children with type 1 diabetes mellitus highlighting its possible role in normoalbuminuric patients as no previous study was done in type 1 DM. • Ninety participants were enrolled in this study divided into three groups: healthy control, T1DM without DN, and DN groups, urinary afamin were collected and measured by ELISA technique. • We found that urinary afamin and afamin creatinine ratio was statistically significant higher in type 1 DM versus control group, and afamin/creatinine ratio ≥ 0.44 is a strong discriminator of T1DM vs. non-diabetic control subjects (AUC=0.843). • We found also that urinary afamin level and afamin / creatinine ratio (AfCR) was statistically ominously higher in DN patients vs. non-DN group patients. • Our study showed that afamin at cutoff value of ≥ 68 can discriminate DN from non-DN with a 97% sensitivity and NPV, but with 72% specificity and PPV. • Our study also found that AfCR at cutoff value of 1.6 or more has 9.7 times higher odds that diabetic participants will exhibit DN, so it is reliable biomarker for predication of DN.