الفهرس 
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Abstract
SUMMARY
iabetes mellitus is a metabolic disorder characterized by a
state of chronic hyperglycemia resulting due to a
disturbance in insulin secretion, action, or both, with a resultant
long-term dysfunction of all organs, particularly the kidney.
Diabetic nephropathy, or diabetic kidney disease,
describes the chronic decline in kidney function occurring in
diabetic patients. Management of patients with diabetic kidney
disease poses a challenge to physicians. Diabetic kidney disease
is an ongoing process that can progress despite adequate
glycemic, blood pressure and proteinuria control. Therefore, the
study of its pathogenic pathways is crucial to the development
of new drugs that could slow its course. The progression of
diabetic kidney disease is poorly predicted and assessed due to
the scarcity of biomarkers in spite of the breakthrough in the
management of diabetes mellitus.
Urokinase-type plasminogen activator (uPA) is a
serineprotease that converts inactive plasminogen to active
plasmin. It also acts on urokinase-type plasminogen activator
receptor (uPAR) expressed on the surface of different cells,
including activated T-lymphocytes, monocytes, macrophages,
megakaryocytes, keratinocytes, fibroblasts, endothelial cells,
vascular smooth muscle cells and podocytes mediating various
non-proteolytic processes. The soluble form of urokinase-type
D
Summary
92
plasminogen activator receptor (suPAR) is released from the
cell membrane after the cleavage action of uPA on uPAR.
Elevated serum suPAR levels were noticed in a wide
range of diseases, including Diabetes Mellitus, focal segmental
glomerulosclerosis, CKD, inflammatory disorders such as
sepsis, cardiovascular diseases, cancers, autoimmune diseases,
HIV infection and smoking.
The aim of this study was to investigate the diagnostic
value of suPAR in patients with diabetes mellitus, its role as an
indicator of diabetic kidney disease, its correlation with
biological parameters of kidney function and its capacity as a
biomarker for renal impairment severity.
This was a comparative cross-sectional study that was
conducted at Diabetes Outpatient Clinic, Ain Shams University
Hospitals on 180 diabetic patients with criteria of diabetic
kidney disease according to American Diabetes Association
(ADA) attending Ain Shams Diabetes Outpatient Clinic. They
were divided into 70 diabetic patients with criteria of diabetic
kidney disease, 70 diabetic patients without criteria of diabetic
kidney disease and 40 healthy subjects. Study period was six
months.
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93
The results of our present study can be summarized as
follows:
In the current study, the level of suPAR was significantly
increased among the diabetic group than the control group.
Our study showed that, the mean of age was 48.20 years in
diabetic with DN group, 42.99 in Diabetic without DN and
41.50 in control group. Males were (80.0%) in diabetic with
DN group and (71.4%) in diabetic without DN with no
significant difference.
In our study, there was no statistically significant difference
between diabetic with DN, diabetic without DN and control
groups regarding hypertension. Hypertension was present in
51.4% in diabetic with criteria kidney disease, 38.6% in
diabetic without criteria kidney disease and 30.0% in control
group.
In this study, the level of suPAR was significantly higher
among diabetic with DN group then diabetic without DN
group than the control group (P=0.000).
The present study revealed that eGFR was significantly
lower among diabetic with DN group (40.59 ± 18.80) than
diabetic without DN group (66.30 ± 25.57) and the control
group (96.10 ± 22.41) (P=0.000).
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94
In this study, there were positive correlations between the
level of suPAR and age , age of onset of DM , duration of
DM , BMI , FBS , HBA1c, albumin/ creatinine ratio and
serum creatinine. were There was negative correlation
between suPAR and eGFR. While there were no
statistically significant correlation berween suPAR and
PPBS.
Regarding the diagnostic accuracy of serum suPAR to
differentiate between diabetic without DN group and
diabetic with DN group, sensitivity was 65.71%, specificity
was 90.0%, PPV was 86.8%, NPV was 72.4% and AUC
was 0.860%. The cut off point to differentiate between
patients with and without DN regarding suPAR level was
830 ng/l.