Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy
Urinary MCP-1 and RBP: Independent predictors of renal outcome in macroalbuminuric diabetic nephropathy
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DOI：
10.1016/j.jdiacomp.2012.06.006
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发表时间：
2012-11-01
影响因子：
3
通讯作者：
Zatz, R.
中科院分区：
文献类型：
--
作者：
Titan, S. M.;Vieira, J. M., Jr.;Zatz, R.
背景资料：白蛋白尿被认为是诊断糖尿病肾病（DN）的必要条件，并已被广泛用作慢性肾脏疾病（CKD）的替代结局。然而，最近的数据表明，白蛋白尿可能会失败的一个子集的患者的生物标志物，寻找新的标记物是intensive.Methods：我们分析了尿RBP的作用和血清和尿细胞因子（TGF-β，MCP-1和VEGF）的透析的风险预测。血清肌酐加倍或死亡（主要结局）。结果：平均随访时间为30.7 ± 10个月。尿RBP和MCP-1在PO患者中显著升高，而TGF-β或VEGF无差异。在考克斯回归中，尿RBP。MCP-1和VEGF与PO的危险性呈正相关，血清VEGF与PO的危险性呈负相关。然而，在调整肌酐清除率、蛋白尿和血压后，（OR 11.6; log RBP的95% CI 2.7-49.2，p = 0.001）和尿MCP-1（OR 11.0; 95%CI 1.6-76.4，log MCP-1的p = 0.02）仍然是PO的显著独立预测因子。尿RBP和MCP-1与大量白蛋白尿DN患者的CKD进展风险独立相关。这些生物标志物是否在DN的正常白蛋白尿和微量白蛋白尿中起作用还有待进一步研究。(C)2012 Elsevier Inc. All rights reserved.
Background: Albuminuria has been considered a sine qua non condition for the diagnosis of diabetic nephropathy (DN) and has been widely used as a surrogate outcome of chronic kidney disease (CKD). However, recent data suggest that albuminuria may fail as a biomarker in a subset of patients, and the search for novel markers is intense.Methods: We analyzed the role of urinary RBP and of serum and urinary cytokines (TGF-beta, MCP-1 and VEGF) as predictors of the risk of dialysis. doubling of serum creatinine or death (primary outcome. PO) in 56 type 2 diabetic patients with macroalbuminuric DN.Results: Mean follow-up time was 30.7 +/- 10 months. Urinary RBP and MCP-1 were significantly higher in patients presenting the PO, whereas no difference was shown for TGF-beta or VEGF. In the Cox regression, urinary RBP. MCP-1 and VEGF were positively associated and serum VEGF was inversely related to the risk of the PO. However, after adjustments for creatinine clearance, proteinuria, and blood pressure only urinary RBP (OR 11.6; 95% CI 2.7-49.2, p = 0.001 for log RBP) and urinary MCP-1 (OR 11.0; 95% CI 1.6-76.4, p = 0.02 for log MCP-1) remained as significant independent predictors of the PO.Conclusion: Urinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated. (C) 2012 Elsevier Inc. All rights reserved.