Microalbuminuria; is the only option in the early diagnosis of diabetic nephropathy?

Diabetic Nephropathy (DN) is one of the most important complications of Diabetes Mellitus and the most common cause of end stage renal disease. The acceleration of the incedance of the diabetes mellitus in the last decade indicates that the requirement for renal replacement therapy will increase. Therefore early detection of the kidney damage is of great importance to prevent the disease, at least to slow down the development. Due to type 2 diabetes can advance silent, at the time of the diagnosis there can be a diabetic nephropathy for a long time. Also microalbuminuria which is used in the diagnosis of incipient DN has a low predictive value in the diagnosis of early diabetic nephropathy.While most attention has focused on glomerular changes , it is now increasingly recognized that tubules play an important role in the pathogenesis of diabetic nephropathy. In many studies, it is shown that proteins also determined tubular markers called neutrophil gelatinase-associated lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1) are good markers for earlier detection of acute renal injury after cardiopulmonery surgery, transplantation and toxic renal injury much earlier than serum creatinin distinction. The importance of these proteins in chronic diseases are investigated in a limited research.We investigated the prevalence of these tubular markers and also their relationship with renal indices at different stages of diabetic nephropathy. We analysed urine NGAL and KIM-1 concentrations. We have normoalbuminuric (n=31), microalbuminuric (n=18) and control group (n=22). We take the number of normoalbuminuric patients more than other groups to determine whether an increase in the earlier stages of DN. There was a difference in KIM-1 between microalbuminuric and control group (p<0.05), KIM-1 was higher in microalbuminuric group. Interestingly we found NGAL concentrations higher in control group than in microalbuminuric group (p<0.05). In conclusion urinary KIM-1 can be a promising early marker for diabetic nephropathy in short term diabetes but for NGAL we may predict that it can be used as a diagnostic predictor for incipient DN in advance stages of diabetes that kidneys are exposed to hyperglycemia for a long time.