Urinary Transferrin as A Marker for Diagnosis and Progression of Diabetic Nephropathy: Short-Term Follow Up

Ghada El-Said Ahmed Ibrahim, Assistant professor of Internal Medicine and Nephrology, Nephrology and Dialysis Unit Mansoura University hospital, Faculty of Medicine, Mansoura University, EgyptFollow
Ibrahim Mohammed Adel Ibrahim Bakr, Internal medicine, Faculty of Medicine, Mansoura University, Egypt
Amany Ragab Youssef Ahmed, Professor of Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
Rasha Mahmoud Abdel Fattah, Assistant professor of Internal Medicine and Nephrology, Nephrology and Dialysis Unit Mansoura University hospital, Faculty of Medicine, Mansoura University, Egypt

Subject Area

Nephrology

Article Type

Original Study

Abstract

Background: One of the most serious and devastating effects of diabetes mellitus is diabetic nephropathy, which in many cases progresses to end-stage kidney disease (ESKD). Microalbuminuria is currently the gold standard biomarker for DN diagnosis. Microalbuminuria has a poor predictive value, though. Patients occasionally experienced progressive renal failure without microalbuminuria. A plasma protein called transferrin has a different ionic charge from albumin but is otherwise similar in weight. Aim: Our objectives were to evaluate urinary transferrin as a more accurate and earlier marker for the diagnosis of diabetic kidney disease and to investigate its relationship to the excretion of urinary albumin. Methods: In a prospective study, 180 patients with type 2 diabetes who had normo-, micro-, and macroalbuminuria were included. Urinary albumin creatinine ratio (ACR) was measured, and repeated it after 3 months to confirm the findings; we also assessed the urinary transferrin creatinine ratio (uTCR). We then followed all patients for six months to obtain the same laboratory data. Results: The uTCR level was statistically substantially greater in group with severely increased albuminuria (macroalbuminuria) when compared to the group with normoalbuminuric, but not to the group with moderately increased albuminuria (microalbuminuria). Only normoalbuminuric patients with the high urinary transferrin creatinine ratio showed a significant change in ACR between the three time periods; ACR was greater at 9 months, more than 3 months, and more than baseline. uTCR with a cut-off value >2.8 mg/g is a statistically significant discriminator between macroalbuminuria and normoalbuminuria, as well as between both (micro and macroalbuminuria) and normoalbuminuria, with a high sensitivity but low specificity. Furthermore, the duration of diabetes and uTCR greater than 2.8 mg/g independently predicted the development of albuminuria. Conclusion: The uTCR level is an earlier and more sensitive marker for diabetic nephropathy than ACR, as it is an independent predictor for albuminuria.

Recommended Citation

Ibrahim, Ghada El-Said Ahmed; Ibrahim Bakr, Ibrahim Mohammed Adel; Ahmed, Amany Ragab Youssef; and Fattah, Rasha Mahmoud Abdel (2025) "Urinary Transferrin as A Marker for Diagnosis and Progression of Diabetic Nephropathy: Short-Term Follow Up," Mansoura Medical Journal: Vol. 56 : Iss. 1 , Article 14.
Available at: https://doi.org/10.58775/2735-3990.1434