الفهرس 
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Abstract
Diabetic microvascular disease is present mainly as retinopathy, nephropathy, neuropathy, and vascular abnormalities in the lower extremities, leading to visual impairment, kidney failure, stroke, diabetic cardiomyopathy, and lower extremity dysfunction, respectively. T2DM has changed from a mild disorder of old age to a serious cause of morbidity and mortality in young and middle-aged people. Inflammation resulting from an imbalance between pro and anti-inflammatory cytokines leads to T2DM and its complications. Elevated serum concentrations of TNFR1 or TNFR2 in patients with type 2 diabetes are associated with early glomerular structural lesions. CXCL16 is a recently discovered cytokine belonging to the CXC chemokine family and is unique in that it combines scavenger receptor functions with properties of an inflammatory chemokine. Several lines of evidence indicate that CXCL16 plays an important role in the pathogenesis of lupus nephritis, diabetic nephropathy and chronic kidney diseases.
The aim of this study was to evaluate the potential role of circulating Chemokine CXC ligand 16 (CXCL16) and TNF- receptors 1 & 2 in the pathogenesis of diabetic nephropathy in Egyptian patients with type 2 DM with and without renal disease, and that potentially may be used to predict the onset and/or monitor the progression of nephropathy.
Seventy Egyptian subjects, including patients with diabetic nephropathy (DN group), type 2 diabetes mellitus (T2DM group), and healthy controls of similar age and gender (control group), were enrolled in this study. Serum levels of CXC Chemokine Ligand 16 (CXCL16) and tumor necrosis factor receptors 1 & 2 (TNFR1 & TNFR2) were measured using ELISA technique. The levels of Lipid profile including (TAG, TC, HDL-c, LDL-c and VLDLc), kidney function tests including (Creatinine, eGFR, BUN, uric acid, Urinary P/C Ratio), CRP, fasting blood glucose (FBG) and HbA1c were also analyzed.
The results of the present study were clearly indicated that:
• Levels of CXCL16 and TNFR 1 & 2 to be higher in the DN group than in the control group.
• In the meantime, results showed levels of lipid profile (except HDLc) were significantly higher in the DN group than in the control group.
• A highly significant negative correlation was shown between eGFR and either HbA1c or Creatinine also between TNFR1 and Albumin. In the meantime, a highly significant positive correlation was shown between TNFR1 and either BUN or TNFR2 in group I.
• A highly significant negative correlation was observed between eGFR and Creatinine also between CXCL16 and either HbA1c or ALP in group Ⅱ.
• A highly significant negative correlation was shown between eGFR and CXCL16 also between TNFR1 and Albumin. In the meantime, a highly significant positive correlation was shown between Creatinine and either BUN or Protein/Creatinine Ratio in group Ⅲ.
• CXCL16, TNFR1 and TNFR2 showed high accuracy in the nephropathy group. While, eGFR yielded a worse accuracy for diagnosing of DN.
In conclusion, TNFRs 1 & 2 and CXCl16 may be early, highly sensitive and specific markers and they could be used as a useful promising biomarker for early detection of diabetic nephropathy. Targeting on reducing their levels may be specific therapeutic interventions to prevent DN progression. While eGFR couldn’t be used as a reliable diagnostic biomarker for this disease. Future studies should focus on social and genetic determinants of inflammation and their association with DN in Egyptian diabetic nephropathy patients.