Association of serum and urinary tumor necrosis factor-alpha (TNF-?) with albuminuria in diabetic nephropathy.

Background: Diabetic nephropathy is the leading cause of end stage renal disease in diabetes and albuminuria is the most common indicator of progressive glomerular damage. Several markers of diabetic nephropathy were discovered but not sensitive for its early detection. Aim of the study: was to evaluate the levels of serum and urinary TNF-? in patients with diabetic nephropathy and to clarify its possible relationship as well as other parameters to different stages of albuminuria in diabetic patients. Methods: This cross-sectional study was conducted on 100 patients with diabetes and diabetic nephropathy and seventy healthy control subjects. The enrolled patients were divided into three groups according to the level of albuminuria (49 normoalbuminuric patients, 30 microalbuminuric patients, and 21 macroalbuminuric patients).Tumor necrosis factor-alpha was measured in all subjects using immunoenzymatic ELISA kits. RESULTS: Type 2 diabetic patients (T2DM) with diabetic nephropathy had significantly higher values of clinical and biochemical parameters of metabolic syndrome. Serum and urinary TNF-? levels were significantly higher in patients with type 2 diabetes compared to control group. Moreover when we stratified diabetic nephropathy patients according to albumin excretion ratio, we found that patients with macroalbuminuria had higher levels of serum and urinary TNF-? than normoalbuminuric and microalbuminuric patients and for further evaluation, serum and urinary TNF-? levels in type 2 diabetic patients were positively correlated to systolic and diastolic blood pressure, total cholesterol, LDL.c, WBC\'s count, fasting blood glucose, HbA1c, uric acid and albumin excretion ratio. Conclusion: Serum and urinary TNF-? level were elevated in Type 2 diabetes mellitus patients with diabetic nephropathy with positive correlation between serum and urinary levels. Their levels were significantly positively correlated to albuminuria and may be used as a strong predictive factor for progression of glomerular disease in type 2 diabetes.