Forum Diagnosticum No.04/2013
HbA1c and Urine Biomarkers (Gamma Glutamyl Transferase, Albumin, Clusterin and Type IV Collagen) as the Kidney Damage Markers in Patients with Type 2 Diabetes Mellitus
Hyperglycemia condition in patients with diabetes can cause microvascular and macrovascular complications. This condition can lead to increased morbidity and mortality in diabetic patient. A common complication that occurs in the patients with diabetes is diabetic nephropathy, which will ultimately lead to the occurrence of terminal renal failure or end stage renal disease (2.4).
Urine albumin is used to determine the condition of albuminuria (microalbuminuria and macroalbuminuria). Here an increase of urine albumin in diabetic nephropathy is mainly derived from the glomerulus (12). In addition, urine albumin is currently used as the gold standard to detect and predict the occurrence of diabetic nephropathy and cardiovascular risks (5).
The activity measurement of urinary gamma-glutamyl transferase is used as the marker of kidney cell membrane damage, and clusterin to detect the presence of disruption in the proximal tubules of the nephron (11).
The kidney damage in uncontrolled diabetic patients occurs through the accumulation of ECM proteins characterized by increased level of urinary type IV collagen and low-grade inflammation that is characterized by elevated level of hsCRP. The mechanism of kidney damage through ECM has been proven instrumental to the occurrence of glomerular injury characterized by increased urine albumin as a marker of glomerular damage, while the low-grade inflammation mechanism has not yet been proven by biomarkers of damage to the glomerulus (urine albumin), the cell membranes of the kidney (urine GGT), as well as the proximal tubules (urine clusterin).
Author: Yuliana Sambara (PT Prodia Widyahusada)