The Role of Netrin-1 and Interleukin-6 in Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus
Hoda Halim Salem
Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Faiza lashin
Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Dina Abd El Hai
Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Amal Selim
Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Netrin-1 is a laminin like protein highly induced after acute and chronic kidney injury, represent tubular damage and excreted in urine of both animals and humans. Netrin-1 is a potential biomarker predicting the development of diabetic kidney disease. Interleukin-6 (IL-6) is an inflammatory cytokine that has a role in the transformation from acute to chronic inflammation. The aim of this work was to evaluate the role of Netrin-1 and IL-6 in the development of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM).
Methods: Our study included 75 patients with T2DM and 25 healthy control group. The study duration started from October 2019 to January 2021. Participants were subdivided into four equal groups: group I: 25 healthy subjects as control group, group II: 25 diabetic patients with albumin/creatinine ratio < 30 mg/g, group III: 25 diabetic patients with albumin/creatinine ratio 30-300 mg/g, group IV: 25 diabetic patients with albumin/creatinine ratio > 300 mg/g. All subjects underwent complete clinical examination, laboratory investigations and measurement of serum Netrin-1 and IL-6 by ELISA.
Results: Nertin-1 was significantly higher in group III and group IV than group II and control group (P<0.001*). Netrin-1 was positively correlated with IL-6, fasting BG, 2HPP, HbA1C, B. urea, S. creatinine and urinary ACR, but it was negatively correlated with eGFR, Hb and S. albumin. IL-6 was significantly higher in group IV than group III, group II and control group (p<0.001*). There was a positive correlation between IL-6 and 2HPP, HbA1C, B. urea, S. creatinine and urinary ACR, but there was a negative correlation between IL-6 and eGFR, Hb and S. albumin. Netrin-1 was more sensitive 96.5% and more specific 99.8% than IL-6 sensitivity 83.3% and specificity 85.0%.
Conclusions: Netrin-1 and IL-6 were significantly higher in diabetic nephropathy patients with macroalbuminuria than other groups. Netrin-1 was more sensitive and specific than IL-6 in predicting DN and its progression.
Keywords: Netrin-1, interleukin-6, diabetic nephropathy, diabetes mellitus