Urinary excretions of lipocalin-type prostaglandin D synthase predict renal injury in type-2 diabetes: a cross-sectional and prospective multicentre study.
BACKGROUND
Urinary excretions of lipocalin-type prostaglandin D synthase/beta-trace (L-PGDS) probably reflect the increased permeability of injured glomerular capillary walls of the kidney. We tested the hypothesis in cross-sectional and prospective studies that urinary L-PGDS excretions predict renal injury in type-2 diabetes.


METHODS
(1) In the cross-sectional studies, we evaluated whether urinary L-PGDS excretions were able to predict renal diseases in a pooled population including 793 healthy subjects and 200 patients with various forms of renal diseases. (2) We determined the cut-off point of urinary L-PGDS excretions to predict >or=30 mg/gCr albuminuria in 666 patients with type-2 diabetes. (3) In the prospective study, 121 type-2 diabetic patients with <30 mg/gCr albuminuria were followed for almost 2 years to examine whether urinary L-PGDS excretions predict the future status of renal injury in type-2 diabetes.


RESULTS
(1) In the cross-sectional studies, receiver operating characteristic analysis revealed that urinary L-PGDS excretions better predicted the patients with kidney diseases than the other markers of renal injury. (2) It was also demonstrated that >or=4.2 mg/gCr urinary L-PGDS excretions better predicted >or=30 mg/gCr albuminuria in type-2 diabetic patients than other markers. (3) The prospective study revealed that in type-2 diabetic patients with <30 mg/ gCr albuminuria, the patients with >or=4.2 mg/gCr urinary L-PGDS excretions more likely exhibited the renal injury during the follow-up periods than those with <4.2 mg/gCr urinary L-PGDS excretions.


CONCLUSIONS
Urinary L-PGDS excretions reflect the current increased permeability of injured glomerular capillary walls and better predict the future status of renal injury in type-2 diabetes with <30 mg/gCr albuminuria.
Uehara
Yoshio
Y
Health Service Center, University of Tokyo, Japan. uehara-2im@h.u-tokyo.ac.jp
Makino
Hirofumi
H
Seiki
Kousuke
K
Urade
Yoshihiro
Y
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000201:enzymology / Q000652:urine; D015415:Biomarkers / Q000652:urine; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000201:enzymology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000201:enzymology* / Q000652:urine; D005260:Female; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000652:urine*; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D055815:Young Adult
D015415:Biomarkers; D054834:Lipocalins; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase