title: Association between mannose-binding lectin, high-sensitivity C-reactive protein and the progression of diabetic nephropathy in type 1 diabetes.
abstract: OBJECTIVE
  Diabetic nephropathy has been associated with low-grade inflammation and activation of the complement system in cross-sectional studies. Data from prospective studies are sparse. We investigated the associations of the complement activator mannose-binding lectin (MBL) and the inflammatory marker high-sensitivity C-reactive protein (hsCRP) with the development of nephropathy in a large prospective study of patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study.
  
  
  METHODS
  Baseline MBL and hsCRP were measured in 1,564 type 1 diabetes patients from the FinnDiane study, of whom 1,010 had a normal albumin excretion rate, 236 had microalbuminuria and 318 had macroalbuminuria. The main outcome was progression in renal disease during follow-up.
  
  
  RESULTS
  Both baseline MBL (p = 0.038) and hsCRP (p < 0.001) increased with increasing level of albuminuria. During 5.8 +/- 2.2 years of follow-up, progression to a higher albuminuria level or end-stage renal disease (ESRD) occurred in 201 patients. MBL levels were higher in progressors compared with non-progressors at all steps of progression, and in a covariate adjusted multivariate Cox-regression analysis MBL levels above the median were significantly associated with progression from macroalbuminuria to ESRD (hazard ratio 1.88, 95% CI 1.06-3.32, p = 0.030). In a univariate analysis, hsCRP levels above the median were significantly associated with progression from normal albumin excretion rate to microalbuminuria, but the association was only borderline significant after adjustment for covariates (hazard ratio 1.56, 95% CI 0.97-2.51, p = 0.068).
  
  
  CONCLUSIONS
  This study demonstrates that concentrations of both MBL and hsCRP are associated with the progression of renal disease in type 1 diabetes.
authors.affiliation: Immunoendocrine Research Unit, Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Clinical Institute, Aarhus University Hospital, Norrebrogade 42-44, DK-8000, Aarhus C, Denmark. tkh@dadlnet.dk
authors.forename: T K
authors.initials: TK
authors.lastname: Hansen
authors.forename: C
authors.initials: C
authors.lastname: Forsblom
authors.forename: M
authors.initials: M
authors.lastname: Saraheimo
authors.forename: L
authors.initials: L
authors.lastname: Thorn
authors.forename: J
authors.initials: J
authors.lastname: Wadén
authors.forename: P
authors.initials: P
authors.lastname: Høyem
authors.forename: J
authors.initials: J
authors.lastname: Østergaard
authors.forename: A
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: P-H
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D037601:Mannose-Binding Lectin / Q000378:metabolism*; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D037601:Mannose-Binding Lectin; D002097:C-Reactive Protein
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