title: Urinary collagen IV and πGST: potential biomarkers for detecting localized kidney injury in diabetes--a pilot study.
abstract: OBJECTIVE
  Urinary biomarkers can identify damage to specific parts of the nephron. We performed a cross-sectional study to characterise the pattern of diabetic nephropathy using urinary biomarkers of glomerular fibrosis (collagen IV), proximal tubular damage (α-glutathione-S-transferase, GST) and distal tubular damage (πGST).
  
  
  METHODS
  Clinical data from 457 unselected patients attending a hospital diabetes clinic were collected. Spot urine samples were analysed for albumin and creatinine. Biomarkers were measured by enzyme-linked immunosorbent assay, and corrected to urinary creatinine.
  
  
  RESULTS
  All 3 biomarkers correlated weakly with albumin/creatinine ratios (Pearson correlation <0.2, p values <0.001). The most common abnormality was elevated urinary collagen IV (glomerular, 35%) compared to αGST (proximal tubule, 18%) or πGST (distal tubule, 15%). The proportion of patients with abnormal biomarker results increased across the normo-, micro- and macroalbuminuria groups, with collagen IV (26, 58, 65%) and πGST (11, 25, 35%) but not αGST.
  
  
  CONCLUSIONS
  In patients with diabetes, these urinary biomarkers appear to identify renal damage that is related to, but distinct from, urine albumin/creatinine ratios. The markers of glomerular fibrosis and distal tubular damage related most closely to the degree of albuminuria. Longitudinal studies are now required to assess whether these biomarkers can detect early renal disease with greater specificity and sensitivity than the albumin/creatinine ratio.
authors.forename: T J
authors.initials: TJ
authors.lastname: Cawood
authors.forename: M
authors.initials: M
authors.lastname: Bashir
authors.forename: J
authors.initials: J
authors.lastname: Brady
authors.forename: B
authors.initials: B
authors.lastname: Murray
authors.forename: P T
authors.initials: PT
authors.lastname: Murray
authors.forename: D
authors.initials: D
authors.lastname: O'Shea
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000652:urine; D024141:Collagen Type IV / Q000652:urine*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000652:urine*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology / Q000652:urine*; D005260:Female; D051549:Glutathione S-Transferase pi / Q000652:urine*; D005982:Glutathione Transferase / Q000652:urine*; D006801:Humans; D007527:Isoenzymes / Q000652:urine*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV; D007527:Isoenzymes; D051549:Glutathione S-Transferase pi; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha