title: Tubular markers are associated with decline in kidney function in proteinuric type 2 diabetic patients.
abstract: Our aim was to investigate u-NGAL, u-KIM1 and p-FGF23 and prediction of decline in kidney function in type 2 diabetic patients with proteinuria.
  
  
  METHODS
  We performed a follow-up study, follow-up median (range) 3.5 (1-5) years. At baseline u-NGAL, u-KIM1 and p-FGF23 (ELISA) was measured and patients were followed yearly with estimated(e)-GFR (MDRD) and u-albumin.
  
  
  RESULTS
  We included 177 patients (44 women), mean age (SD) 59 (9) years. eGFR 90 (24) ml/min/1.73 m(2) at baseline, u-albumin: median (interquartile range) 104 (39-238) mg/24 h. Patients with levels of u-KIM1 in the highest quartile had a greater decline in eGFR than patients with the lowest quartile 6.0 (5.4) versus 3.2 (5.5) ml/min/1.73 m(2) per year (p=0.02). u-NGAL in the highest versus lowest quartile eGFR decline: 5.1 (4.7) and 2.8 (7.1)ml/min/1.73 m(2) per year (p=0.07). Higher values of u-NGAL and u-KIM1 were associated with enhanced decline in eGFR (R=0.16 and R=0.19, p<0.05), however not after adjustment for progression promoters. p-FGF23 was not predictive of decline in eGFR.
  
  
  CONCLUSIONS
  Higher levels of markers of tubular damage are associated with a faster decline in eGFR. However, since this is not independent of known progression promoters, measurement of tubular markers does not give additional prognostic information.
authors.affiliation: Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark. Sene@steno.dk
authors.forename: Stine E
authors.initials: SE
authors.lastname: Nielsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Reinhard
authors.forename: Dietmar
authors.initials: D
authors.lastname: Zdunek
authors.forename: Georg
authors.initials: G
authors.lastname: Hess
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jacobsen
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D015415:Biomarkers / Q000652:urine; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000652:urine*; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000652:urine*; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000652:urine*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D001786:Blood Glucose; C000717427:FGF23 protein, human; D000089703:Fibroblast Growth Factor-23