Urinary n-acetyl-beta-d-glucosaminidase excretion: an indicator of neuropathy in type 2 diabetes.
The established marker for tubular damage, urinary n-acetyl-beta-d-glucosaminidase is significantly increased in type 1 and 2 diabetes patients and is related to albuminuria and other diabetic complications. In this cross sectional study of type 2 diabetes patients with a history of albuminuria, we studied the relationship between excretion of n-acetyl-beta-d-glucosaminidase in urine and diabetic neuropathy.160 type 2 diabetes patients were screened for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy. N-acetyl-beta-d-glucosaminidase excretion was detected in 24 h urine samples.Urinary excretion of n-acetyl-beta-d-glucosaminidase correlated significantly with -glucose control (fasting glucose r=0.18; p=0.04; HbA1c r=0.20; p=0.02) and urine albumin excretion (r=0.22; p=0.01). Binary regression analyses showed that increased urinary n-acetyl-beta-d-glucosaminidase concentration is an independent predictor for presence of clinical symptoms of peripheral neuropathy (OR 1.8 [95%CI 1.2-2.74] and vibration deficiency [OR 1.7; 95% CI 1.2-2.66]. There was also a significant negative association between urinary n-acetyl-beta-d-glucosaminidase and E/I-Ratio (r=-0.21, p<0.02) as well as the 30:15-Ratio (r=-0.24; p<0.01) of heart rate variability. Furthermore, increased n-acetyl-beta-d-glucosaminidase excretion independently predicted cardiovascular autonomic diabetic neuropathy with an OR for decreased E/I-Ratio of 1.7 [95%CI 1.1-2.75]; (p<0.02) and 30:15-Ratio:OR 2.4 [95% CI 1.26-4.45]; (p<0.01).Urinary n-acetyl-beta-d-glucosami-nidase excretion is an independent marker for diabetic peripheral and cardiovascular autonomic neuropathy in type 2 diabetic patients.
Department of Medicine 1 and Clinical Chemistry of University Hospital Heidelberg, Germany.
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S
Kopf
D
D
Oikonomou
D
D
Zdunek
M
M
von Eynatten
G
G
Hess
P P
PP
Nawroth
A
A
Bierhaus
P M
PM
Humpert
D000118:Acetylglucosaminidase / Q000652:urine*; D000368:Aged; D000419:Albuminuria / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000652:urine*; D003929:Diabetic Neuropathies / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000118:Acetylglucosaminidase