Urinary netrin-1 as an early marker for diabetic nephropathy

Abstract

Background: Netrin-1, a laminin-related secreted protein, is a proximal tubular injury urinary marker. It is released in the urine of both humans and mice and highly stimulated after acute and chronic renal diseases. Objective: The current study aimed to assess the value of urinary netrin-1 level as an early marker for diabetic nephropathy. Patients and Methods: A total of 60 diabetic patients and 20 healthy controls were enrolled in this case-control study. Diabetic patients were subdivided into normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary netrin-1 levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Results: Urinary netrin-1 excretion was significantly higher in the diabetic group (1418.3±733.6 pg/mg creatinine) compared to the control group (477.4±283.6 pg/mg creatinine) with the highest value in the macroalbuminuria group (1919.4±573.4 pg/mg creatinine) and the lowest value in normoalbuminuria group (833.7±595.3 pg/mg creatinine). ROC curve analysis showed that urinary netrin 1/creatinine at a cutoff point of >630.75 pg/mg with AUC of 0.899 had 83.3% sensitivity and 85% specificity for prediction of diabetic nephropathy (P<0.001). Conclusion: Our study is suggesting that urinary netrin-1 may be a useful biomarker for early detection of diabetic nephropathy.