ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO440

Urinary Excretion of Podocyte mRNA as a Risk Prediction Biomarker for Progression of Diabetic Nephropathy: 2-Year Follow-Up Study

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Fukuda, Akihiro, Oita University, Yufu, Japan
  • Sato, Yuji, University of Miyazaki, Kiyotake, MIYAZAKI, Japan
  • Minakawa, Akihiro, University of Miyazaki, Kiyotake, MIYAZAKI, Japan
  • Kikuchi, Masao, University of Miyazaki, Kiyotake, MIYAZAKI, Japan
  • Fujimoto, Shouichi, University of Miyazaki, Kiyotake, MIYAZAKI, Japan
Background

Recent studies suggest that podocyte injury has already occurred at the early stage of diabetic nephropathy. Podocyte cell lineage-specific mRNA can be recovered from urine pellets. We previously reported that urinary excretion of podocyte mRNA could be an early diagnostic biomarker for diabetic nephropathy. Here, we examine whether it can be used as a risk prediction biomarker for progression of diabetic nephropathy.

Methods

For our previous study, outpatients at various stages of diabetes (n=83, normoalbuminuria group, n=31, microalbuminuria group, n=31, macroalbuminuria group) were enrolled from January to June 2015 and spot urine samples were collected. For the present study, we performed a prospective observational cohort study of these participants using data from a 2-year follow-up period (2015–2017). Renal outcome was defined as a decrease in the estimated glomerular filtration rate (eGFR) of >4% per year. Predictors used were baseline urinary excretion of podocyte mRNA (podocin/aquaporin 2 mRNA ratio), podocin mRNA/creatinine ratio (UPodCre), podocin/nephrin mRNA ratio, and albumin/creatinine ratio (UAlbCre). A logistic regression analysis was used to calculate the odds ratios (ORs) for eGFR decrease, with adjustments made for age, sex, duration of diabetes, body mass index, systolic blood pressure, eGFR, low density lipoprotein cholesterol, serum albumin, glycated hemoglobin, and usage of insulin or a renin-angiotensin system inhibitor.

Results

Of the 145 patients, 31 were excluded because of lack of follow-up or data. UPodCre and UAlbCre were significantly associated with decreased eGFR in univariable analysis [OR, 2.95 (95% CI, 1.18–7.34) and OR, 2.70 (95% CI, 1.67–4.36), respectively], and remained significantly associated with decreased eGFR in multivariable analysis adjusted for the above confounding factors [OR, 2.97 (95% CI, 1.07–8.27) and OR, 3.98 (95% CI, 1.94–8.15), respectively].

Conclusion

Urinary excretion of podocyte mRNA was independently associated with eGFR decline in addition to albuminuria in diabetic patients. Results from this and our previous study suggest that urinary excretion of podocyte mRNA could be used as early diagnostic and risk prediction biomarker for progression of diabetic nephropathy.

Funding

  • Private Foundation Support