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NDT Advance Access published online on September 17, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn515
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Urinary excretions of lipocalin-type prostaglandin D synthase predict renal injury in type-2 diabetes: a cross-sectional and prospective multicentre study

Yoshio Uehara1, Hirofumi Makino2, Kousuke Seiki3, Yoshihiro Urade4 on behalf of L-PGDS Clinical Research Group of Kidney*

1 Health Service Center, University of Tokyo, Tokyo 2 Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 3 Central Research Institute, Maruha Group Inc., Tsukuba 4 Department of Molecular Behavioral Biology, Osaka Bioscience Institute, Osaka, Japan

Correspondence and offprint requests to: Yoshio Uehara, Health Service Center, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan. Tel: +81-3-3815-5411; Fax: +81-3-3814-0021; E-mail: uehara-2im{at}h.u-tokyo.ac.jp



  Abstract

Backgrounds. Urinary excretions of lipocalin-type prostaglandin D synthase/β-trace (L-PGDS) probably reflect the increased permeability of injured glomerular capillary walls of the kidney. We tested the hypothesis in cross-sectional and prospective studies that urinary L-PGDS excretions predict renal injury in type-2 diabetes.

Methods. (1) In the cross-sectional studies, we evaluated whether urinary L-PGDS excretions were able to predict renal diseases in a pooled population including 793 healthy subjects and 200 patients with various forms of renal diseases. (2) We determined the cut-off point of urinary L-PGDS excretions to predict ≥30 mg/gCr albuminuria in 666 patients with type-2 diabetes. (3) In the prospective study, 121 type-2 diabetic patients with <30 mg/gCr albuminuria were followed for almost 2 years to examine whether urinary L-PGDS excretions predict the future status of renal injury in type-2 diabetes.

Results. (1) In the cross-sectional studies, receiver operating characteristic analysis revealed that urinary L-PGDS excretions better predicted the patients with kidney diseases than the other markers of renal injury. (2) It was also demonstrated that ≥4.2 mg/gCr urinary L-PGDS excretions better predicted ≥30 mg/gCr albuminuria in type-2 diabetic patients than other markers. (3) The prospective study revealed that in type-2 diabetic patients with <30 mg/ gCr albuminuria, the patients with ≥4.2 mg/gCr urinary L-PGDS excretions more likely exhibited the renal injury during the follow-up periods than those with <4.2 mg/gCr urinary L-PGDS excretions.

Conclusions. Urinary L-PGDS excretions reflect the current increased permeability of injured glomerular capillary walls and better predict the future status of renal injury in type-2 diabetes with <30 mg/gCr albuminuria.

Keywords: albuminuria; biomarker; diabetes mellitus; nephropathy; prostaglandin D synthase

* The members of L-PGDS Clinical Research Group of Kidney are listed in the Appendix.

Received for publication: 30. 4.08
Accepted in revised form: 20. 8.08


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