Study of Neutrophil-Lymphocyte Ratio, Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-) in Type 2 Diabetes with Diabetic Nephropathy

Abstract

Diabetic kidney disease is defined by characteristic structural and functional changes. The predominant structural changes include mesangial expansion, glomerular basement membrane thickening, podocyte injury, and, ultimately, glomerular sclerosis. The major clinical manifestations of diabetic nephropathy are albuminuria, hematuria (less often), and, in many patients, progressive chronic kidney disease, which can be slowed with optimal therapy. Although microalbuminuria has traditionally remained the gold-standard biomarker for predicting diabetic nephropathy, its draw-backs include the following. Firstly, not all microalbuminuric diabetics will end up with diabetic nephropathy and ESRD. Secondly, microalbuminuria can only occur in the presence of significant renal injury since it is preceded by the appearance of several tubular and glomerular biomarkers in urine. Thirdly, many diabetic patients with diabetic nephropathy can revert to normoalbuminuria, and these patients can also present with a reduction in GFR without progressing from normo- to macroalbuminuria (the concept of ‘non-albuminuric’ diabetic nephropathy). Thus, in place o