Abstract

*Younis M. Y. G., ***Elkoriny Nesrin, **Ezwaie Mohamed Osama, *Sara A. Abdulla

ABSTRACT

Background: Diabetic nephropathy (DN) may cause end-stage renal disease. Prompt detection and management are crucial for slowing the progression of DN and improving patient outcomes. Traditional diagnostic methods, such as assessing albuminuria and serum creatinine levels, frequently fail to detect early kidney damage, as structural changes in the kidneys can occur before any rise in albumin excretion. Urinary heme oxygenase-1 (UHO-1), a cytoprotective enzyme induced by oxidative stress, has emerged as a potential early biomarker for DN. Aim: This study aims to investigate whether urinary UHO-1 levels can serve as an earlier biomarker of DN and compare the results with those of the conventional markers of DN. Material and methods: A cross-sectional study was conducted on 85 participants with type 2 diabetes (45 diabetics and 40 with DN) at the Diabetes Center in Ajdabiya, Libya, from May to August 2024. Clinical assessments and laboratory tests, including fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), serum creatinine, blood urea, urine albumin, albumin-creatinine ratio (ACR), and urinary HO-1 (UHO-1), were performed. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS). Results: UHO-1 levels were not significantly (p = 0.547) different in DN patients compared to diabetics. In contrast, common markers such as ACR and microalbuminuria showed significant increases in DN patients (p < 0.001). When DN patients were further classified according to ACR, urinary HO-1 showed a mild but non-significant (p > 0.05) increase across these subgroups. Whereas the classical markers of DN (microalbuminuria, ACR, GFR, urinary creatinine, and albumin) were significantly different in DN groups compared to normal albuminuric subjects. However, UHO-1 levels in the macroalbuminuric group showed a strong negative correlation (r = -0.994) with HbA1c, moderate correlation (r = -0.566) with blood urea, and weak correlation with other renal function markers (serum creatinine and urinary albumin). group, indicating that UHO1 levels is inversely related to glycemic control and the degree of renal damage. Conversely, the gold biomarkers (microalbuminuria and ACR) were significantly changed among DN patients with different stages. Conclusion: Urinary HO-1 may be regarded as a non-inferior, compared to the other classical biomarker of diabetic nephropathy.