The diagnosis of diabetic kidney disease; frequencies of urinary microalbumin and creatinine ratios, and the establishment of causal relationships between lipid and glycemic levels and obesity in an Algerian population

Samira Fetni^1,*, Tahar Goudjil², Salima Zekri^3,4, Mohamed Cherif Lemdaoui⁵

¹Department of Pharmacy, Faculty of Medical Sciences, University of Batna2, 05000, Algeria - 2 Department of Natural and Life Sciences, Faculty of Exact Sciences and Natural and Life Sciences, University of Tebessa 12000, Algeria - ³Laboratory of Molecular Biology and Genetics, Faculty of Medicine, University of Constantine3, 25065, Algeria - 4Laboratory of Biochemistry UHC Constantine, 25030, Algeria - ⁵Epidemiology service, UHC Constantine, 25030, Algeria

Introduction: Diabetic nephropathy (DN) is an insidious disease and is the leading cause of renal failure in diabetic patients. The main objective of this study was the early diagnosis of DN in at-risk individuals, using urinary albumin excretion to establish associations between glycemic balance, dyslipidemia, and renal involvement. 

Methods: This prospective study included 292 patients with type 1 and 2 diabetes (T1D and T2D). Microalbuminuria was assessed using urinary microalbumin and creatinine ratios, assessed from the same first-morning urine sample. A glycated hemoglobin (EHbA1c) assay and lipid balance were also performed. 

Results: The cohort had an average age of 55±15.9 years and a sex ratio of 0.67. Of the 292 patients, 35.3% were positive for microalbuminuria. A linear regression model showed a strong correlation between microalbuminuria and glycemic imbalance, total cholesterol, triglyceride, low-density lipoprotein (LDL-cholesterol), systolic blood pressure (SBP), and blood pressure diastolic (DBP), however, the chi-square test (X2) showed a negative association with the absence of microvascular complications (retinopathy and neuropathy) in type 1 diabetics. In type 2 diabetics, the linear regression model showed a positive relationship between microalbuminuria and EHbA1c, SBP, DBP, body mass index (BMI), abdominal perimeter, and lipid balance. While the chi-square (X2) test showed strong links between microvascular complications, smoking, alcohol consumption, high blood pressure (BP), and microalbuminuria, more detailed logistic regression analyses revealed associations between microalbuminuria and poorly balanced EHbA1c, systolic blood pressure (SBP), and disturbances in the balance sheet of HDL-cholesterol only.

Conclusions: DN appeared to be strongly correlated with poor glycemic control and disturbances in lipid profiles, suggesting dietary and improved medical control are important parameters for this condition.