Utility of Urinary Netrin-1 in Patients With Type 2 Diabetic Nephropathy and Its Correlation With Renal Function

Abstract Purpose-Netrin-1 is a urinary protein that may help in the diagnosis of diabetic nephropathy. The objectives of this study were to assess urinary netrin-1 levels in patients with type 2 diabetic nephropathy and to determine its correlation with renal function among them. Methodology- This cross-sectional analytical study was conducted at a tertiary care teaching hospital in south India for 18 months. Study subjects were divided into four groups: non-diabetics, diabetics with normal to mildly increased albuminuria, moderately increased albuminuria, and severely increased albuminuria. Urinary albumin was quantified by nephelometry for all study subjects. The ELISA technique estimated urinary netrin-1 levels in all groups. Results- Urinary netrin-1 levels were higher in diabetic subjects with normal to mildly increased and severely increased albuminuria than in the control group. Correlation analysis showed that there was a positive correlation of urinary netrin-1 with urinary albumin-creatinine ratio (UACR) and no correlation with estimated glomerular filtration rate (eGFR). Urinary netrin-1 showed a sensitivity of 88.3% and specificity of 75% at a cut-off value of 889.74 pg/mg creatinine for diagnosing diabetic nephropathy. Conclusion-Urinary netrin-1 levels were elevated in diabetic subjects with moderately and severely increased albuminuria as compared to non-diabetic subjects. It showed a positive correlation with the urinary albumin-creatinine ratio and no correlation with eGFR in diabetic subjects.