Correlation of Urinary Gamma Glutamyl Transferase to Creatinine Ratio with Albumin Creatinine Ratio in Patients with Type 2 Diabetes Mellitus

Authors

  • Shazia Hameed Department of Chemical Pathology, FPGMI, Shaikh Zayed Medical Complex, Lahore, Pakistan
  • Mahnoor Khan Department of Biochemistry, FPGMI, Shaikh Zayed Medical Complex. Lahore, Pakistan
  • Shahjahan Ustrana Department of Biochemistry, Gomal Medical College, D.I.Khan, Pakistan

DOI:

https://doi.org/10.53685/jshmdc.v5i1.139

Keywords:

Diabetes, Urinary Gamma Glutamyl Transferase to creatinine ratio, Urinary albumin creatinine ratio

Abstract

Background: Diabetic Nephropathy is one of the most serious outcomes of Diabetes Mellitus worldwide. As tubular injury precedes albuminuria, tubular enzyme Gamma Glutamyl Transferase (GGT) may serve as a more sensitive diagnostic biomarker for diabetic nephropathy.

Objective: To determine and correlate urinary Gamma Glutamyl Transferase to creatinine ratio with urinary albumin creatinine ratio (uACR) in Type 2 diabetics based on gender.

Methods: A cross-sectional study was undertaken at Shaikh Zayed Hospital from March 2022 to April 2023. A total of 100 male and female participants were included in this study. The study participants included 75  type 2 diabetics and 25 controls. The diabetic group was subdivided into normoalbuminuric and microalbuminuric based on urinary albumin creatinine ratio.  All subjects' fasting blood glucose, urinary albumin, urinary creatinine, and urinary GGT levels were measured on the automated chemistry analyzer. The data was analyzed by SPSS version 24. “t-test” was used to compare the variables between different groups. The Pearson correlation test was used to establish the correlation between Gamma Glutamyl Transferase to creatinine ratio and uACR.

Results: Urinary GGT (uGGT) levels were significantly higher in all type 2 diabetics as compared to controls (p <0.001). Both urinary albumin and uACR were raised in male diabetics (p<0.001) and female diabetics (p<0.005) as compared to controls, in male diabetics more increase was observed (p<0.001). A highly significant positive correlation was observed between uGGT:Creatinine ratio and uACR of all normoalbuminuric patients (‘r’ males=0.837 & females=0.919) and microalbuminuric patients (‘r’ males=0.600 & females=0.636) at p<0.001.

Conclusion: Urinary Gamma Glutamyl Transferase to creatinine ratio is positively correlated with urinary albumin creatinine ratio and may serve as a more sensitive biomarker than urinary albumin creatinine ratio in diabetic patients with renal damage.

References

Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: Challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017; 12(12): 2032-2045.doi: 10.2215/CJN.11491116

Sagoo MK, Gnudi L. Diabetic nephropathy: An overview. Methods Mol Biol. 2020; 2067: 3-7.doi:10.1007/978-1-4939-9841-8_1

Uwaezuoke SN. The role of novel biomarkers in predicting diabetic nephropathy: a review. Int J Nephrol Renovasc Dis. 2017; 10: 221–231. doi:10.2147/IJNRD.S143186

Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci. 2017; 54(5): 326-342. doi:10.1080/10408363.2017.1377682

Löwen J, Gröne EF, Groß-Weißmann M-L, Bestvater F, Gröne H-J, Kriz W. Pathomorphological sequence of nephron loss in diabetic nephropathy. Am J Physiol Renal Physiol.2021;321(5): F600–16. doi:10.1152/ajp renal.00669.2020

Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, et al. Urinary biomarkers in the assessment of early diabetic nephropathy. J Diabetes Res. 2016; 2016: 4626125. doi:10.1155 /2016/4626125

Bazargani B, Moghtaderi M. New biomarkers in early diagnosis of acute Kidney Injury in children. Avicenna J Med Biotechnol. 2022;14(4):264-269. doi:10.18502/ajmb.v14i4.10478

Ndrepepa G, Colleran R, Kastrati A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease. Clin Chim Acta. 2018; 476: 130-138. doi:10.1016/j. cca.2017. 11.026

Bhatt MP, Rai N, Pokhrel S, Acharya P, Marhatta SB, Khanal DP, et al. Standardization of visible kinetic assay for the estimation of plasma glucose by glucose oxidase and peroxidase method. JMMIHS.2021;7(1):49-59.doi:10.3126/jmmihs.v 7i1.43150

Sun K, Li F, Lin D, Qi Y, Xu M, Li N, et al. Serum gamma-glutamyltransferase is associated with albuminuria: a population-based study. PLoS One. 2014; 9(12). doi:10.1371/journal.pone.0114 970

Jędrusik P, Symonides B, Gaciong Z. Performance of 24-hour urinary creatinine excretion-estimating equations in relation to measured 24-hour urinary creatinine excretion in hospitalized hypertensive patients. Sci Rep. 2019; 9(1):3593. doi:10.1038/s41598-019-40416-w

Ambade V, Sing P, Somani BL, Basanna D. Urinary N-acetyl beta glucosaminidase and gamma glutamyl transferase as early markers of diabetic nephropathy. Indian J Clin Biochem. 2006;21(2):142-148. doi:10.1007/ BF02912930

Jung K, Schulze G, Reinholdt C. Different diuresis-dependent excretions of urinary enzymes:N-acetyl-beta-D-glucosaminidase, alanine aminopeptidase, alkaline phosphatase, and gamma-glutamyltransferase. Clin Chem. 1986;32(3):529–532.doi:10.1093/clinchem/32.3. 529

Sasikala, Bitla AR, Sachan A. Urinary brush border enzymes for early diagnosis of tubular dysfunction in patients with type 2 diabetes mellitus. Int J Res Med Sci. 2019;7(6): 2015.doi: 10.18203/23206012.ijrms20192475

Papadopoulou-Marketou N, Kanaka-Gantenbein C, Marketos N, Chrousos GP, Papassotiriou I. Biomarkers of diabetic nephropathy: A 2017 update. Crit Rev Clin Lab Sci. 2017;54(5):326-42. doi:10.1080/10408363.2017.1377682

de Carvalho JAM, Tatsch E, Hausen BS, Bollick YS, Moretto MB, Duarte T, et al. Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin as indicators of tubular damage in normoalbuminuric patients with type 2 diabetes. Clin Biochem. 2016; 49(3): 232-236. doi:10.1016/j.clinbiochem.2015.10.016

Ho KM, Morgan DJR. The proximal tubule as the pathogenic and therapeutic target in acute kidney injury. Nephron. 2022; 146(5): 494-502. doi:10. 1159/000522341

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321(7258):405-412.doi:10.1136 /bmj.321.7258. 405

Nosadini R, Velussi M, Brocco E, Bruseghin M, Abaterusso C, Saller A, et al. Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate. Diabetes. 2000; 49(3): 476-484. doi:10.2337/diabetes.49. 3.476

Dai H, Zhu L, Pan B, Li H, Dai Z, Su X. The relationship between serum γ-glutamyltransferase (GGT) and diabetic nephropathy in patients with type 2 diabetes mellitus: a cross-sectional study. Clin Exp Med. 2023; 23(7): 3619-3630. doi:10.1 007/s10238-023-00991-9

Vallon V, Thomson SC. The tubular hypothesis of nephron filtration and diabetic kidney disease. Nat Rev Nephrol. 2020; 16(6): 317-336. doi:10. 1038/s41581-020-0256-y

Downloads

Published

06/29/2024

How to Cite

1.
Shazia Hameed, Khan M, Ustrana S. Correlation of Urinary Gamma Glutamyl Transferase to Creatinine Ratio with Albumin Creatinine Ratio in Patients with Type 2 Diabetes Mellitus. J Shalamar Med Dent Coll [Internet]. 2024 Jun. 29 [cited 2024 Nov. 7];5(1):42-8. Available from: https://journal.smdc.edu.pk/index.php/journal/article/view/139

Issue

Section

Original Articles