Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 May 22:9:225.
doi: 10.3389/fendo.2018.00225. eCollection 2018.

Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease

Lauren Winter  1   2 , Lydia A Wong  1 , George Jerums  1 , Jas-Mine Seah  1 , Michele Clarke  1 , Sih Min Tan  3 , Melinda T Coughlan  3 , Richard J MacIsaac  4   5 , Elif I Ekinci  1   2
Affiliations
Review

Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease

Lauren Winter et al. Front Endocrinol (Lausanne). .

Abstract

Diabetic kidney disease is a common complication of type 1 and type 2 diabetes and is the primary cause of end-stage renal disease in developed countries. Early detection of diabetic kidney disease will facilitate early intervention aimed at reducing the rate of progression to end-stage renal disease. Diabetic kidney disease has been traditionally classified based on the presence of albuminuria. More recently estimated glomerular filtration rate has also been incorporated into the staging of diabetic kidney disease. While albuminuric diabetic kidney disease is well described, the phenotype of non-albuminuric diabetic kidney disease is now widely accepted. An association between markers of inflammation and diabetic kidney disease has previously been demonstrated. Effector molecules of the innate immune system including C-reactive protein, interleukin-6, and tumor necrosis factor-α are increased in patients with diabetic kidney disease. Furthermore, renal infiltration of neutrophils, macrophages, and lymphocytes are observed in renal biopsies of patients with diabetic kidney disease. Similarly high serum neutrophil and low serum lymphocyte counts have been shown to be associated with diabetic kidney disease. The neutrophil-lymphocyte ratio is considered a robust measure of systemic inflammation and is associated with the presence of inflammatory conditions including the metabolic syndrome and insulin resistance. Cross-sectional studies have demonstrated a link between high levels of the above inflammatory biomarkers and diabetic kidney disease. Further longitudinal studies will be required to determine if these readily available inflammatory biomarkers can accurately predict the presence and prognosis of diabetic kidney disease, above and beyond albuminuria, and estimated glomerular filtration rate.

Keywords: atherosclerosis; diabetic kidney disease; diabetic nephropathy; inflammation; lymphocytes; neutrophils; neutrophil–lymphocyte ratio.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overview of the immune system.
Figure 2
Figure 2
Inflammatory components of the innate immune system and diabetic kidney disease in type 2 diabetes.
Figure 3
Figure 3
Inflammatory components of the innate immune system and diabetic kidney disease in type 1 diabetes.
Figure 4
Figure 4
Changes to leukocytes in diabetic kidney disease.
Figure 5
Figure 5
Elevated neutrophil–lymphocyte ratio and various disease states.
Figure 6
Figure 6
Increased neutrophil–lymphocyte ratio and complications in diabetes mellitus.
Figure 7
Figure 7
Increased neutrophil–lymphocyte ratio and diabetic kidney disease.
See this image and copyright information in PMC

References

    1. Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med (2016) 375(4):323–34. 10.1056/NEJMoa1515920 - DOI - PubMed
    1. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med (2017) 377(7):644–57. 10.1056/NEJMoa1611925 - DOI - PubMed
    1. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med (2016) 375(4):311–22. 10.1056/NEJMoa1603827 - DOI - PMC - PubMed
    1. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med (2016) 375(19):1834–44. 10.1056/NEJMoa1607141 - DOI - PubMed
    1. de Zeeuw D, Bekker P, Henkel E, Hasslacher C, Gouni-Berthold I, Mehling H, et al. The effect of CCR2 inhibitor CCX140-B on residual albuminuria in patients with type 2 diabetes and nephropathy: a randomised trial. Lancet Diabetes Endocrinol (2015) 3(9):687–96. 10.1016/S2213-8587(15)00261-2 - DOI - PubMed