Urine clusterin/apolipoprotein J is linked to tubular damage and renal outcomes in patients with type 2 diabetes mellitus

Summary Objective The objective of this study was to evaluate the association of urine clusterin/apolipoprotein J (Apo J) with the development and/or progression of diabetic kidney disease (DKD) in type 2 diabetes. Materials and Methods A total of 159 type 2 diabetic patients and 20 nondiabetic subj...

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Published in:Clinical endocrinology (Oxford) 2017-08, Vol.87 (2), p.156-164
Main Authors: Kim, Sang Soo, Song, Sang Heon, Kim, Jong Ho, Jeon, Yun Kyung, Kim, Bo Hyun, Kang, Min‐Cheol, Chun, Sung Wan, Hong, Soo Hyun, Chung, Michelle, Kim, Yong Ki, Kim, In Joo, Kim, Young‐Bum
Format: Article
Language:English
Subjects:
Adult
Aged
Albuminuria
Apolipoproteins
Case-Control Studies
Clusterin
Clusterin - urine
Developmental stages
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - complications
Diabetic Nephropathies - pathology
Diabetic nephropathy
Disease Progression
Epidermal growth factor receptors
Female
Glomerular Filtration Rate
Humans
Kidney diseases
Kidney transplantation
Kidney Tubules - injuries
Male
Middle Aged
Multivariate analysis
proteinuria
Risk Factors
Urine
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Summary:Summary Objective The objective of this study was to evaluate the association of urine clusterin/apolipoprotein J (Apo J) with the development and/or progression of diabetic kidney disease (DKD) in type 2 diabetes. Materials and Methods A total of 159 type 2 diabetic patients and 20 nondiabetic subjects with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 were enrolled. The baseline values of urine clusterin and tubular damage markers were measured. The primary outcome was the annual decline rate in eGFR, and secondary outcomes were the development of chronic kidney disease (CKD) stage 3 or greater and the persistence/progression of albuminuria. The median follow‐up duration of enrolled patients was 3.0 (1.0‐5.9) years. Results Baseline clusterin levels in urine were significantly increased in type 2 diabetic subjects compared with those of nondiabetic subjects. The levels of urine clusterin had a significant correlation with urine tubular damage markers. A positive correlation between the annual rate of decline in eGFR and urine clusterin after adjusting for clinical confounding factors was detected. Multivariate analysis further indicated that urine clusterin correlated with the development of CKD stage 3 or greater and persistence/progression of albuminuria. In type 2 diabetic subjects with albuminuria, urine clusterin remained associated with the annual decline rate in eGFR and the progression of CKD stage. Conclusions Urine clusterin reflects tubular damage in the early stage of DKD. The increase in urine clusterin along with albuminuria could be an independent predictive marker for the progression of DKD in type 2 diabetes.
ISSN:0300-0664
1365-2265
DOI:10.1111/cen.13360