الفهرس 
Introduction & Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
This study was designed to evaluate the changes in urinary uromodulin level and corresponding urinary exosomal UMOD mRNA expression, as potential biomarkers of diabetic nephropathy in type 2 diabetic patients. Also correlate urinary uromodulin and its urinary exosomal gene expression with other renal and glycemic biomarkers.
The subjects of this study were divided into the following groups:
group Ⅰ: consisted of 25 healthy subjects as a control group, (15 females, 10 males) ranged from 40 – 61 years with a mean age of 50 ± 5.31 years.
group Ⅱ: consisted of 25 type-2 diabetic patients with normoalbuminuria (ACR<30 mg/g Cr), (16 females, 9 males) ranged from 40 – 65 years with a mean age of 52.64 ± 6.25 years.
group Ⅲ: consisted of 25 type-2 diabetic patients with microalbuminuria (ACR between 30-300 mg/g Cr), (14 females, 11 males) ranged from 40 – 65 years with a mean age of 52.76 ± 7.64 years.
group Ⅳ: consisted of 25 type-2 diabetic patients with macroalbuminuria (ACR >300 mg/g Cr), (12 females, 13 males) ranged from 45 – 65 years with a mean age of 55.24 ± 6.25 years.
All studied groups were subjected to the following:
• Full history taking
• Complete clinical examination
• Abdominal ultrasonography
• Routine laboratory investigations
j) Complete urine analysis
k) Fasting and postprandial blood glucose levels
l) Glycosylated hemoglobin (HbA1C)
m) Urinary albumin to creatinine ratio
n) Serum creatinine level
o) Blood urea nitrogen level
p) Estimated glomerular filtration rate (eGFR)
q) Serum Na+ and K+ levels
r) Lipid profile
• Specific laboratory investigations
d) Serum cystatin-C
e) Urinary level of uromodulin using ELISA
f) Gene expression of exosomal uromodulin mRNA using real-time PCR
The results of this study showed that:
• Total urinary uromodulin level showed a significant increase in all diabetic groups with and without nephropathy compared to the control group, while there was a significant decrease in the macroalbuminuria group compared to normoalbuminuria and microalbuminuria.
• The expression level of urinary exosomal UMOD mRNA showed a significant upregulation in gene expression in all diabetic groups compared to the control group.
• The urinary level of uromodulin showed a significant positive correlation with ACR, s.creatinine, BUN, cystatin-C, serum Na+, and a significant negative correlation with e-GFR and serum K+ in normo and microalbuminuria groups, while in macroalbuminuria group it showed a significant negative correlation with ACR, s.creatinine, BUN, cystatin-C serum K+ and a significant positive correlation with eGFR, and serum Na+.
• The exosomal UMOD mRNA showed a significant positive correlation with uUromodulin, ACR, s.creatinine, cystatin-C, and a significant negative correlation with eGFR in normo and microalbuminuria groups, while in macroalbuminuria group it showed a significant positive correlation with uUromodulin, eGFR, and a significant negative correlation with ACR, s.creatinine, BUN, and cystatin-C.
• Multivariant logistic regression showed that there was an association between urinary uromodulin and DN and it is an independent predictor of DN.
• ROC curve showed high diagnostic ability for exosomal UMOD gene expression and urinary uromodulin excretion as it showed AUC 0.95 (sensitivity 92%, specificity 84%), and 0.81 (sensitivity 80%, specificity 60%) respectively.