PloS one · 2026
Urinary podocalyxin as an early biomarker for diabetic nephropathy.
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Hossain Md Sabbir, Dwipi Shamsia Tasnim, Ahmed Nazma, Murshed Khaled Mahbub, Aftab Kazi Ali, Al Mahdi Abdullah, Hoque Md Mojibul, Taraq Md Jobayer Hossain, Hussain Md Zakir, Azad Md Abul Kalam
Аннотация
BACKGROUND: Conventional biomarkers, such as the urinary albumin-to-creatinine ratio (uACR), detect diabetic nephropathy (DN) late in its course and may miss early podocyte injury. Urinary podocalyxin (u-PDX), a sialylated glycoprotein shed from podocytes, may offer an earlier means of detection.
METHODS: We conducted a cross-sectional analytical study at Bangabandhu Sheikh Mujib Medical University between March 2023 and August 2024. Eighty-eight adults were enrolled: 59 participants with type 2 diabetes mellitus (T2DM) and 29 healthy controls. Participants with diabetes were stratified into normoalbuminuric (n = 29), microalbuminuric (n = 15), and macroalbuminuric (n = 15) subgroups based on uACR. Clinical variables and biochemical indices were recorded. u-PDX concentrations were measured using ELISA, and associations with uACR and eGFR were analyzed using Kendall's tau-b and Pearson's correlation coefficients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves with bootstrap internal validation.
RESULTS: Among participants with diabetes, u-PDX levels increased progressively across normo-, micro-, and macroalbuminuric groups (p < 0.001). u-PDX correlated positively with fasting blood glucose, post-glucose plasma glucose, HbA1c, serum creatinine, serum urea, and uACR, with the strongest correlation for uACR (r = 0.79, p < 0.001), and inversely with serum albumin (r = -0.62, p < 0.001) and eGFR (r = -0.51, p < 0.001). In pairwise ROC analysis, a u-PDX cutoff of 0.80 ng/mL discriminated healthy controls from diabetic patients without albuminuria (sensitivity 100.0%, specificity 96.4%); 1.60 ng/mL discriminated diabetic patients without albuminuria from those with microalbuminuria (86.7%, 93.1%); and 5.51 ng/mL discriminated microalbuminuric from macroalbuminuric patients (86.7%, 93.3%). For overall discrimination of albuminuria-defined DN among diabetic patients, the optimal u-PDX cutoff was 2.92 ng/mL (AUC 0.96, 95% CI 0.90-1.00).
CONCLUSIONS: Urinary podocalyxin is a sensitive early biomarker of diabetic nephropathy, rising before overt albuminuria and correlating with albuminuria severity and declining eGFR. However, longitudinal validation is required before u-PDX can be recommended for routine screening in adults with T2DM.
METHODS: We conducted a cross-sectional analytical study at Bangabandhu Sheikh Mujib Medical University between March 2023 and August 2024. Eighty-eight adults were enrolled: 59 participants with type 2 diabetes mellitus (T2DM) and 29 healthy controls. Participants with diabetes were stratified into normoalbuminuric (n = 29), microalbuminuric (n = 15), and macroalbuminuric (n = 15) subgroups based on uACR. Clinical variables and biochemical indices were recorded. u-PDX concentrations were measured using ELISA, and associations with uACR and eGFR were analyzed using Kendall's tau-b and Pearson's correlation coefficients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves with bootstrap internal validation.
RESULTS: Among participants with diabetes, u-PDX levels increased progressively across normo-, micro-, and macroalbuminuric groups (p < 0.001). u-PDX correlated positively with fasting blood glucose, post-glucose plasma glucose, HbA1c, serum creatinine, serum urea, and uACR, with the strongest correlation for uACR (r = 0.79, p < 0.001), and inversely with serum albumin (r = -0.62, p < 0.001) and eGFR (r = -0.51, p < 0.001). In pairwise ROC analysis, a u-PDX cutoff of 0.80 ng/mL discriminated healthy controls from diabetic patients without albuminuria (sensitivity 100.0%, specificity 96.4%); 1.60 ng/mL discriminated diabetic patients without albuminuria from those with microalbuminuria (86.7%, 93.1%); and 5.51 ng/mL discriminated microalbuminuric from macroalbuminuric patients (86.7%, 93.3%). For overall discrimination of albuminuria-defined DN among diabetic patients, the optimal u-PDX cutoff was 2.92 ng/mL (AUC 0.96, 95% CI 0.90-1.00).
CONCLUSIONS: Urinary podocalyxin is a sensitive early biomarker of diabetic nephropathy, rising before overt albuminuria and correlating with albuminuria severity and declining eGFR. However, longitudinal validation is required before u-PDX can be recommended for routine screening in adults with T2DM.