DIAGNOSTIC SIGNIFICANCE OF NEPHRIN IN EARLY DETECTION OF CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES MELLITUS

Abstract

Diabetic kidney disease is a major complication of type 2 diabetes mellitus and a leading cause of chronic kidney disease (CKD) and end-stage renal failure. Early detection of renal damage remains a clinical challenge, as traditional biomarkers such as serum creatinine and microalbuminuria have limited sensitivity in the initial stages of the disease. The aim of this study was to investigate the role of nephrin as an early marker of structural damage to the glomerular apparatus in patients with CKD stages 1–2 associated with type 2 diabetes mellitus. A total of 88 patients were included and divided into two groups: CKD stage 1 (n = 53) and CKD stage 2 (n = 35). All patients underwent comprehensive clinical and laboratory evaluation, including biochemical parameters, metabolic indicators, and hemostatic system assessment. Nephrin levels were determined using a sandwich enzyme-linked immunosorbent assay (ELISA). Patients with CKD stage 2 were significantly older and had a longer disease duration. While creatinine levels showed only moderate increases, nephrin concentrations were more than twofold higher in CKD stage 2 compared to stage 1 (p < 0.001) and significantly exceeded control values. ROC analysis demonstrated excellent diagnostic performance of nephrin (AUC = 0.91; 95% CI: 0.84–0.97; p < 0.001), with an optimal cut-off value of ≥8.5 ng/mL providing 86% sensitivity and 83% specificity. These findings indicate that nephrin is a highly sensitive and specific biomarker capable of detecting early podocyte injury and structural renal changes prior to significant decline in renal function. Its incorporation into clinical practice may improve early diagnosis and enable timely nephroprotective interventions in patients with type 2 diabetes mellitus