New-onset diabetes after kidney transplantation: Assessing urinary Wilm's tumor-1 protein to predict renal allograft dysfunction

• Published in: Advances in medical sciences 2024-03, Vol.69 (1), p.153-159
• Main Authors: de Andrade, César Endrigo Silva, Souza, Karla Simone Costa de, Galdino, Ony Araújo, de Lima, Mabelle Alves Ferreira, de Medeiros, Paulo José, Abbott Galvão Ururahy, Marcela, Pereira, Maurício Galvão, de Almeida, José Bruno, de Rezende, Adriana Augusto
• Format: Article
• Language: English
• Subjects: Adult; Allografts; Biomarkers - blood; Biomarkers - urine; Diabetes Mellitus - urine; Female; Follow-Up Studies; Glomerular Filtration Rate; Glycated Hemoglobin - metabolism; Humans; Kidney transplantation; Kidney Transplantation - adverse effects; Male; Middle Aged; New-onset diabetes after transplantation; Prognosis; Renal allograft dysfunction; Urine; Wilm's tumor-1; WT1 Proteins - urine
• ISSN: 1896-1126; 1898-4002
• DOI: 10.1016/j.advms.2024.03.002

New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication associated with podocyte damage and renal allograft dysfunction. Thus, Wilm's tumor-1 (WT-1) protein, as a podocyte marker, holds promise as an option to evaluate renal allograft dysfunction in NODAT. Therefore, the study aimed to investigate urinary WT-1 levels in NODAT patients during the first year after kidney transplantation (KTx). KTx patients were categorized into non-NODAT and NODAT groups. Fasting blood glucose, glycated hemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), serum creatinine, estimated glomerular filtration rate (eGFR), and urinary WT-1 were measured at 3, 6, 9, and 12-months post-KTx. The NODAT group manifested elevated levels of blood glucose and HbA1c during the first year post-KTx. Also, exhibited elevations in ACR and serum creatinine levels at 6, 9, and 12-months post-KTx when compared to non-NODAT group. Conversely, eGFR values in the NODAT group demonstrated significant declines at 3, 6, and 9-months post-KTx relative to non-NODAT. Furthermore, NODAT group exhibited a median annual eGFR of 47 ​mL/min/1.73 ​m2. Urinary WT-1 levels at 3, 6, 9, and 12-months post-KTx were significantly higher in the NODAT group compared to non-NODAT. Additionally, noteworthy positive correlations were identified between urinary WT-1 and HbA1c levels, along with significant negative correlations between urinary WT-1 and eGFR at the 3, 6, 9, and 12-months post-KTx. The increased urinary WT-1 levels from 3-months post-KTx in NODAT patients may indicate the first sign of podocyte injury, predicting a renal allograft dysfunction in these patients.