Plausible diagnostic value of urinary isomeric dimethylarginine ratio for diabetic nephropathy

• Published in: Scientific reports 2020-02, Vol.10 (1), p.2970-2970, Article 2970
• Main Authors: Parmar, Dharmeshkumar, Bhattacharya, Nivedita, Kannan, Shanthini, Vadivel, Sangeetha, Pandey, Gautam Kumar, Ghanate, Avinash, Ragi, Nagarjuna Chary, Prabu, Paramasivam, Pramodkumar, Thyparambil Aravindakshan, Manickam, Nagaraj, Mohan, Viswanathan, Sripadi, Prabhakar, Kuppan, Gokulakrishnan, Panchagnula, Venkateswarlu
• Format: Article
• Language: English
• Subjects: 692/53/2423; 692/699/2743/137/138; 82/58; Adult; Aged; Albuminuria - diagnosis; Albuminuria - etiology; Albuminuria - urine; Arginine - analogs & derivatives; Arginine - urine; Biomarkers; Chromatography, High Pressure Liquid; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - urine; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - etiology; Diabetic Nephropathies - urine; Diabetic nephropathy; End-stage renal disease; Feasibility Studies; Female; Glucose; Glucose tolerance; Humanities and Social Sciences; Humans; Kidney diseases; Male; Middle Aged; multidisciplinary; Nephropathy; Predictive Value of Tests; Regression analysis; Renal failure; ROC Curve; Science; Science (multidisciplinary); Tandem Mass Spectrometry
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-59897-1

Altered circulatory asymmetric and symmetric dimethylarginines have been independently reported in patients with end-stage renal failure suggesting their potential role as mediators and early biomarkers of nephropathy. These alterations can also be reflected in urine. Herein, we aimed to evaluate urinary asymmetric to symmetric dimethylarginine ratio (ASR) for early prediction of diabetic nephropathy (DN). In this cross-sectional study, individuals with impaired glucose tolerance (IGT), newly diagnosed diabetes (NDD), diabetic microalbuminuria (MIC), macroalbuminuria (MAC), and normal glucose tolerance (NGT) were recruited from Dr. Mohans’ Diabetes Specialties centre, India. Urinary ASR was measured using a validated high-throughput MALDI-MS/MS method. Significantly lower ASR was observed in MIC (0.909) and MAC (0.741) in comparison to the NGT and NDD groups. On regression models, ASR was associated with MIC [OR: 0.256; 95% CI: 0.158–0.491] and MAC [OR 0.146; 95% CI: 0.071–0.292] controlled for all the available confounding factors. ROC analysis revealed ASR cut-point of 0.95 had C-statistic of 0.691 (95% CI: 0.627-0.755) to discriminate MIC from NDD with 72% sensitivity. Whereas, an ASR cut-point of 0.82 had C-statistic of 0.846 (95% CI: 0.800 - 0.893) had 91% sensitivity for identifying MAC. Our results suggest ASR as a potential early diagnostic biomarker for DN among the Asian Indians.