Archive

Volume 8, Number 2 / August issue 2022
Mohamed R. Bahi Elgmmal, Mohamed Abdelhady Mashahet, Hoda Abdel-badie Hussein, Shereen R.M. Kaddafy, Amal M. Maher
Urinary immunoglobulin G as A parameter for early detection of chronic kidney disease in patients with metabolic syndrome
Abstract

Background and aim: Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are silent major global health issues and are major risk factors of cardiovascular and all cause death. Patients with MetS are at a significantly higher risk for CKD. Urinary IgG is an important marker protein for early glomerular damage and increased urinary IgG levels was found to be useful predictor of diabetic kidney disease in normoalbuminuric patients. We aimed to assess urinary immunoglobulin G (IgG) levels as a predictor of early CKD in subjects with MetS.
Methods: A cross-sectional study with 81 adult individuals were enrolled. All participants were divided into 2 groups: with MetS (56 in MetS group) and without MetS (25 in non-MetS group), with MetS being identified using the NCEP-ATPIII criteria. Patients with known CKD, DM, neoplasm, infection or autoimmune diseases and pregnant women were excluded. Anthropometric, clinical and biochemical measures including urinary albumin/creatinine ratio (ACR), serum fasting plasma glucose, creatinine, lipid profiles, Haemoglobin A1c and fasting plasma Insulin were performed for all participants. IgG concentrations were measured by using human enzyme-linked immunosorbent assay (ELISA) and correlated these levels with urinary ACR and estimated glomerular filtration rate (GFR). CKD was identified by albuminuria and estimating GFR using the CKD-EPI equation. Logistic regression models were used to estimate the chances of elevated urinary IgG levels associated with MetS and its components.
Results: Showed that as compared with the non-MetS group, the adjusted odds ratios (ORs) of elevated urinary IgG levels were 7.7 in MetS group. Unadjusted analysis showed that the ORs of elevated urinary IgG levels were associated with elevated waist circumference, hypertension, elevated FBG and reduced HDL-c but not with elevated TG. In the adjusted model, ORs of elevated urinary IgG levels were 19.16 (OR: 19.16; 95% CI: 4.40-83.5, P<0.001) for elevated waist circumference, 3.53 (OR: 3.53; 95% CI: 1.03-12.2, P<0.05) for low HDL-c. TG/ HDL-c ratio, urinary ACR and HOMA-IR were significantly higher in the MetS group than in the non-MetS group (all P<0.05). Elevated urinary IgG levels was significantly correlating with urinary ACR (P<0.019) and showed statistically high significant negative correlation with absolute values eGFR.
Conclusion: It is suggested that elevated urinary IgG levels could be a predicting biomarker for CKD in MetS normoalbuminuric subjects. From MetS components, mainly abdominal obesity accounted for the greatest strength of association with elevated urinary IgG levels. More attention should be focused on visceral obesity during risk management in order to prevent CKD and further research into the mechanism behind is needed.
Keywords: metabolic syndrome, chronic kidney disease, urinary immunoglobulin

Cite this article:
Mohamed R. Bahi Elgmmal, Mohamed Abdelhady Mashahet, Hoda Abdel-badie Hussein, Shereen R.M. Kaddafy, Amal M. Maher. Urinary immunoglobulin G as A parameter for early detection of chronic kidney disease in patients with metabolic syndrome. Acta Scientiae et Intellectus, 8(2); 2022, 60-77.


REFERENCES

  1. Gurka M.J., Guo Y., Filipp S.L., et al. Metabolic syndrome severity is significantly associated with future coronary heart disease in type 2 diabetes. Cardiovasc. Diabetes. 2018,17(1):17-7.
  2. WHO Global Health Estimates. 2020. The Top 10 Causes of Death.
  3. Zulhendri, F.; Ravalia, M.; Kripal, K.; Chandrasekaran, K.; Fearnley, J.; Perera, C.O. Propolis in Metabolic Syndrome and Its Associated Chronic Diseases: A Narrative Review. Antioxidants 2021, 10, 348. https://doi.org/10.3390/antiox10030348
  4. Van der Pal K.C., Koopman A.D.M., Lakerveld J., van der Heijden A.A., Elders P.J., et al. The association between multiple sleep-related characteristics and the metabolic syndrome in the general population: the New Hoorn study. Sleep Med. 2018 Dec; 52:51-57.
  5. Kolaitis A., A. Ceasovschih, V. Sorodoc, A. Stoica, O. Sirbu, L. Sorodoc. Particularities of chronic kidney disease in patients with metabolic syndrome. Atherosclerosis. 2020 Dec 31;10(315) e185.
  6. Philip D. Evans, Maarten W. Taal. Epidemiology and causes of chronic kidney disease. Medicine 2015; Volume 43, Issue 8, Pages 450-453
  7. Klein S.J., Brandtner A.K., Lehner G.F., et al. Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Intensive Care Medicine 2018; 44:323-36.
  8. Lousa, I.; Reis, F.; Beirão, I.; Alves, R.; Belo, L.; Santos-Silva, A. New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature. Int. J. Mol. Sci. 2021, 22, 43. https://dx.doi.org/10.3390/ijms22010043
  9. Qin Yongzhang, Shuang Zhang, Xiaofang Shen, Shunming Zhang, Jingyu Wang, et al. Evaluation of urinary biomarkers for prediction of diabetic kidney disease: a propensity score matching analysis. Ther Adv Endocrinol Metab 2019, Vol. 10: 1-11.
  10. Gao J., Wang F., Kuang X., et al. Assessment of chronic renal injury from melamine‐associated pediatric urolithiasis: an eighteen‐month prospective cohort study. Ann Saudi Med. 2016; 36(4): 252‐257.
  11. NCEP-ATP III, Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-3421 [PMID: 12485966]
  12. Ford E.S., Giles W.H., Dietz W.H. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002; 287: 356-9.
  13. KDIGO. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3:1-150.
  14. Chen, H.; Zheng, X.; Zong, X.; Li, Z.; Li, N.; Hur, J.; Fritz, C.D.L.; Chapman, W., et al. Metabolic syndrome, metabolic comorbid conditions and risk of early-onset colorectal cancer. Gut 2020. [CrossRef]
  15. Joshi, P.; Ghosh, K.; Natarajan, V.S.; Mandal, P. Impact of healthcare access and socio-economic conditions on prevalence of metabolic syndrome: Evidence from 2015 brfss. Int. J. Bus. Excell. 2020, 21, 429-443. [CrossRef]
  16. Mohammad Zulkarnain Bidin, Anim Md Shah, Stanslas, Christopher Lim Thiam Seong. Blood and urine biomarkers in chronic kidney disease: An update. Clin Chim Acta. 2019 Aug; 495: 239-250. doi: 10.1016/j.cca. 2019. 04.069
  17. Mota, E.; Popa, S.G.; Mo¸ta, M.; Mitrea, A.; Penescu, M.; Tu¸tă, L.; et al. Prevalence of chronic kidney disease and its association with cardio-metabolic risk factors in the adult Romanian population: The PREDATORR study. Int. Urol. Nephrol. 2015, 47, 1831-1838.
  18. Comini L.O., de Oliveira L.C., Borges L.D., Dias H.H., Batistelli C.R.S., da Silva L.S., et al. Individual and Combined Components of Metabolic Syndrome with Chronic Kidney Disease in Individuals with Hypertension and/or Diabetes Mellitus Accompanied by Primary Health Care. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2020:13: 71-80.
  19. Alswat, K.A.; Althobaiti, A.; Alsaadi, K.; Alkhaldi, A.S.; Alharthi, M.M.; et al. Prevalence of Metabolic Syndrome Among the End-Stage Renal Disease Patients on Hemodialysis. J. Clin. Med. Res. 2017, 9, 687-694.
  20. Hu Ying, Shi L.X., Zhang Q., Peng N.C. Increased risk of chronic kidney diseases in patients with metabolic syndrome: a 3-year prospective cohort study. Curr Med Sci. 2019; 39: 204-210. doi: 10.1007/s11596-019-2020-8. [PubMed] [CrossRef] [Google Scholar]
  21. Chen J., Kong X., Jia X., et al. Association between metabolic syndrome and chronic kidney disease in a Chinese urban population. Clin Chim Acta. 2017;470:103-108. doi:10.1016/j.cca.2017.05.012
  22. Huh J.H., Yadav D., Kim J.S., et al. An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study. Metabolism. 2017, 67(2):54-61.
  23. Zammit, R.A.; Katz, J.M.; Derby, C.; Bitzer, M.; Lipton, B.R. Chronic Kidney Disease in Non-Diabetic Older Adults: Associated Roles of the Metabolic Syndrome, Inflammation, and Insulin Resistance. PLoS ONE 2015, 10, e0139369.
  24. Raikou, Vaia D. and Gavriil, Sotiris. Metabolic Syndrome and Chronic Renal Disease. Diseases 2018, 6, 12; doi:10.3390/diseases6010012
  25. Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD. Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2011;6: 2364-2373. doi:10.2215/CJN. 02180311.
  26. Whaley-Connell A, Sowers JR. Insulin Resistance in Kidney Disease: Is There a Distinct Role Separate from That of Diabetes or Obesity? Cardiorenal Med. 2017,8(1):41-49
  27. Garofalo C., Borrelli S., Minutolo R., Chiodini P., De Nicola L., Conte G. A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int. 2017 May; 91(5):1224-1235.
  28. Nehus Edward. Obesity and chronic kidney disease. Curr Opin Pediatr. 2018 Apr;30(2):241-246.
  29. Xie Kun, Liwen Bao, Xiaofei Jiang, Zi Ye, Jianping Bing, Yugang Dong, et al. The association of metabolic syndrome components and chronic kidney disease in patients with hypertension. Lipids in Health and Disease. 2019 Dec; 18:229.
  30. Narita T., H. Sasaki, M. Hosoba et al., “Parallel increase in urinary excretion rates of immunoglobulin G, ceruloplasmin, transferrin, and orosomucoid in normoalbuminuric type 2 diabetic patients”, Diabetes Care 2004; 27 (5): 1176-1181.
  31. Kamal, Nafesa M., Ahmed M. Elsayed, Essam Amin, Amal Zedan. Urinary immunoglobulin G versus microalbuminuria as an indicator of diabetic nephropathy in type 2 diabetic patients. Egypt J Intern Med. 2018 July 25;30:58-62.
  32. Ho Chih-I, Jau-Yuan Chen, Shou-Yen Chen, Yi-Ming Weng, Yu-Chung Tsao, Wen-Cheng Li. Relationship between TG/HDL-C ratio and metabolic syndrome risk factors with chronic kidney disease in healthy adult population. Clinical Nutrition. 2015; 34(5): 874-880.
  33. Grundy S.M., Brewer H.B., Cleeman J.I., Smith S.C., Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433-438 [PMID: 14744958 DOI: 10.1161/01.CIR.0000111245.75752.C6]
  34. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am. J. Kidney Dis. 2002, 39, S1-S266.