USA: In diabetic kidney disease (DKD), circulating monocytes and serum albumin are associated significantly with albuminuria, reveals a recent study. The results, published in the Canadian Journal of Diabetes, support the potential role of the innate immune system in diabetic microvascular end-organ damage and urinary protein loss.
Cagney Cristancho and Christopher C. Hemond conducted the study with the objective to characterize clinical associations between peripheral blood immune populations and DKD in type 2 diabetes (T2D) patients.

For this purpose, the researchers queried hospital records from an outpatient diabetes primary care clinic for clinical and laboratory data, including complete blood counts with differentials, glycated hemoglobin (A1C), serum albumin and globulin, and urine albumin-to-creatinine ratio. 198 patients had complete cross-sectional data with temporally proximate complete blood counts and urine albumin-to-creatinine ratios.
The hypothesis that higher numbers of circulating innate immune populations would be associated with DKD was tested while accounting for known demographic, clinical, and laboratory risk factors. DKD was defined as an albumin-to-creatinine ratio of >3 mg/mmol or an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 from the Chronic Kidney Disease Epidemiology Collaboration.
Following were the study's key findings:
· Adjusted analyses demonstrated significant associations between higher urine albumin-to-creatinine ratio and peripheral circulating monocytes, independent of other established significant risk factors, including blood pressure, A1C, age, and sex.
· Serum albumin was identified as a potentially important modifying factor of albuminuric kidney disease, which interacts with monocytes in more advanced diseases. In contrast, age was the variable most strongly predictive of eGFR.
"These results back the potential role of the innate immune system in diabetic microvascular end-organ damage and urinary protein loss, and maybe readily translatable clinical markers to be incorporated into risk-assessment models for diabetes prognostication," the authors concluded.
Reference:
The study titled, "Serum Albumin Modifies the Effect of Peripheral Blood Monocytes on Severity of Diabetic Nephropathy in an Adult Population," was published in the Canadian Journal of Diabetes.
DOI: https://doi.org/10.1016/j.jcjd.2021.06.001