Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Abstract Background: Defining new predictive biomarkers in diabetic kidney disease (DKD) would provide a window of opportunity for preventive and/or therapeutic interventions to prevent or delay the onset of irreversible long-term micro and or macro vascular complications. Adiponectin (ADPN) has been variously associated with diabetic microvascular complications; however, no comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Aim of study: we aimed to measure the plasma levels of adiponectin in patients with type 2 diabetes mellitus, to assess whether these levels vary with the different stages of DKD according to their e GFR and to evaluate its relation to their microvascular complications and glycemic control. Methods: This is a prospective observational study including 100 T2DM classified into two groups according to their albuminuria levels and estimated GFR. Participants subjected to thorough history taking and clinical examination. Serum level of ADPN was assessed in all patients. Results: Serum ADPN levels were significantly lower in T2DM patients with nephropathy (P = 0.001), while their levels were nonsignificantly higher in patients with non-proliferative retinopathy or neuropathy. Their levels were lowered with more advanced stages of DKD with nephropathy and the decrement was dependent on their severity (P0.001). Levels of ADPN with cutoff value of 22600 (μg/mL) had ability to diagnose microvascular complications in our diabetic patients with sensitivity (81%) and specificity (27%). Multivariate logistic regression analysis showed that the odds ratio for the presence of nephropathy in the lowest tertile of ADPN was 1.09 (95% CI; 11.45- 13.08, P= 0.06), therefore, ADPN was not an independent risk factor for diabetic nephropathy. However, its higher level was independently associated with increased odds for the presence of neuropathy in particular. Conclusions: ADPN plays a role in the pathogenesis of microvasculopathy in diabetic patients and help to identify high-risk patients and modulate the therapeutic potential in the revention of DKD.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.

Introduction: Acute kidney injury is associated with increased mortality in hospitalized cirrhotic patients; therefore early and accurate diagnosis is crucial. The prognosis of AKI in cirrhosis depends on its specific aetiology which remains a challenge. Aim: We aimed to determine the accuracy of urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) for diagnosis, differentiation of the various aetiologies of AKI in cirrhotics and to evaluate its value in short term prognosis. Methods: Eighty-two cirrhotic patients were investigated for uNGAL during hospital admission and AKI types were determined blinded to uNGAL measurements. Patients were followed up till discharge. Results: Patients with liver cirrhosis and renal impairment (n= 62) had significantly higher levels of uNGAL (102.4 ±100 ng/ml) when compared with patients with cirrhotics with normal kidney function (n= 20) (102.4 ±100 vs 17.4±14.71 ng/ml). Patients with acute tubular necrosis (ATN) had significantly higher uNGAL (189.2±124 ng/ml) compared to other aetiologies, while prerenal azotemia had the lowest value (46.1±39.9 ng/ml). UNGAL levels were significantly higher in the mortality group of patients (p=0.006) and in patients admitted to ICU (p0.001) than the survivors and patient without ICU admission respectively. The AUC of uNGAL for diagnosis of AKI was 0.892 with a cutoff > 33 ng/ml providing specificity 90% and sensitivity 79%. In multivariate regression analysis, uNGAL was highly significant independent predictor of inpatient cirrhosis relayed mortality. Conclusion: UNGAL is a promising biomarker for diagnosis of AKI and differentiation between its different aetiologies in cirrhosis including ATN, HRS and pre renal azotemia. UNGAL can independently predict poor short term prognosis.