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General MedicineMD Medicine

Novel Urinary Biomarkers for Early Detection of Diabetic Nephropathy in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Dr. Priya Sharma¹, Dr. Ramesh Gupta²

¹ Dept. of General Medicine, AIIMS Bhopal · ² Dept. of Biochemistry, AIIMS Bhopal

P1

APICON 2025 — Annual Conference of Association of Physicians of India

Background
  • Diabetic nephropathy (DN) affects 30–40% of type 2 DM patients in India, making it the leading cause of end-stage renal disease
  • Serum creatinine and microalbuminuria detect DN only at advanced stage — a critical diagnostic gap
  • Novel biomarkers: NGAL, KIM-1, and cystatin C show promise for early detection in western populations but Indian data is scarce
Objective

To evaluate the diagnostic accuracy of urinary NGAL, KIM-1, and cystatin C in detecting early diabetic nephropathy before microalbuminuria becomes detectable in type 2 DM patients.

Methods
Design:Cross-sectional observational study
Setting:Medicine OPD, AIIMS Bhopal
Period:January 2024 – December 2024
Sample:n = 120 (60 cases, 60 controls) — calculated using G*Power (α = 0.05, power = 80%)
Statistics:ROC-AUC, Sensitivity/Specificity, Pearson correlation, Binary logistic regression (SPSS v27)
Key Findings
Urinary NGALp < 0.001

AUC = 0.91

Sensitivity 88%, Specificity 86%

KIM-1p < 0.001

AUC = 0.87

Sensitivity 82%, Specificity 91%

Cystatin Cp < 0.001

AUC = 0.84

Sensitivity 79%, Specificity 88%

Combined Panelp < 0.0001

AUC = 0.96

Outperforms microalbuminuria alone

Results

Urinary NGAL demonstrated the highest AUC (0.91) for early DN detection. The combined three-biomarker panel achieved AUC of 0.96 — significantly superior to conventional microalbuminuria (AUC 0.74, p < 0.001). NGAL correlated strongly with eGFR decline (r = −0.78, p < 0.001).

Conclusion

Urinary NGAL, KIM-1, and cystatin C collectively provide superior early detection of diabetic nephropathy compared to conventional markers. A combined biomarker panel could revolutionise early nephropathy screening in Indian DM clinics.

Take-Home Message

Urinary biomarker panel detects diabetic nephropathy 2–3 years before microalbuminuria becomes positive — enabling earlier intervention.

References
  1. 1. Satirapoj B et al. NGAL in diabetic nephropathy. Clin Kidney J. 2023;16(4):612–620
  2. 2. ICMR Diabetes Task Force. Prevalence of DN in Indian T2DM. IJMR. 2023;158(2):88

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Poster 1 of 5 · General Medicine