تقييم مستويات البروكالسيتونين ,سستاتين سي ,جزيئي اصابة الكلى والنفرين في مرضى القدم السكري وعلاقتها ب اعتلال الكلى المزمن

Evaluation of Procalcitonin, Cystatin C, Nephrin and Kidney Injury Molecule-1 in Patients with Diabetic Foot and Relation with chronic Kidney Disease

Abstract

Diabetes mellitus is a metabolic disorders characterized by high blood suger levels due to insulin deficiency or resistance ,one of the most important complication of it diabetic foot , that may be lead to foot amputation if not treated. Chronic hyperglycemia, peripheral arteries disease, ischemia and neuropathy are the main risk factor for diabetic foot. When the skin damage or break in foot , the infection complicates to ulcer. In their lifetime, about 34% of diabetics patients (Type 1 or Type 2) get a foot ulcer .It may lead to serious complications as gangrene and limb amputation if not recognized in the early stage.
This study aimed to investigated the serum level of Procalcitonin (PCT), Cystatin C, Nephrin and Kidney injury molecule -1(KIM-1) in patients with Diabetic foot and kidney disease , also determine the specificity and sensitivity, cut off value of this factors and there correlation with various clinical parameters.
This is a case-control study, including 120 individuals who were divided into four groups: control group, diabetes mellitus without complication group, diabetic foot ulcer group and (diabetic foot with chronic kidney disease) group .
All the diabetic patients were diagnosed by an endocrinologist conducted in the diabetic center at Marjan Teaching Hospital and ALHilla Teaching Hospital in AL Hilla City from October 2023 to March 2024.
Procalcitonin, Cystatin C, Nephrin ,and Kidney injury molecule-1 were determined by using the Enzyme-linked immunosorbent assay (ELISA) technique while C-reactive protein(CRP) and HbA1C were determined by using immune detection Method, Blood glucose, blood urea and serum creatinine were measured using a colorimetric method.
The results of the current study revealed increased a significantly in mean of serum Procalcitonin, Cystatin C, CRP, Nephrin, KIM-1 ,HbA1C ,fasting blood

sugar, blood urea and serum creatinine among diabetic foot patients when compared with control and a significant decrease in body mass index (BMI) and estimated glomerular filtration rate in diabetic foot patients compared with control. This study showed that PCT may be diagnostic performance for Diabetic foot , current results showed area under the curve(AUC) (0.96), sensitivity(91.1%) , specificity(99%), cut‐off points were(0.231) at (p < 0.001) ,also the study showed that KIM-1 prognostic diabetic kidney disease current results showed area under the curve(AUC) (0.939), sensitivity(93.3%) ,specificity(99.3%), cut‐off points were(0.66) at (p < 0.001).The correlation of PCT with Cystatin C, CRP, and WBC were positive correlation,
In conclusion the PCT, Cystatin c, increase in diabetic foot and may be used as parameters for early detection of infection in these disease. KIM-1 and Nephrin levels were significantly increased in Diabetic foot with kidney disease patients and can be used as prognostic parameters .