Porman P Maduna
Over 415 million people have diabetes mellitus (DM) and among them, 40% develops diabetes nephropathy (DN). Because of DN, 5 to 15% end up developing end-stage renal failure (ESRF). Diagnosis of DN includes; urinary albumin excretion (UAE) persistently at 30 mg/day to 300 mg/day, and greater than 300 mg/day, in microalbuminuria and macroalbuminuria respectively. Another method is the glomerular filtration rate (GFR) or creatinine clearance rate < 60 ml/min, as calculated from a simplified MDRD formula.
DN follows a very complex pathogenic process. However, a large body of evidence demonstrates that, inflammation is key to events related to the development and progression of DN. Most epidemiologic reports based on observational studies investigating the hypotheses that inflammation is a risk factor in the development of DM and DN, have constantly agreed on a relationship found between CRP and nephropathy, by consistent findings that, the increasing CRP and pro-inflammatory markers independently correlates positively with DN. CRP’s release is mediated by the pro-inflammatory cytokines. The pro-inflammatory cytokines known to be involved in DN includes: interleukin- 6(IL6), interleukin-1 (IL1), and tumor necrosis factor alpha (TNF-α). A better understanding of a detailed mechanistic involvement of CRP-DM and CRP-DN related pathologic processes will be beneficial for future in both medical research and clinical settings, where CRP might serve to reveal new avenues for the prevention and or treatment of both DM and DN.
Conclusion: In DM, microalbuminuria is accompanied by elevated CRP levels, suggesting activation of inflammatory pathways in progression of renovasculopathies.