Evaluation of ischemia-modified albumin, malondialdehyde, and advanced oxidative protein products as markers of vascular injury in diabetic nephropathy

This study aimed at evaluation of ischemia-modified albumin (IMA), malondialdehyde (MDA), and advanced oxidative protein products (AOPP) as markers of vascular injury in diabetic nephropathy (DN) with derivation of cutoff values for the same.Materials and methods: Study population comprised 60 diabetes patients and ˂30 controls, with diabetes patients further categorized into three groups based on urine albumin/creatinine ratio (UACR) of,30 mg/g (diabetes without microalbuminuria), 30-300 mg/g (early DN), and ˃300 mg/g of creatinine (overt DN). Serum IMA, MDA, and AOPP were estimated by enzyme-linked immunosorbent assay; HbA1c, serum creatinine, urine albumin, and urine creatinine were estimated using automated analyzers. Statistical analysis was done using analysis of variance, Pearson’s correlation coefficient, and receiver-operating characteristic curve.Results: A statistically significant difference was found in the levels of IMA among patients with early DN (154 ng/mL), diabetes without nephropathy (109.4 ng/mL), and healthy controls (45.7 ng/mL), with highest levels in early DN cases. Similar increase was seen in AOPP as well. A significant correla-tion was observed between IMA and UACR in diabetes without nephropathy (r = 0.448).Conclusion: The present study postulates serum IMA as a novel biomarker for the assessment of disease progression in diabetes even before microal-buminuria, and a cutoff point ≥99 ng/mL can be used for detection of early DN.