Urinary interleukin-6 and tumour necrosis factor-alpha as early markers for diabetic nephropathy in children and adolescents with type 1 diabetes

Background: Diabetic nephropathy (DN) is the main cause of morbidity and mortality in young adults with type 1 diabetes mellitus (T1DM). The accuracy of albuminuria has been frequently questioned as a predictor and prognosticator of renal injury. Therefore, new urinary markers were investigated for the early detection of DN.

Objectives: To assess the potential value of urinary interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) as early markers for detection of DN in children and adolescents with T1DM.

Method: This case-control study was conducted on 50 children and adolescents with T1DM, aged ≤ 18 years. Patients were classified according to their albumin/creatinine ratio (ACR) into two groups; normo-albuminuric and albuminuric group, together with 25 age and sex-matched healthy controls. ACR, urinary IL-6 and TNF-α levels were assayed for the patients and controls.

Results: Urinary interleukin-6/creatinine (IL-6/Cr) ratio of albuminuric patients was significantly higher compared to normo-albuminuric patients or controls. Urinary IL-6/Cr ratio ≥ 0.24 pg/mg showed a significant cutoff value to detect albuminuria with 72% sensitivity and 52% specificity (p= 0.04). While, we did not observe different urinary tumour necrosis factor-alpha/creatinine (TNF-α/Cr) ratio in the studied groups, or between albuminuric and normo-albuminuric patients or controls

Conclusions: Urinary IL-6/Cr ratio seems to be a promising new marker for early detection of DN in patients with T1DM, while urinary TNF-α /Cr ratio showed no significant difference between diabetic patients and controls.

Sri Lanka Journal of Child Health, 2020; 49(3): 269-275