Urinary N-acetyl-β-D-glucosaminidase, an early marker of diabetic kidney disease, might reflect glucose excursion in patients with type 2 diabetes

Recently, several renal tubular damage markers have gained considerable attention because of their clinical implications as sensitive and specific biomarkers for early stage diabetic kidney disease. However, little is known about the demographic and glucometabolic factors affecting levels of urinary N-acetyl-beta-D-glucosaminidase (NAG), a marker of proximal tubular damage, in type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the clinical relevance of urinary NAG with regard to demographic and glucometabolic parameters, as well as nephropathic parameters, by comparing the glomerulopathic marker of albuminuria. In this retrospective cross-sectional study, we enrolled a total of 592 patients with either prediabetes (N=29) or T2DM (N=563). Glucometabolic parameters (glucose, hemoglobin A1c, glycated albumin [GA], insulin, C-peptide, homeostasis model assessment [HOMA] of insulin resistance, HOMA-beta, postprandial C-peptide-to-glucose ratio [PCGR], and urinary glucose-to-creatinine ratio) and nephropathic parameters (urinary NAG, albumin-to-creatinine ratio [ACR], and estimated glomerular filtration rate) were measured. The levels of urinary NAG showed moderate positive correlation with the levels of urinary ACR in T2DM (r=0.46). In correlation analysis, urinary NAG was more strongly correlated with body mass index (BMI) (r=-0.22; P<0.001 vs. r=-0.02; P=0.74), plasma stimulated glucose (r=0.25; P<0.001 vs. r=0.08; P=0.10), GA (r=0.20; P<0.001 vs. r=0.13; P=0.01), PCGR (r=-0.17; P=0.001 vs. r=-0.09; P=0.11), and HOMA-beta (r=-0.10; P=0.05 vs. r=-0.02; P=0.79) than urinary ACR. In multiple regression analysis, age, lower BMI, stimulated glucose, GA, and urinary ACR predicted increased urinary NAG. In conclusion, increase in urinary NAG may be related to glycemic parameters reflecting glucose fluctuation and decreased insulin secretory capacity in patients with T2DM. Further longitudinal, prospective studies are needed to investigate a causal relationship between glucose fluctuations, renal tubular damage, and other vascular complications of diabetes.