Study Of Neutrophil Lymphocyte Ratio As A Novel Marker Of Diabetic Nephropathy In Type 2 Diabetes Mellitus

Abstract

BACKGROUND AND OBJECTIVES: Diabetic nephropathy is the leading cause of chronic kidney disease and ESRD leading to renal replacement therapy. Neutrophil to Lymphocyte ratio (N:L ratio) was found to be a useful inflammatory marker which predicts the adverse outcomes in many conditions . Diabetic nephropathy has an inflammatory pathology but not much information regarding the relationship between diabetic nephropathy and N:L ratio is available. METHODS : 100 consecutive patients with diabetic nephropathy admitted in the wards of JN Medical College and Hospital between the time period of January 2018 – December 2018 were included in this cross sectional study according to the inclusion and exclusion criteria. Relevant history , clinical examination and investigations were recorded. All diabetic nephropathy patients were investigated for N:L ratio , proteinuria , creatinine , eGFR ,CKD stage and a correlation between N:L ratio and these variables were done. Statistical analysis was done using SPSS version 23. RESULT : The mean age of patients was 59.6±11.4 years ( mean±sd ).56% of patients were in 50 to 70 year age group. 68% of subjects in the study were male whereas the remaining 32% were females. The mean NLR in this study was 10.8 (SD - 9.05).The mean NLR in males was 9.53±8.42 (mean±sd) whereas 11.54±10.2 ( mean±sd ) in females which was statistically not significant (p>0.05) . The mean eGFR was 16.5 ml/min (SD - 16.9 ml/min). eGFR range was from 2 – 85 ml/min ..The mean serum creatinine was 5.93 mg/dl with standard deviation of 3.66 mg/dl. . There were 5 , 3, 8, 16, and 68 diabetic nephropathy patients in CKD stage 2, 3A,3B, 4 and 5 respectively. Patients with proteinuria grade 1+ was 31 %, 2+ was 31% , 3+ was 36% and 4+ was 2%. In our study 28 patients were on hemodialysis support while 72 patients were not dependant on HD .NLR had statistically significant co-relation with higher CKD stages, lower EGFR, and higher levels of serum creatinine levels in diabetic nephropathy patients. There was no co-relation between NLR with grade of proteinuria, sex, and age. CONCLUSION : From our study we conclude that NLR can be used a novel marker for diabetic nephropathy patients.