Study of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as a predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients

Background: Diabetes mellitus (DM) is a systemic disease having serious microvascular and macrovascular complications. Microvascular complications include diabetic nephropathy (DN), diabetic retinopathy, and diabetic neuropathy while macrovascular complications include stroke, cardiovascular diseases (CVDs), and peripheral vascular diseases.                             DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related to DN, such as interleukin1 (IL1), IL6, IL8, transforming growth factor beta 1(TGF-β1) and tumor necrosis factor alpha (TNF α). However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process. AIM OF THE WORK: To assess neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as a predictor inflammatory markers for diabetic nephropathy in type 2 diabetic patients. Methodology: This study is a prospective one that was carried out on one hundred (100) type 2 Diabetes mellitus (T2DM) patients attending to internal medicine outpatient clinic and inpatient department of internal medicine at Al-Azhar university hospital, Damietta and twenty five (25) apparently healthy volunteers as a control. The populations of the study were classified into three groups according to their level of albuminuria. All were subjected to full history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were obtained and examined for complete urine analysis and albumin/creatinine ratio (UACR), Complete blood count (CBC), HbA1c, Fasting blood sugar, Renal Function Tests, eGFR and Abdominal ultrasonography, Fundus examination and ECG, Assessment of NLR by dividing the absolute neutrophil count on the absolute lymphocyte count. Assessment of PLR by the platelet count dividing on the absolute lymphocyte count Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB when compared to group IA, II and III. and also there was statistically significant increased NLR,PLR and UACR in group IA in comparison to group II and and also there was statistically significant increased NLR,PLR and UACR in group II in comparison to group III. Conclusion: Neutrophil lymphocyte ratio (NLR) & Platelet lymphocyte ratio (PLR) was significantly associated with diabetic nephropathy (DN) and high Neutrophil lymphocyte ratio (NLR) & Platelet lymphocyte ratio (PLR) values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy (DN).