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Islamic University of Gaza Postgraduate Deanship Faculty of Science Biological Sciences Master Program Medical Technology Department
Detection of Some Enzymes and Transferrin as Early Diagnostic Markers
for Diabetic Nephropathy among Type-2 Diabetic Patients in Gaza
Shimaa Waleed Shubair
Supervisor: Prof. Mohammad E. Shubair
A thesis submitted in partial fulfillment of the requirements for the degree of master of biological sciences / Medical Technology
DECLARATION I hereby declare that this manuscript is my own work and that, to the best of my
knowledge and belief, it contains no material previously published, or written by
another person, nor material which to a substantial extent has been accepted
for the award of any other degree of the university or other institute, except
where due a acknowledgment has been made in the text.
Author Shimaa W. Shubair
All Right Reserved 2008. No part of this work can be copied, translated or stored in retrieval system, without prior permission of the author.
Detection of some enzymes and transferrin as early diagnostic markers for diabetic nephropathy among type-2 diabetic patients in Gaza
Abstract Kidney Function assessment is important in diabetic patients and early
detection of diabetic nephropathy in preclinical stage of disease and will
contribute to decreasing morbidity and mortality rates.
This study focused on the determination of N-acetyl--D-glucosaminidase
(NAG) and gamma glutamyl transferase (GGT) enzymes, transferrin (TRF) and
creatinine (CR) in urine of type-2 diabetic subjects and controls of healthy
subjects for detection of the relationship between these markers and diabetic nephropathy in type-2 diabetic patients in Gaza.
Early morning urine samples were collected from 100 diabetic patients,
their age range was from 40-60 years and some of them have hypertension and
from 80 control non diabetic subjects with the same age. All the 180 subjects
did not suffer from urinary tract infection, liver or renal diseases. In addition, the
control subjects did not suffer hypertension, or abnormalities in carbohydrate
metabolism. NAG and GGT were measured in urine samples using colorimetric
assay kits while TRF was assayed using a turbidimetric immunoassay kit. CR
was assayed using the alkaline picrate method.
Urinary TRF concentration, NAG and GGT activities showed significant
differences between diabetic patients and control. The study showed also that
these markers did not have significant difference between hypertensive and
non-hypertensive diabetic patients and no significant difference between males
and females of patients group. Furthermore, the study showed that 32% have
shown elevated NAG excretion but GGT excretion was found elevated only in
15% of cases and TRF was found higher in 29% of patients. One female patient
had abnormally elevated levels of TRF, NAG and GGT. No correlations was
found between age, body mass index (BMI), smoking, duration of diabetes,
systolic or diastolic pressure and these markers. This study indicates that the
appearance of the NAG, GGT and TRF in urine may be useful as a non-
invasive surrogate test in detecting diabetic nephropathy at an early stage.
Key words: Diabetic nephropathy, N-acetyl--D-glucosaminidase, Gamma glutamyl transferase, Transferrin, Gaza.
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Turbidimetric Immunoassay .
LIST OF ABBREVIATIONS
Angiotensin converting enzyme
Albumin/ creatinine ratio
Anno domini after Christ birth
Albumin excretion rate
Advanced glycosylation end products
Acquired immunodeficiency syndrome
Angiotensin receptor blockers
Before Christ birth
Body mass index
Center for disease control and prevention
Coronary heart disease
Dipeptidyl aminopeptidase IV
Eastern Mediterranean and middle east region
End stage renal disease
Gestational diabetes mellitus
Glomerular filtration rate
Gamma glutamyl transpeptidase / transferase
Glycosylated (or glycated) hemoglobin
Hyperosmolar hyperglycemic nonketotic coma
Human immunodeficiency virus
Hypertension optimal treatment
Human serum transferrin
International diabetes federation
Ministry of Health-Palestine
North American region
National diabetes data group
Palestinian central bureau of statistics
Primary health care department
Retinol binding protein
South and central America region
South-East Asian Region
Statistical package for social science
Transferrin excretion rates
Transforming growth factor beta
United kingdom prospective diabetes study group
Union of Palestinian medical relief committee
World health organization
Western pacific region
I would like to thank .
The Islamic University of Gaza and the Faculty of Science for giving me the
opportunity and knowledge so that I achieve this research.
My supervisor Prof. Mohammad shubair, who stood for me, step by step, during
this journey to be sure that every detail will be correct .
My family for strengthening my self confidence and encouraging me always to
pursue my goal.
Dr. Samir Safi for his help in the statistical background of this research.
Mr. Yusif Al Arqan for facilitating the task of sample-testing in his own
The employees of the diabetes clinic at Remal Health Center for all the help
they provided during sample collection process.
This thesis is dedicated to my father and mother who have
supported me all the way since the beginning of my study .
Also, this thesis is dedicated to my husband who has been a great
source of motivation and inspiration and his loving and kind
Finally, dedication continues to my beloved Palestinian
community, especially diabetes patients.
Chapter I Introduction 1.1 Background of the problem 1.2 Diabetes in Palestine
1.2.1 Prevalence of diabetes mellitus
1.2.2 Cost of anti diabetic drugs in MOH
1.2.3 Mortality of diabetes mellitus
1.3 Global prevalence of diabetes mellitus 1.4 Aim of the study 1.5 Significance Chapter II literature Review 2.1 Diabetes mellitus 2.1.1 History of diabetes mellitus
2.1.2 Definition and description of diabetes mellitus
2.1.3 Classification of diabetes mellitus
184.108.40.206 Type-1 diabetes
220.127.116.11 Type-2 diabetes
18.104.22.168 Gestational diabetes mellitus (GDM)
2.1.4 The insulin
2.1.5 Diet and exercise in diabetes
22.214.171.124 Principles of diet therapy in diabetes
126.96.36.199 Exercise and diabetes
2.2 Complications of diabetes mellitus 2.2.1 Acute glycemic complications 188.8.131.52 Diabetic ketoacidosis (DKA)
184.108.40.206 Hyperosmolar hyperglycemic