Article Type

Case Report


Objective The aim of this work was to study the role of toll-like receptor 4 (TLR4) in the development of type 2 diabetes mellitus (T2DM) as well as its relation to the occurrence of diabetic nephropathy. Background Chronic kidney disease is one of the major complications of T2DM and is the leading cause of end-stage renal disease. There is growing evidence indicating that chronic low-grade inflammatory response is a recognized factor in the pathogenesis and progression of diabetic renal injury. Patients and methods A total of 50 T2DM patients were divided into three groups according to urinary albumin excretion: those with normoalbuminuria, those with microalbuminuria, and those with macroalbuminuria. In addition, 10 apparently healthy individuals were included as a control group. Fasting blood glucose, glycated hemoglobin, blood urea, and serum creatinine were measured in all patients. Urinary albumin excretion was measured using a morning spot urine sample and the urinary albumin/creatinine ratio was calculated. Quantification of CD14 and TLR4 expression on monocyte subsets was performed by means of flow cytometry. Results Levels of CD14 were found to be significantly increased in patients with macroalbuminuria, whereas TLR4 levels were increased in T2DM patients, with further elevation in patients with macroalbuminuria. Both markers showed significant positive correlations with the duration of diabetes, glycated hemoglobin, serum creatinine, and urinary albumin/creatinine ratio and significant negative correlations with estimated glomerular filtration rate. Multivariate regression analysis demonstrated that CD14 and TLR4 are independent predictors of the occurrence of microalbuminuria in T2DM patients. Conclusion TLR4 levels were higher in T2DM patients compared with normal individuals. These observations significantly add to the emerging role of TLRs in T2DM development. TLR4 was also found to correlate well with the severity of albuminuria in T2DM and to be a good predictor of microalbuminuria, suggesting its possible role in the pathogenesis and progression of diabetic nephropathy.