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7.24 [Document code] A diabetic nephropathy (diabetesnephrapatny, DN) diabetes (diabetesmellitus, DM) the most common chronic microvascular complications, onset occult. Is the DM disability, a major cause of death. The improvement of living standards and lifestyle changes, DM incidence increased year by year, DN The number of patients also will be gradually increased. DN early clinical symptoms was not obvious as to appear as the characteristic traces of proteinuria, normal serum creatinine and blood urea nitrogen, urine routine examination of urine protein was negative. The event of clinical DN, glomerular filtration rate decreased,[link widoczny dla zalogowanych], the pathological damage become irreversible. Therefore, the sensitivity of indicators used to monitor the early DN glomerular and tubular function damage, have important clinical significance. Now laboratory markers for early diagnosis of DN are summarized below. A urinary albumin microalbuminuria (mALB) is increased in urine from the protein, and urinary total protein was within the normal range or test paper disc method was negative. mALB defined as urinary albumin excretion in 30-300mg/24h, according to the current standard for the early morning urine> 30mL. Molecular proteins in urine mALB for the molecular weight of 69,000, proteins in the urine negative DM patients can be detected in urine higher than normal mALB, was recognized early detection of DN sensitive indicators. Since albumin is the glomerular filtration membrane can of minimum protein, accounting for 40% of total protein filtration. Almost all of these proteins were renal proximal tubule reabsorption in the active mode, the remote little tubular reabsorption, so only a trace of albumin in urine. Pathological cases with loss of glomerular basement membrane anionic proteoglycan acid acetyl hepatic cord, it allows large amounts of albumin through the glomerular basement membrane, so that not all tubular reabsorption, proteinuria appeared. With DM the disease progresses, the amount of renal excretion of protein gradually increased, eventually leading to the occurrence of DN. Bi Zhen-hong DM patients reported 92 cases,[link widoczny dla zalogowanych], 35 patients had increased urinary albumin. 2 proteinuria, urinary retinol-binding retinol binding protein (RBP) is a small protein (molecular weight 21,000), 90% of the body RBP and retinol-binding form of retinol RBP [Article ID] 1673 -7768 (2007) 04-0532-03 complex combination of RBP is not free from the urine of glomerular filtration and access to the original, in the proximal tubule reabsorption of almost all break down, so even normal levels of urinary RBP Micro. When the renal proximal tubule injury, the proximal tubule reabsorption of RBP decreased significantly increased urinary excretion of RBP. Urinary RBP and p: - microglobulin (p:-MG) transport in the kidney of the same process. But experiments show that at room temperature or 4 ~ C conditions, the urine RBP stability in acidic urine better than the p:-MG is more practical, more reliable detection of targets], so important for the diagnosis of kidney disease . First of all involved in the early lesions DN peritubular capillaries, caused by telangiectasia, exudation of plasma proteins, tubular interstitial volume and pressure increased, which led to reduced renal tubular reabsorption. DN compared with primary glomerulonephritis, the renal damage is more significant, and with primary glomerulonephritis caused by the pathogenesis of tubular damage is different. First of all DM patients with endothelial dysfunction affect the capillary network around tubules, endothelial dysfunction, oxidative damage, renal disease before the glomerular lesions. Ellis so that the urine of urinary albumin excretion rate (UAE) / RBP ratio is a very important indicator, the ratio decreases, that early renal tubular damage; When the ratio increases, indicates the simultaneous kidney damage or glomerular tubular lesions ball injury. Some studies showed that J, DM patients with urinary RBP,[link widoczny dla zalogowanych], UAE, urinary transferrin (1'F) and p: MG were significantly higher than the normal control group, and with the UAE increased urinary excretion of RBP has also increased; Urinary RBP and the UAE, TF, and p:-MG was positively correlated, suggesting that increased with the DM glomerulosclerosis, tubular damage was also found increasing trends. Therefore, both the tubular injury before the glomerular lesions, glomerular lesions, or simultaneous, early diagnosis of urinary RBP are a sensitive indicator of DN. Only 3 of urine, a one-microglobulin microglobulin (. MG) mainly from the liver cells and lymphocytes,[link widoczny dla zalogowanych], the molecular weight of 27000-33000, in the normal blood-MG bound to free form and two forms. Free type. MG freely through the glomerular filtration membrane, in the proximal tubule is reabsorbed and almost all of catabolism. Bound. MG