Urinary Excretion of Pancreatic Stone Protein in Diabetic Nephropathy

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Urinary pancreatic stone protein (PSP) levels were measured in 68 diabetic patients and 170 healthy controls to investigate the relationship between the progression of diabetic nephropathy and PSP excretion. Urinary albumin, N-acetyl-β-glucosaminidase (NAG), (α₁-microglobulin, creatinine clearance, and the blood PSP level were also determined in the diabetic patients. The urinary glucose level and glycemic control did not influence the urinary PSP level. In patients with normoalbuminuria (urinary albumin <20 mg/gCr, n=31), microalbuminuria (20-200 mg/Cr, n=19), and macroalbuminuria (>200 mg/gCr, n=18), the mean urinary PSP level was 347, 507, and 860 μg/gCr, respectively. These levels were significantly higher than the level in normal volunteers (168 μg/gCr, p<0.01). A significant positive correlation was observed between the urinary PSP level and the NAG or α₁-microglobulin levels (p<0.01). There was a stronger correlation with α₁-microglobulin. Blood PSP levels were also elevated in patients who had renal impairment with a decreased creatinine clearance. In conclusion, urinary PSP excretion was increased from the initial stage of diabetic nephropathy and this increase became more marked as nephropathy progressed. Increased PSP excretion may reflect renal tubular dysfunction.
(Internal Medicine 37: 500-503, 1998)