Monocyte-to-HDL Cholesterol Ratio as a Marker of Proteinuria in Pre-Diabetes and Type 2 Diabetes Mellitus

The Monocyte-to-HDL cholesterol ratio is an emerging marker of inflammation, high values of which have been linked to metabolic syndrome, cardiovascular mortality and endothelial dysfunction. This ratio is of particular relevance in diabetic kidney disease due to its pathogenesis involving recruitment of monocytes, and the countering effect of HDL by inhibiting the proliferation and maturation of monocytes, making the MHR a reflection of the overall inflammatory milieu in the kidney in diabetics. Also, while proteinuria is a well-established marker of diabetic kidney disease, pre-diabetics have also been observed to develop proteinuria without decline in eGFR, thus prompting the possibility of pathological renal changes even in pre-diabetics, and promoting screening in this subset of the population.

Patients will be recruited from the Department of Medicine. Following informed consent, they will be asked questions pertaining to their medical history and also undergo a basic physical examination for assessing BMI and vitals. For BP, the average of two recordings taken 15 minutes apart will be considered. They will then be asked to provide a fasting blood sample for fasting glucose, HbA1c, CBC, urea, creatinine, fasting lipid profile, and mid-stream urine sample for microscopy, routine analysis, random protein and random creatinine. Proteinuria will be assessed using UPCR. eGFR will be calculated using the 2021 CKD-EPI equation, and used as an outcome measure for decline in renal function. Patients will be divided into diabetic and pre-diabetic groups, and further sub-groups based on the degree of proteinuria. First, within the diabetic group, the researcher will assess the independent relations of diabetic control and MHR with proteinuria. Second, the degree of proteinuria and the MHR between diabetics and pre-diabetics will be compared. Third, the eGFRs of all subjects will be calculated and compared with the respective MHRs to detect any association between MHR and decline in renal function.