Prognostic importance of platelet/lymphocyte ratio and neutrophil/lymphocyte ratio in proteinuria associated with primary glomerular diseases
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Abstract
Objective: Proteinuria is associated with inflammation, endothelial dysfunction, platelet activation, and progression of kidney disease. The biological mechanisms by which platelet/lymphocyte rate (PLR) and neutrophil/lymphocyte rate (NLR) variables play a role in mediating protein excretion are not fully known. Here we aimed to compare NLR and PLR variables between patients with the primary glomerular disease (PPGD) with normal estimated glomerular filtration rate (eGFR) and healthy individuals (HIs). We divided the primary glomerular disease (PGD) participants into three sub-groups according to the level of proteinuria. In addition, a comparison was made between the sub-groups of patients with PGD in terms of these variables.
Methods: This cross-sectional, double arm, single center retrospective study was performed between January 2019 and April 2020. Serum platelet, total, and differential leukocyte analyses were evaluated using an automated cell counter. Biochemical analysis and 24-hour urinalysis in order to measure protein excretion and creatinine (Cr) clearance were performed using a chemistry analyzer. Of 225 participants in the study, 111 were patients with PGD, and 114 were HIs.
Results: A statistically significant difference was found when compared with PPGD and HI participants in terms of red blood cell (RBC), hemoglobin (HGB), white blood cell (WBC), platelet, neutrophil, NLR, and PLR variables. PPGDs revealed higher median C-reactive protein (CRP) and lower median albumin levels compared to HIs. Age, gender, urea, Cr, CRP, WBC, RBC, HGB, platelet, neutrophil, lymphocyte, NLR, and PLR variables between the sub-groups of patients with PGD were not statistically significant. But, there was only a difference between the sub-groups of patients with PGD in terms of albumin levels.
Conclusions: Our data suggested that PLR and NLR can be used as predictors in PPGDs. Higher median CRP and lower median albumin levels were also associated with proteinuria in PPGDs.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2022-05-01
Published 2022-05-15
References
Salifu MO, Delano BG. Chronic Glomerulonephritis. From available https://emedcine.medscape.com/article/239392-overview#a1. Access date: Feb 24, 2020
D’Amico G, Ferrario F, Rastaldi MP. Tubulointerstitial damage in glomerular diseases: Its role in the progression of renal damage. Am J Kidney Dis. 1995; 26(1): 124–132. DOI: https://doi.org/10.1016/0272-6386(95)90165-5
Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. N Engl J Med. 1998; 339(20): 1448–1456. DOI: https://doi.org/10.1056/NEJM199811123392007
Kalaitzidis R, Bakris G. Pathogenesis and treatment of microalbuminuria in patients with diabetes: the road ahead. J Clin Hypertens (Greenwich). 2009; 11: 636–643. DOI: https://doi.org/10.1111/j.1751-7176.2009.00184.x
Muhlhauser I, Verhasselt R, Sawicki PT, et al. Leucocyte count, proteinuria and smoking in type 1 diabetes mellitus. Acta Diabetol. 1993; 30: 105–7. DOI: https://doi.org/10.1007/BF00578223
Cavalot F, Massucco P, Perna P, et al. White blood cell count is positively correlated with albumin excretion rate in subjects with type 2 diabetes. Diabetes Care. 2002; 25: 2354–5. DOI: https://doi.org/10.2337/diacare.25.12.2354-a
Tong PC, Lee KF, So WY, et al. White blood cell count is associated with macro-and microvascular complications in Chinese patients with type 2 diabetes. Diabetes Care. 2004; 27: 216–22. DOI: https://doi.org/10.2337/diacare.27.1.216
Tsai JC, Sheu SH, Chiu HC, et al. Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev. 2007; 23: 111–18. DOI: https://doi.org/10.1002/dmrr.647
Afsar B. The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with type 2 diabetes. Am J Med Sci. 2014; 347(3): 217-20. DOI: https://doi.org/10.1097/MAJ.0b013e31828365cc
Akboga MK, Canpolat U, Yayla C, et al. Association of platelet to lymphocyte ratio with inflammation and severity of coronary atherosclerosis in patients with stable coronary artery disease. Angiology. 2016; 67(1): 89-95. DOI: https://doi.org/10.1177/0003319715583186
Thomas B, Lerma EV. Proteinuria. From available https://emedicine.medscape.com/article/238158-overview#a1. Access date: Dec 14, 2021
Núñez A, Gómez J, Zalba LR, et al. Losartan inhibits in vitro platelet activation: comparison with candesartan and valsartan. J Renin Angiotensin Aldosterone Syst. 2000; 1: 175–179. DOI: https://doi.org/10.3317/jraas.2000.022
Emokpae MA, Abdu A, Gwaram B.A. Neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios and their association with atherogenic index of plasma in sickle cell nephropathy. J. Appl. Hematol. 2016, 7, 24–29. DOI: https://doi.org/10.4103/1658-5127.181109
Binnetoğlu E, Şengül E, Halhallı G, et al. Is neutrophil lymphocyte ratio an indicator for proteinuria in chronic kidney disease? J Clin Lab Anal. 2014; 28(6): 487-92. DOI: https://doi.org/10.1002/jcla.21715
Kutlugun AA, Ebinc FA, Ozturk MT, et al. Association of neutrophil-to-lymphocyte ratio and microalbuminuria in patients with normal eGFR. Rom J Intern Med. 2018; 56(1): 21-26 DOI: https://doi.org/10.1515/rjim-2017-0036
Mansur A. Membranous Glomerulonephritis. From available https://emedicine.medscape.com/article/239799-overview#a5. Access date: Apr 22, 2022
Knoppova B, Reily C, Maillard N, et al. The Origin and Activities of IgA1-Containing Immune Complexes in IgA Nephropathy. Front Immunol. 2016; 7: 117 DOI: https://doi.org/10.3389/fimmu.2016.00117
Fabiano RC, Pinheiro SV, Simões E, Silva AC. Immunoglobulin A nephropathy: a pathophysiology view. Inflammation Research: Official Journal of the European Histamine Research Society. 2016; 65(10): 757-770. DOI: https://doi.org/10.1007/s00011-016-0962-x
Lorenz EC, Sethi S, Leung N, et al. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int. 2010; 77(8): 721-8 DOI: https://doi.org/10.1038/ki.2010.1
Mansur A, Georgescu F, Lew S. Minimal-Change Disease. From available https://emedicine.medscape.com/article/243348-overview. Access date: Jan 05, 2021
D'Agati VD. The spectrum of focal segmental glomerulosclerosis: new insights. Curr Opin Nephrol Hypertens. 2008; 17(3): 271-81. DOI: https://doi.org/10.1097/MNH.0b013e3282f94a96
Barisoni L, Schnaper HW, Kopp JB. Advances in the biology and genetics of the podocytopathies: implications for diagnosis and therapy. Arch Pathol Lab Med. 2009; 133(2): 201-16. DOI: https://doi.org/10.5858/133.2.201
Ernst E, Hammerschmidt DE, Bagge U, et al. Leukocytes and the risk of ischemic diseases. JAMA. 1987; 257: 2318–24. DOI: https://doi.org/10.1001/jama.257.17.2318
Emokpae MA, Aruomaren A, Osime E. Relationship between Neutrophil-to-Lymphocyte Ratio and Inflammatory Markers in Sickle Cell Anaemia Patients with Proteinuria. Med Sci (Basel). 2016; 4(3): 11. DOI: https://doi.org/10.3390/medsci4030011
Yilmaz G, Sevinc C, Ustundag S, et al. The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease. Saudi J Kidney Dis Transpl. 2017; 28(1): 90-94. DOI: https://doi.org/10.4103/1319-2442.198152
Kawamoto R, Ninomiya D, Kikuchi A, et al. Association of neutrophil-to-lymphocyte ratio with early renal dysfunction and albuminuria among diabetic patients. Int Urol Nephrol. 2019; 51(3): 483-490. DOI: https://doi.org/10.1007/s11255-018-02065-2