NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A MARKER OF RENAL DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Introduction. The combination of arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) is associated with an increased risk of target organ damage, particularly renal injury, which necessitates the search for early biomarkers of subclinical damage. Neutrophil gelatinase-associated lipocalin (NGAL) is considered a promising marker of early nephropathic and cardiometabolic changes; however, its relationships with clinical and metabolic parameters in AH, especially when combined with T2DM, remain insufficiently studied. Aim. To investigate clinical, laboratory, immunological, biochemical, and hemodynamic factors and to determine their association with NGAL levels in patients with arterial hypertension with and without type 2 diabetes mellitus. Materials and Methods. The study included 136 patients with AH, divided into two groups: the first group comprised patients with isolated AH (n=64), and the second group comprised patients with AH combined with T2DM (n=72). The control group consisted of 20 apparently healthy individuals. All participants underwent clinical, biochemical, immunological, and instrumental examinations, including assessment of lipid profile, HbA1c, insulin, cystatin C, leptin, NT-proBNP, and NGAL by ELISA; evaluation of lymphocyte subpopulations, renal function indices, and echocardiographic parameters. Statistical analysis was performed using correlation and stepwise multiple regression. Results. Patients with combined AH and T2DM demonstrated a more unfavourable metabolic profile, with increased BMI, total cholesterol, triglycerides, and atherogenic coefficient, as well as activation of the cellular immune response and more pronounced myocardial remodeling. NGAL levels did not differ significantly between the groups (p>0.05). Stratification by the median NGAL level showed a significant increase in leptin (p=0.011) and a decrease in insulin (p=0.009) in patients with higher NGAL values. According to stepwise regression analysis, independent predictors of NGAL in patients with AH were HbA1c, urea level, insulin level, and diastolic blood pressure (R²=0.31; p<0.0139). In patients with AH + T2DM, the model demonstrated greater explanatory power (R²=0.37; p<0.035) and included metabolic, immunological, and echocardiographic parameters.

Conclusions. NGAL levels in patients with arterial hypertension are shaped by a complex set of metabolic, immunological, and hemodynamic factors. In the presence of concomitant type 2 diabetes mellitus, the spectrum of determinants expands to include indicators of myocardial remodeling and immune activation. NGAL is associated with disturbances in adipokine regulation and insulin homeostasis and may be considered an integral biomarker for early subclinical target-organ damage and for cardiometabolic risk stratification.