Evaluation of Serum Tumor Necrosis Factor Alpha (TNFα) in Type 1 Diabetic Children and Adolescents as Predictor for Diabetic Nephropathy in Correlation to Proteinuria

Abstract

Background: Diabetic nephropathy (DN) is a major complication of type 1 diabetes mellitus (T1DM) and a leading cause of chronic kidney disease. Tumor necrosis factor alpha (TNFα), an inflammatory cytokine, may serve as a biomarker for early detection of DN.

Objective: To evaluate serum TNFα levels in children and adolescents with T1DM and assess its potential as a predictor for DN in correlation with proteinuria and clinical variables.

Methods: This cross-sectional study included 50 children with T1DM for over 5 years, subdivided into two groups based on urinary albumin-creatinine ratio (ACR): Group I (normoalbuminuria, n=25) and Group II (microalbuminuria, n=25). A control group (n=30) of age- and sex-matched healthy children was included. Serum TNFα levels were measured using ELISA. Clinical and laboratory parameters were analyzed for correlations.

Results: Serum TNFα levels were significantly higher in diabetic patients compared to controls (p=0.036) but not significantly different between normoalbuminuric and microalbuminuric groups (p=0.401). ROC analysis identified a TNFα cutoff of 5.1 µg/ml with 76% sensitivity and 63.6% specificity for distinguishing T1DM patients from controls. No significant correlations were found between TNFα and age, diabetes duration, glycemic control, or BMI, except for a weak association with height in the microalbuminuric group (p=0.048).

Conclusion: Serum TNFα may serve as a differentiating marker between diabetic and non-diabetic children but lacks predictive value between normoalbuminuria and microalbuminuria groups. Its role in early DN detection requires further validation.