Serum and Urinary Netrin-1 as Biomarkers for Kidney Injury in Adults with Transfusion-Dependent Beta-Thalassemia

Objective: Kidney disease in transfusion-dependent β thalassemia (TDBT) patients is more common and is associated with prolonged patient survival.Methods: This was a case‒control study that included 44 adult patients with TDBT and evidence of kidney disease (impaired renal function, microalbuminuria, or macroalbuminuria) without other obvious causes of kidney disease who were recruited from the Hematology Unit. Kidney injury was predicted by measuring the serum and urinary netrin 1 (NTN 1) levels via ELISA. Routine tests, such as hemoglobin, ferritin, serum albumin, and creatinine, were also performed on the patients and controls.Results: The results revealed statistically significant increases in S. urea, S. creatinine, S. ferritin, S. NTN-1, and urinary NTN-1 (P value <0.05). A significant positive correlation was found between S. NTN-1 and urea, creatinine, and the albumin‒creatinine ratio, and urinary Netrin-1 was positively correlated with urea, creatinine, the albumin‒creatinine ratio, and the serum ferritin level (P value <0.05). S. NTN-1 is a predictor of kidney injury among TDBT patients, with an AUC (95% CI) = 0.841, and at a cutoff value ≥ 564.5 pg/ml, its sensitivity and specificity were 81% and 72%, respectively. The urinary NTN-1 AUC (95% CI) was 0.993, and at a cutoff value of ≥ 645 pg/mg creatinine, its sensitivity and specificity were 96% and 89%, respectively.Conclusion: Serum and urinary NTN-1 may be promising potential biomarkers for the early detection of renal dysfunction in β-TM patients, with promising sensitivity and specificity.