Objectives: Diabetic nephropathy is the leading cause of chronic kidney
disease. The pathogenesis of DN remains incompletely understood. It has been
recently demonstrated that inflammatory processes play a significant role in
the development and progression of DN. Toll-like receptors play a fundamental
role in the innate immune system by triggering proinflammatory signaling
pathways. Our aim is to evaluate the expression of TLRs on monocytes and relate
their expression with inflammation in HD patients with & without diabetic
nephropathy. Method: In a case
control study (60) patients from Alkasr El Aini Hospital on hemodialysis were divided
into two groups: Group 1, 30 patients on heamodialysis not due to diabetic
nephropathy, Group 2, 30 patients on heamodialysis due to diabetic nephropathy,
compared to Group 3, including 30 healthy controls. All participants were
subjected to: Full medical history, complete physical examination, Serum
creatinine, uric acid, A1C, fundus examination, detection of TLR2, TLR
expression by real time PCR in peripheral blood mononuclear cells. Data were
statically calculated using SPSS, comparision between groups was done using
student T test comparing 2 groups, correlation using spearman’s correlation. Results: Diabetic had significantly
increased TLR2, TLR4 mRNA in peripheral blood mononuclear cells compared to
controls and non diabetics patient on heamodialysis (p < 0.001), TLR2, TLR4
significantly correlated with dialysis duration in diabetic (p < 0.001), no
correlation with A1C in relation to TLR2 (p = 0.078), TLR4 (p = 0.163). Conclusion: TLR2, TLR4 were
significantly elevated in diabetic on dialysis initiating event in the pathogenesis
of DN, providing a link between hyperglycemia and hypoxia with inflammation and
fibrosis within the kidney. Hence, therapeutic interventions aimed at targeting
the inflammatory component through interruption of TLR signaling may be a novel
strategy to target prevention and treatment of DN.