Evaluation of the Association between Ischemia Modified Albumin (IMA), Glycemic and Lipid Status in Diabetic Nephropathy

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Afzal Ahmad
Poornima Manjrekar
Ashish Agarwal
Charu Yadav
Nadia Az Zahra


Introduction: Hyperglycemia induced oxidative stress in Type 2 Diabetes Mellitus modify various biomolecules to cause Diabetic Nephropathy (DN). IMA (Ischemia-Modified Albumin) is one such oxidative stress marker already examined in various clinical events but have not yet been evaluated in different stages of DN.

Aim: To estimate and assess the relationship of IMA with glycemic status and lipid parameters in all stages of DN.

Study Design: Cross-sectional study.

Place and Duration of Study: Study was conducted at Department of Biochemistry, Kasturba Medical College Hospitals, Mangaluru conducted between 2014 and 2015.

Materials and Methods: There were 60 type 2 diabetic cases and 30 healthy controls. Diabetic cases were further categorized into three equal groups on the basis of UACR (urine albumin-creatinine ratio), DN stage I having UACR less than 30 mg/g, DN stage II having UACR 30 to 300 mg/g, and DN stage III having UACR ≥ 300 mg/g of creatinine. Using enzyme-linked immunosorbent assay serum IMA level was estimated whereas automated analyzers was used for serum creatinine, HbA1c, urine albumin and urine creatinine analysis.

Results: Lowest level of IMA (109 ng/mL) measured in DN stage I, which was significantly different from those in DN stage II (154 ng/mL) and DN stage III (178 ng/mL). The significant positive correlation between IMA and fasting blood glucose, glycated hemoglobin were present in stage II and stage III DN.  In this study significant positive correlation of serum IMA to serum total cholesterol, low density lipoprotein cholesterol and negative correlation with high density lipoprotein were revealed in all stage of DN.

Conclusion: Current study postulates that early evaluation of serum IMA in diabetic patients with deranged lipid profile will provide an index of nephropathy development. This will help in prognosis and controlling complication in diabetes mellitus.

Diabetic nephropathy, dyslipidemia, ischemia-modified albumin, oxidative stress, urine albumin creatinine ratio.

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How to Cite
Ahmad, A., Manjrekar, P., Agarwal, A., Yadav, C., & Zahra, N. A. (2019). Evaluation of the Association between Ischemia Modified Albumin (IMA), Glycemic and Lipid Status in Diabetic Nephropathy. International Journal of Biochemistry Research & Review, 27(2), 1-9. https://doi.org/10.9734/ijbcrr/2019/v27i230117
Original Research Article


Agrawal RP, Ola V, Bishnoi P, Gothwal S, Sirohi P, Agrawal R. Prevalence of micro and macrovascular complications and their risk factors in type-2 diabetes mellitus. J Assoc Physicians India. 2014;62(6): 504-8.

Wanner C, Zimmermann J, Quaschning T. Lipid disorders in diabetic nephropathy. In: Hasslacher C, editor. Diabetic Nephropathy [Internet]. John Wiley & Sons Ltd. 2001;12.

Gawandi S, Gangawane S, Chakrabarti A, Kedare S, Bantwal K, Wadhe V, et al. A Study of Microalbuminuria (MAU) and Advanced Glycation End Products (AGEs) levels in diabetic and hypertensive subjects. Indian J Clin Biochem. 2018;33 (1):81-5.

Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention and treatment. Diabetes Care. 2005;28(1):164-76.

Incerti J, Zelmanovitz T, Camargo JL, Gross JL, de Azevedo MJ. Evaluation of tests for microalbuminuria screening in patients with diabetes. Nephrol Dial Transplant. 2005;20:2402–7.

Ito H, Komatsu Y, Mifune M, Antoku S, Ishida H, Takeuchi Y, et al. The estimated GFR, but not the stage of diabetic nephropathy graded by the urinary albumin excretion, is associated with the carotid intima-media thickness in patients with type 2 diabetes mellitus: A cross-sectional study. Cardiovascular Diabetology. 2010;9: 18.

Chen J, Tao F, Zhang B, Chen Q, Qiu Y, Luo Q, et al. Elevated squamous cell carcinoma antigen, cytokeratin 19 fragment and carcinoembryonic antigen levels in diabetic nephropathy. Int J Endocrinol. 2017;2017:5304391.

Kim NH, Pavkov ME, Knowler WC, Hanson RL, Weil EJ, Curtis JM, et al. Predictive value of albuminuria in American Indian youth with or without type 2 diabetes. Pediatrics. 2010;125(4):844-51.

Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. UKPDS study group. Risk factors for renal dysfunction in type 2 diabetes: U.K. Prospective Diabetes Study 74. Diabetes. 2006;55(6):1832-9.

Shah VN, Cheema BS, Iyengar S, Khullar M, Kohli HS, Bhansali A. Risk factors for proteinuria and renal insufficiency in Asian Indian patients with type 2 diabetes. Int J Diabetes Dev Ctries. 2015;35(4):554–8.

Budhiraja P, Thajudeen B, Popovtzer M. Absence of albuminuria in type 2 diabetics with classical diabetic nephropathy: Clinical pathological study. J. Biomedical Science and Engineering. 2013;6:20-25.

Yin MC. Anti-glycative potential of triterpenes: A mini-review. Bio Medicine. 2012;2(1):2-9.

Chawla R, Loomba R, Guru D, Loomba V. Ischemia Modified Albumin (IMA) - A Marker of Glycaemic Control and Vascular Complications in Type 2 Diabetes Mellitus. J Clin Diagn Res. 2016;10(3):BC13-6.

Gurumurthy P, Borra SK, Yeruva RK, Victor D, Babu S, Cherian KM. Estimation of Ischemia Modified Albumin (IMA) levels in patients with acute coronary syndrome. Indian J Clin Biochem. 2014;29(3):367-71.

Turk A, Nuhoglu I, Mentese A, Karahan SC, Erdol H, Erem C. The relationship between diabetic retinopathy and serum levels of ischemia-modified albumin and malondialdehyde. Retina. 2011;31(3): 602-8.

Patil P, Rao AV, Shetty S. Association of ischemia modified albumin with glycaemic status in type 2 diabetes mellitus. Int J Recent Sci Res. 2017;8(1):15374-8.

Ma SG, Jin Y, Hu W, Bai F, Xu W, Yu WN. Evaluation of ischemia-modified albumin and C-reactive protein in type 2 diabetics with and without ketosis. Biomark Insights. 2012;7:19-26.

Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of Ischemia modified albumin: A new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J. 2004;21(1):29-34.

Ahmad A, Manjrekar P, Yadav C, Agarwal A, Srikantiah RM, Hegde A. Evaluation of Ischemia - Modified Albumin, Malondialdehyde and Advanced Oxidative Protein Products as Markers of Vascular Injury in Diabetic Nephropathy. Biomark Insights. 2016;11:63-8.

Dahiya K, Kumawat M, Kaur R, Yadav S, Singh J, Ghalaut VS, et al. Ischemia modified albumin and nitric oxide in diabetic nephropathy. Journal of Diabetology. 2013;1(1):1-5.

Piwowar A, Knapik-Kordecka M, Warwas M. Ischemia-modified albumin level in type 2 diabetes mellitus – preliminary report. Dis Markers. 2008;24(6):311–7.

Kaefer M, Piva SJ, De Carvalho JA, Da Silva DB, Becker AM, Coelho AC, Duarte MM, Moresco RN. Association between ischemia modified albumin, inflammation and hyperglycemia in type 2 diabetes mellitus. Clin Biochem. 2010;43(4-5):450-4.

Duarte MM, Rocha JB, Moresco RN, Duarte T, Da Cruz IB, Loro VL, Schetinger MR. Association between ischemia-modified albumin, lipids and inflammation biomarkers in patients with hypercholesterolemia. Clin Biochem. 2009; 42(7-8):666-71.

Han K, Jia N, Yang L, Min LQ. Correlation between ischemia-modified albumin and lipid levels in patients with acute cerebrovascular disease. Mol Med Rep. 2012;6(3):621-4.

Kotani K, Kimura S, Kinugasa E, Ogata H, Caccavello R, Taniguchi N, Gugliucci A. Correlation between ischaemia-modified albumin and intermediate-density lipoprotein in haemodialysis patients with end-stage renal disease. J Int Med Res. 2011;39(4):1541-5.

Valle Gottlieb MG, da Cruz IB, Duarte MM, Moresco RN, Wiehe M, Schwanke CH, Bodanese LC. Associations among metabolic syndrome, ischemia, inflammatory, oxidatives and lipids biomarkers. J Clin Endocrinol Metab. 2010; 95(2):586-91.

Panimathi R, Lalitha. Ischemia modified albumin - An early marker of myocardial ischemia. JMSCR. 2016;4(7):11596-604.

Zurawska-Płaksej E, Grzebyk E, Marciniak D, Szymańska-Chabowska A, Piwowar A. Oxidatively modified forms of albumin in patients with risk factors of metabolic syndrome. J Endocrinol Invest. 2014;37(9): 819-27.

Bhavya N, Kumar VA. Study of association between microalbuminuria and microvascular complications in type II diabetes mellitus patients in Raja Rajeswari Medical College and Hospital, Karnataka. J Med Sci. 2017;3(1):6-10.

Sharada HM, Abdalla MS, Amin AI, Khouly SA, El-Sherif HA. Plasma levels of oxidation protein products in type 2 diabetic patients with nephropathy. Aust J Basic Appl Sci. 2012;6(7):537–44.

Kim HY. Analysis of Variance (ANOVA) comparing means of more than two groups. Restor Dent Endod. 2014;39(1): 74-7.

Adinortey MB, Gyan BE, Adjimani J, Nyarko P, Sarpong C, Tsikata FY, et al. Dyslipidaemia associated with type 2 diabetics with micro and macrovascular complications among Ghanaians. Indian J Clin Biochem. 2011;26(3):261-8.

Schernthaner G, Mogensen CE, Schernthaner GH. The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system. Diab Vasc Dis Res. 2014;11(5):306–23.

Gaze DC. Ischemia modified albumin: A novel biomarker for the detection of cardiac ischemia. Drug Metab. Pharmacokinet. 2009;24(4):333–41.

Piwowar A, Knapik−Kordecka M, Mariawarwas. Connection between ischemia−modified albumin levels and markers of diabetic nephropathy and oxidative protein damage in type 2 diabetic patients. Adv Clin Exp Med. 2009;18(4): 353–60.

Lin CC, Chen CC, Chen FN, Li CI, Liu CS, Lin WY, et al. Risks of diabetic nephropathy with variation in hemoglobin A1c and fasting plasma glucose. The American Journal of Medicine. 2013;126 (11):1017.e1-10.

Marrocco I, Altieri F, Peluso I. Measurement and Clinical Significance of Biomarkers of Oxidative Stress in Humans. Oxid Med Cell Longev. 2017;6501046.

Bilgi M, Keser A, Katlandur H, Sahin E, Kalkan AO, Yildiz M, et al. Evaluation of the relationship between microalbuminuria and urine ischemia-modified albumin levels in patients with diabetic nephropathy. J Clin Lab Anal. 2017;31(3).

Sadik L, Yogoub Z, Sayed N, El Nour A, Abide El Hameed M, Satee B. The level of Ischemic Modified Albumin (IMA) as risk marker for Cardio Vascular Disease (CVD) among some diabetic patients (type II) in Khartoum State-Sudan. Sudan Journal of Medical Sciences. 2017;12(4): 231-9.

Refaat S, Ghaffar NAE, Khalil A. The Relationship between ischemia modified albumin and lipids in type 2 Egyptian diabetic patients. Advan. Biol. Res. 2014;8 (1):18-22.