Type 2 Diabetes Mellitus (T2DM) constitutes approximately 90% of global diabetes cases and is a major contributor to microvascular complications, especially diabetic nephropathy (DN) (1). DN is a leading cause of end-stage renal disease (ESRD) and significantly worsens prognosis (2).

Early identification of renal impairment can facilitate interventions that potentially reverse or delay disease progression. While chronic hyperglycaemia is the prime driver of DN, emerging research indicates that serum uric acid (SUA) may also contribute to renal dysfunction by promoting endothelial dysfunction, oxidative stress, and inflammation (3).

However, clinical data establishing SUA as an early biomarker for DN in T2DM patients remain limited and sometimes conflicting. This study aimed to examine the association between serum uric acid levels and microalbuminuria among T2DM patients attending a tertiary care hospital in the Rohilkhand region.

Study Design and Population

A cross-sectional observational study was conducted over 12 months at the Department of Medicine, Rajshree Medical Research Institute, Bareilly.
A total of 125 T2DM patients aged 30–80 years, diagnosed according to the American Diabetes Association (ADA) criteria, were enrolled after informed consent.

Inclusion Criteria:

• Diagnosed cases of T2DM aged 30–80 years

Exclusion Criteria:

• Type 1 diabetes or other specific types of diabetes
• History of chronic kidney disease, malignancy, autoimmune diseases, liver disorders
• Current use of uric acid-lowering therapies

Data Collection

Demographic information, clinical examination findings, and laboratory parameters were recorded.
Serum uric acid was estimated by the uricase enzymatic method. Microalbuminuria was assessed using the urinary albumin-to-creatinine ratio (ACR) from spot urine samples.

Definitions

• Microalbuminuria: ACR between 30–300 mg/g.
• Hyperuricemia: Serum uric acid >7 mg/dL in males and >6 mg/dL in females.

Statistical Analysis

Statistical analysis was performed using SPSS version 24.0.
Categorical variables were expressed as percentages, and continuous variables as mean ± standard deviation.
Chi-square test and unpaired t-test were used to analyse associations. A p-value <0.05 was considered statistically significant.

ETHICAL CONSIDERATIONS AND CONFIDENTIALITY

Ethical approval for this study was provided by the Institutional Ethical Committee, and informed consent was obtained from each of the study participants. Participants were allowed to withdraw their names at any given time during the course of the study. Confidentiality of all the data was ensured by keeping the responses anonymous.

Demographic Profile

The mean age of participants was 47.5±8.7 years, with a male predominance (55.2%). The majority (59.2%) belonged to the 41–50 years age group.

Anthropometric and Biochemical Findings

The mean BMI was 23.97±3.3 kg/m². The mean fasting blood sugar (FBS) was 148±33 mg/dL, and mean HbA1c was 7.8±1.1%.

Serum Uric Acid and Microalbuminuria Correlation

Microalbuminuria was detected in 49.6% of the participants.

A statistically significant positive correlation was found between serum uric acid levels and the presence of microalbuminuria (p<0.05).

In the present study, serum uric acid was significantly associated with microalbuminuria among T2DM patients. These findings support previous evidence suggesting hyperuricemia is not merely an innocent bystander but may actively contribute to renal microvascular injury.

Several mechanisms may explain this association:
SUA promotes oxidative stress, endothelial dysfunction, glomerular hypertension, and inflammation, leading to early renal damage (4,5).

Experimental models have shown that urate lowering therapies, such as allopurinol, may reduce albuminuria, further supporting a pathogenic role (6).

Other studies corroborating these findings include Zeb et al. (2024), Mumtaz et al. (2023), and Ramakrishnan et al. (2023), who also found a strong positive correlation between SUA and microalbuminuria in T2DM (7–9).

Notably, in this study, traditional risk factors such as longer diabetes duration, higher BMI, and ageing also significantly influenced the presence of albuminuria.
However, even after adjusting for these, SUA retained an independent association.

This suggests that early identification of hyperuricemia in diabetic patients could serve as a window for intervention before the onset of irreversible renal damage.

This study concludes that higher serum uric acid levels are significantly correlated with microalbuminuria among T2DM patients, highlighting hyperuricemia as a potential early biomarker for diabetic nephropathy.

Routine screening for serum uric acid alongside microalbuminuria may help in early detection of at-risk patients, enabling timely initiation of preventive strategies.

Further longitudinal studies are recommended to explore whether uric acid-lowering therapies can delay or prevent diabetic nephropathy progression.

FINANCIAL SUPPORT AND SPONSORSHIP: Nil

CONFLICTS OF INTEREST: There are no conflicts of interest.

1. IDF Diabetes Atlas, 9th ed. International Diabetes Federation; 2019.
2. Afkarian M, Zelnick LR, Hall YN, et al. Clinical manifestations of kidney disease among US adults with diabetes, 1988–2014. JAMA. 2016;316(6):602–10.
3. Johnson RJ, Nakagawa T, Jalal D, et al. Uric acid and chronic kidney disease: which is chasing which? Nephrol Dial Transplant. 2013;28(9):2221–8.
4. Sánchez-Lozada LG, Lanaspa MA, Rivard CJ, et al. Uric acid-induced endothelial dysfunction: a role for vascular nitric oxide deficiency and enhanced oxidative stress. Semin Nephrol. 2011;31(5):441–8.
5. Kang DH, Nakagawa T. Uric acid and chronic renal disease: possible implication of hyperuricemia on progression of renal disease. Semin Nephrol. 2005;25(1):43–9.
6. Sircar D, Chatterjee S, Waikhom R, et al. Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6-month, randomized, double-blind, placebo-controlled trial. Am J Kidney Dis. 2015;66(6):945–50.
7. Zeb S, et al. Correlation of Serum Uric Acid Levels with Microalbuminuria in T2DM Patients. Int J Diab Res. 2024;13(2):55-61.
8. Mumtaz A, et al. Serum Uric Acid and Microalbuminuria: Cross-Sectional Study among T2DM Patients. Pak J Med Sci. 2023;39(1):145–50.
9. Ramakrishnan P, et al. Diagnostic Utility of Serum Uric Acid in Diabetic Nephropathy. Indian J Clin Biochem. 2023;38(3):370–5.