Neutrophil Lymphocyte Ratio (NLR) was Significantly Associated with Diabetic Nephropathy at Sanglah General Hospital, Denpasar, Bali, Indonesia: A Case-Control Study

  • Ivana Paulus Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
  • Kadek Adi Satrya Palguna Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
  • Jourdan Wirasugianto Faculty of Medicine Udayana University- Sanglah General Hospital
  • I Gede Supadmanaba Department of Biochemistry, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
  • I Made Siswadi Semadi Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
  • Ketut Suastika Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia


Background: Diabetic nephropathy (DN) is caused by chronic complications due to microvascular changes in patients with T2DM associated with the inflammatory process. Neutrophils to Lymphocyte Ratio (NLR) is a ratio that can describe the acute and chronic inflammatory systemic and allegedly the inflammatory process in the kidney. This study aims to determine the association between NLR with diabetic nephropathy in patients with type 2 diabetes.

Method: This study is an analytical study with a case-control design. Samples were taken from the medical record installation room at Sanglah General Hospital Denpasar. Data was taken by using a simple random sampling method for 1 year that is 2017 according to inclusion and exclusion criteria. Statistical analysis including univariate analysis, normality test, Mann Whitney test, chi-square test, and AUC was done by using SPSS 23.

Results: 143 sample data were used in this study with an average age of 62 years old (S.D 11.5). Median NLR for DN as case group were found 3.19 ranges within 1.19-29.2 while median NLR for non-DN as control group were found 3.2 (0.82-15.5) with p=0.000. NLR proportion ≥2.5 in the non-DN group was found 30 (42.2%) and DN group were found 49 (68%) with p=0.002. Risk analysis between NLR and Diabetic nephropathy obtained OR 2.91 and 95% CI: 1.45 - 5.76. Other variables such as age, sex, and diabetic status towards NLR levels were found not statistically significant. The results of AUC were 69.6% with 95%CI within the range (61.1% -78.2%).

Conclusion: There is a significant association between NLR and diabetic nephropathy which potentially reflects the inflammation of the diabetic nephropathy process.

Keywords: Type 2 Diabetes Mellitus, Diabetic Nephropathy, Neutrophils to Lymphocyte Ratio (NLR)


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1. B. Roshan and R. C. Stanton, “A story of microalbuminuria and diabetic nephropathy.,” J. Nephropathol., vol. 2, no. 4, pp. 234–40, 2013, doi: 10.12860/JNP.2013.37.
2. World Health Organization, “Diabetes mellitus Fact sheet N°138,” 2017, [Online]. Available:
3. C. a Carrera Boada and J. M. Martínez-Moreno, “Pathophysiology of diabetes mellitus type 2: beyond the duo ‘insulin resistance-secretion deficit’.,” Nutr. Hosp., vol. 28 Suppl 2, pp. 78–87, 2013, doi: 10.3305/nh.2013.28.sup2.6717.
4. S.-I. Yamagishi and T. Matsui, “Advanced glycation end products, oxidative stress and diabetic nephropathy.,” Oxid. Med. Cell. Longev., vol. 3, no. 2, pp. 101–8, 2010, doi: 10.4161/oxim.3.2.11148.
5. R. Palsson and U. D. Patel, “Cardiovascular Complications of Diabetic Kidney Disease,” Adv. Chronic Kidney Dis., vol. 21, no. 3, pp. 273–280, 2015, doi: 10.1053/j.ackd.2014.03.003.Cardiovascular.
6. S. John, “Complication in diabetic nephropathy,” Diabetes Metab. Syndr. Clin. Res. Rev., vol. 10, no. 4, pp. 247–249, 2016, doi: 10.1016/j.dsx.2016.06.005.
7. Z. Cao and M. E. Cooper, “Pathogenesis of diabetic nephropathy,” J. Diabetes Investig., vol. 2, no. 4, pp. 243–247, 2011, doi: 10.1111/j.2040-1124.2011.00131.x.
8. S. Toth-Manikowski and M. G. Atta, “Diabetic kidney disease: Pathophysiology and therapeutic targets,” J. Diabetes Res., vol. 2015, 2015, doi: 10.1155/2015/697010.
9. A. K. H. Lim, “Diabetic nephropathy ? Complications and treatment,” Int. J. Nephrol. Renovasc. Dis., vol. 7, pp. 361–381, 2014, doi: 10.2147/IJNRD.S40172.
10. P. Kruger et al., “Neutrophils: Between Host Defence, Immune Modulation, and Tissue Injury,” PLoS Pathog., vol. 11, no. 3, pp. 1–22, 2015, doi: 10.1371/journal.ppat.1004651.
11. X. Li, J. Shen, Z. Lu, M. Chen, X. Fang, and G. Wang, “High neutrophil-to-lymphocyte ratio is associated with increased carotid artery intima-media thickness in type 2 diabetes,” J. Diabetes Investig., vol. 8, no. 1, pp. 101–107, 2017, doi: 10.1111/jdi.12541.
12. B. Azab et al., “Neutrophil-to-Lymphocyte Ratio as a Predictor of Worsening Renal Function in Diabetic Patients (3-Year Follow-Up Study),” Ren. Fail., vol. 34, no. 5, pp. 571–576, 2012, doi: 10.3109/0886022X.2012.668741.
13. H. Shahbazian and I. Rezaii, “Diabetic kidney disease; review of the current knowledge,” J. Ren. Inj. Prev., vol. 2, no. 2, pp. 73–80, 2013, doi: 10.12861/jrip.2013.24.
14. C. Muhammad and J. Nazar, “Diabetic nephropathy; principles of diagnosis and treatment of diabetic kidney disease,” J. Nephropharmacology J Nephropharmacol, vol. 3, no. 1, pp. 15–20, 2014, doi: 10.1353/dis.2001.0019.
15. K. Umanath and J. B. Lewis, “Update on Diabetic Nephropathy: Core Curriculum 2018,” Am. J. Kidney Dis., vol. 71, no. 6, pp. 884–895, 2018, doi: 10.1053/j.ajkd.2017.10.026.
16. A. Kowalski, A. Krikorian, and E. V. Lerma, “Diabetic nephropathy for the primary care provider: new understandings on early detection and treatment,” Ochsner J., vol. 14, no. 3, pp. 369–379, 2014, [Online]. Available:
17. B. Azab et al., “Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study),” Ren. Fail., vol. 34, no. 5, pp. 571–576, 2012, doi: 10.3109/0886022X.2012.668741.
18. J. Karalliedde and L. Gnudi, “Endothelial factors and diabetic nephropathy,” Diabetes Care, vol. 34, no. SUPPL. 2, pp. 291–296, 2011, doi: 10.2337/dc11-s241.
19. [19] K. Tanabe, Y. Maeshima, Y. Sato, and J. Wada, “Antiangiogenic Therapy for Diabetic Nephropathy,” Biomed Res. Int., vol. 2017, 2017, doi: 10.1155/2017/5724069.
20. L. Gnudi, “Angiopoietins and diabetic nephropathy,” Diabetologia, vol. 59, no. 8, pp. 1616–1620, 2016, doi: 10.1007/s00125-016-3995-3.
21. T. Nakagawa, T. Kosugi, M. Haneda, C. J. Rivard, and D. A. Long, “Abnormal angiogenesis in diabetic nephropathy,” Diabetes, vol. 58, no. 7, pp. 1471–1478, 2009, doi: 10.2337/db09-0119.
22. F. Imtiaz, K. Shafique, S. S. Mirza, Z. Ayoob, P. Vart, and S. Rao, “Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population,” Int. Arch. Med., vol. 5, p. 2, 2012, doi: 10.1186/1755-7682-5-2.
23. A. Shiny et al., “Association of Neutrophil-Lymphocyte Ratio with Glucose Intolerance: An Indicator of Systemic Inflammation in Patients with Type 2 Diabetes,” Diabetes Technol. Ther., vol. 16, no. 8, pp. 524–530, 2014, doi: 10.1089/dia.2013.0264.
24. B. Afsar, “The Relationship Between Neutrophil Lymphocyte Ratio With Urinary Protein Albumin Excretion in Newly Diagnosed Patients With Type 2 Diabetes,” Am. J. Med. Sci., vol. 347, no. 3, pp. 217–220, 2014, doi: 10.1097/MAJ.0b013e31828365cc.
25. E. M. Akbas et al., “Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy,” Int. J. Clin. Exp. Med., vol. 7, no. 7, pp. 1794–1801, 2014.
26. Z. A. Öztürk et al., “Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients?,” J. Endocrinol. Invest., vol. 36, no. 8, pp. 593–599, 2013, doi: 10.3275/8894.
27. W. Huang et al., “Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy,” Clin. Endocrinol. (Oxf)., vol. 82, no. 2, pp. 229–233, 2015, doi: 10.1111/cen.12576.
28. P. Forget, C. Khalifa, J. P. Defour, D. Latinne, and M. C. Van Pel, “What is the normal value of the neutrophil ‑ to ‑ lymphocyte ratio ?,” BMC Res. Notes, pp. 10–13, 2017, doi: 10.1186/s13104-016-2335-5.
29. A. Ake, M. R. Saraswati, and I. G. R. Widiana, “Glycated Albumin Sebagai Penanda Kontrol Glikemik Pada Penderita Diabetes Melitus Tipe 2 Glycated Albumin As a Glycemic Control Marker in Type 2 Diabetes Mellitus Patients,” Udayana J. Intern. Med., vol. 1, no. 1, pp. 1–10, 2016.
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How to Cite
Paulus, I., K. A. S. Palguna, J. Wirasugianto, I. G. Supadmanaba, I. M. S. Semadi, and K. Suastika. “Neutrophil Lymphocyte Ratio (NLR) Was Significantly Associated With Diabetic Nephropathy at Sanglah General Hospital, Denpasar, Bali, Indonesia: A Case-Control Study”. World Journal of Current Medical and Pharmaceutical Research, Vol. 3, no. 3, June 2021, pp. 50-54, doi:10.37022/
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