Background: Diabetic nephropathy (DN) is a significant contributor to end-stage renal failure in individuals with type 2 diabetes mellitus (T2DM). Diabetic nephropathy is characterized by tubular atrophy, glomerular dilation, glomerulosclerosis, interstitial fibrosis, and proteinuria, resulting in deterioration of kidney function. DN, primarily caused by hyperglycemia, accounts for millions of deaths globally and is the leading cause of end-stage renal disease. Matrix metalloproteinase 10 is an enzyme essential for the breakdown of extracellular matrix constituents. Fetuin-A forms soluble complexes with calcium and phosphate to prevent soft tissue mineralization

Objectives: To determine the levels of Matrix Metalloproteinase 10 and Fetuin-A in Iraqi patients with DN, as these factors are considered excellent predictors for early detection.

Methods: The current study was conducted at Baghdad Teaching Hospital / Medical City between August and December 2024, involving 143 males and females aged 35–65 years, divided into four groups based on the albumin-to-creatinine ratio (ACR) criteria. They were: 35 cases of normoalbuminuria, 33 cases of microalbuminuria, 35 cases of macroalbuminuria, and 40 healthy individuals as controls. Auto spectrophotometer techniques were used to estimate uric acid levels and lipid profiles. HbA1c was measured by the I-chroma device, and serum levels of Fetuin-A and matrix metalloproteinase (MMP-10) were measured using an ELISA assay.

Results: The results indicated that Fetuin-A levels (234.3±3.11, 270.1±3.91, 356.7±13.11, 110.6±4.22) and matrix metalloproteinase levels (316.5± 10.11, 523.3± 17.01, 522.3±19.61, 209.5±10.12) were significantly higher in the patient groups relative to the control group. Additionally, all patients indicated increased levels of triglycerides and cholesterol compared to healthy controls.

Conclusion: Matrix Metalloproteinase 10 and Fetuin-A are significant prognostic indicators for predicting the first signs of diabetic nephropathy.