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Background: Raised sodium-lithium counter transport activity (SLCT) in red blood cells (RBC) is claimed to be an early marker of nephropathy in type 1 and type 2 diabetic patients. This study aimed to investigate whether SLCT changes parallel with early nephropathy in young diabetics of Bangladesh. Materials and Methods: Thirty-five newly diagnosed, untreated, young and normotensive Bangladeshi diabetics without ketoacidosis, family history of hypertension and renal disease, and 19 age and body mass index (BMI) matched healthy controls without family history of hypertension and diabetes were studied to investigate whether their blood glucose, C-peptide, lipids and microalbuminuria were related with abnormality of SLCT activity. Results: Diabetic subjects had extremely variable degree of serum glucose (mmol/L) (mean ± SD) (fasting 16.6 5.8; postprandial 29.7 ± 7.5) and C-peptide (pmol/L) [median (range) (fasting 0.289 (0.028-0.994); postprandial 0.379 (0.053-2.424)], significantly higher (P < 0.05) urinary albumin creatinine ratio (ACR) and no difference in SLCT when compared to healthy controls. But on subgrouping of diabetic patients according to fasting C-peptide value 0.16 pmol/L as a cut-off point, subjects with low C-peptide showed higher (P < 0.01) ACR than the controls and higher (P < 0.05) SLCT than moderate C-peptide. Microalbuminuria with ACR > 2.6 (mean + 2SD of control) was found in seven (20%) diabetics with no difference of SLCT between normoalbuminuric and microalbuminuric diabetics. Conclusions: SLCT activity in RBC is not a predictor of nephropathy in young diabetics of Bangladesh and the development of nephropathy is mainly related to glycemic and insulin status. SLCT may be elevated by marked hypoinsulinemia even without hypertension or family history of hypertension. [ABSTRACT FROM AUTHOR]