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[Microalbuminuria and diabetic nephropathy. Detection and correlation with other degenerative complications]
C Thivolet1, L Ayzac, C Simonet
1Clinique Endocrinologique, Hôpital de l'Antiquaille, Lyon.
Abstract:
The prevalence of microalbuminuria and persistent proteinuria was studied in a population of 801 diabetic patients (535 with type II and 266 with type I diabetes). Urinary albumin excretion rate (AER) was measured on morning samples by laser nephelometry. Normoalbuminuria, as defined, in the absence of contaminated urine, by an albumin: creatinine (A/C) ratio below 2, was found in 551 patients, microalbuminuria (NC greater than or equal to 2 with AER below 200 mg/l) in 190 patients and persistent proteinuria (AER greater than or equal to 200 mg/l) in 60 patients. Microalbuminuria was present in 48 (18 p. 100) IDDM patients and 142 NIDDM patients. In IDDM patients, AER increased with the duration of the disease with no apparent influence of age at the onset. The prevalence of hypertension was 25 p. 100 and 61 p. 100 in IDDM patients with microalbuminuria and macroproteinuria respectively versus 10 p. 100 in patients with normoalbuminuria. This prevalence increased in NIDDM patients from 39.3 p. 100 with normoalbuminuria to 40.8 p. 100 and 76.2 p. 100 with microalbuminuria or macroproteinuria respectively. Proliferative retinopathy in type I and type II patients with normal AER was 7.4 p. 100 and 1.2 p. 100 respectively increasing to 15.2 p. 100 and 8.9 p. 100 with microalbuminuria and 27.8 p. 100 and 23.1 p. 100 with macroproteinuria. The prevalence of coronary disease increased from 4 to 10.4 p. 100 in patients with type I diabetes and microalbuminuria. The prevalence of cardiac failure increased from 1.5 to 2.1 p. 100 in type I diabetics and from 3.2 to 7.8 p. 100 in type II diabetics in the presence of microalbuminuria. Patients with microalbuminuria had increased levels of glycosylated hemoglobin A 1C but statistical difference was only obtained for patients with type II diabetes. Routine analysis of AER in diabetics allows early detection of diabetic nephropathy and emphasizes the need for tight metabolic and blood pressure control. Hypertension can be detrimental to nephropathy but might also initiate renal lesions in NIDDM patients.
Insights
Microalbuminuria and persistent proteinuria are common in diabetic patients, indicating increased risk for complications like retinopathy and heart disease. Early detection through routine albumin excretion rate (AER) analysis is crucial for managing diabetic nephropathy.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Context:
- Microalbuminuria and persistent proteinuria are significant indicators of kidney damage in diabetic patients.
- A population of 801 diabetic patients, including Type I and Type II, were studied to assess urinary albumin excretion rates (AER).
- Laser nephelometry was used to measure AER, categorizing patients into normoalbuminuria, microalbuminuria, and persistent proteinuria.
Purpose:
- To determine the prevalence of microalbuminuria and persistent proteinuria in diabetic patients.
- To investigate the association between albuminuria levels and the presence of hypertension, retinopathy, coronary disease, and cardiac failure.
- To highlight the importance of routine AER monitoring for early detection and management of diabetic nephropathy.
Summary:
- Microalbuminuria was found in 190 patients (23.7%) and persistent proteinuria in 60 patients (7.5%).
- Prevalence of hypertension, retinopathy, coronary disease, and cardiac failure significantly increased with higher AER levels in both Type I and Type II diabetes.
- Elevated glycosylated hemoglobin A1C levels were observed in patients with microalbuminuria, particularly in Type II diabetes.
Impact:
- Routine AER analysis enables early detection of diabetic nephropathy, facilitating timely intervention.
- The findings underscore the critical need for strict metabolic control and blood pressure management in diabetic patients to prevent or slow kidney disease progression.
- Hypertension is identified as a detrimental factor in nephropathy and potentially a cause of renal lesions in Type II diabetes.