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Microalbuminuria in patients with cystic fibrosis

Melanie Lind-Ayres1, William Thomas, Bonnie Holme

  • 1Department of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Diabetes Care
|May 13, 2011
PubMed
Abstract

Insights

Transient microalbuminuria is common in cystic fibrosis (CF) patients, but persistent microalbuminuria is a strong indicator of diabetic kidney disease in CF patients with diabetes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pulmonology

Background:

  • Microalbuminuria (MA) prevalence varies in cystic fibrosis (CF) patients, with conflicting data on its utility for screening diabetic nephropathy.
  • Previous findings indicated 14% MA in CF-related diabetes (CFRD), but other studies reported higher rates (32-67%) in CF patients with or without diabetes.

Purpose of the Study:

  • To investigate transient (TMA) and persistent (PMA) microalbuminuria in CF patients to clarify diagnostic utility.
  • To differentiate between temporary and sustained MA in the context of CFRD and other comorbidities.

Main Methods:

  • Retrospective review of 1,449 urinary albumin measurements from 467 CF patients (age ≥10 years) over a decade.
  • Defined TMA as a single resolved MA episode; PMA as two consecutive or two of three MA measurements.
  • Analyzed odds of PMA in relation to CFRD and organ transplant status.

Main Results:

  • Transient microalbuminuria (TMA) prevalence (7.6%) was similar to the general population, observed in 5% of youth and 9% of adults.
  • Persistent microalbuminuria (PMA) was found in 6.1% of CF patients (2% youth, 8% adults).
  • PMA odds significantly increased sevenfold with CFRD (P=0.0002) and 48-fold with CFRD and organ transplant (P<0.0001).

Conclusions:

  • The spot urine albumin-to-creatinine ratio is a specific and valid screening tool for diabetic kidney disease in CFRD.
  • Distinguishing between TMA and PMA is crucial for accurate assessment of diabetic nephropathy risk in CF patients.

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