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The prevalence of micro-albuminuria and glomerular hyperfiltration in young patients with IDDM
1Department of Medicine, University of Witwatersrand, Johannesburg, S., Africa.
Abstract:
We have assessed the prevalence of two risk factors for diabetic nephropathy, i.e., micro-albuminuria and a raised glomerular filtration rate (GFR), in 127 insulin-dependent diabetic patients aged 13-36 years. Micro-albuminuria (albumin excretion rate (AER) 20-200 micrograms/min) was found in 46 subjects (36%) and GFR was elevated (greater than 135 ml/min/1.73 m2) in 43 (34%). The prevalence of supranormal GFR declined and that of micro-albuminuria rose progressively with the increasing duration of diabetes. While age and sex distribution were similar in subjects with and without raised AER, duration of diabetes was significantly longer, blood pressure (BP) was significantly greater and age of onset was lower in the micro-albuminuria group. Blood pressure was significantly elevated only in the patients with AER of 70-200 micrograms/min; there was a linear trend for BP to rise as AER increased. Stepwise logistic regression analysis indicated that duration of diabetes (P less than 0.0001), age of onset of diabetes (P less than 0.005) and current glycaemic control (HbA1) (P less than 0.01) were risk factors for micro-albuminuria. The association with a rising blood pressure appears to be secondary to the renal involvement. In this cross-sectional study an association of micro-albuminuria with a raised GFR could not be demonstrated.
Insights
Micro-albuminuria and elevated glomerular filtration rate (GFR) are key risks for diabetic nephropathy. Longer diabetes duration increases micro-albuminuria risk, linked to higher blood pressure and earlier onset.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Diabetic nephropathy is a major complication of diabetes mellitus.
- Micro-albuminuria and elevated GFR are early indicators of kidney damage.
- Understanding risk factors is crucial for early intervention.
Purpose of the Study:
- To assess the prevalence of micro-albuminuria and raised GFR in insulin-dependent diabetic patients.
- To identify risk factors associated with these indicators.
Main Methods:
- Cross-sectional study of 127 insulin-dependent diabetic patients (aged 13-36 years).
- Measured albumin excretion rate (AER) and glomerular filtration rate (GFR).
- Analyzed risk factors including diabetes duration, age of onset, blood pressure, and glycaemic control (HbA1).
Main Results:
- Prevalence of micro-albuminuria (36%) and elevated GFR (34%) was observed.
- Micro-albuminuria prevalence increased, while elevated GFR declined with longer diabetes duration.
- Risk factors for micro-albuminuria included longer diabetes duration, earlier age of onset, and poorer glycaemic control.
- Elevated blood pressure correlated with higher AER, suggesting secondary renal involvement.
Conclusions:
- Diabetes duration, age of onset, and glycaemic control are significant risk factors for micro-albuminuria.
- Blood pressure elevation appears secondary to renal changes.
- No association between micro-albuminuria and raised GFR was found in this study.