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Prediction of persistent microalbuminuria in patients with diabetes mellitus

L A Bach1, R E Gilbert, M E Cooper

  • 1Endocrinology Unit, Austin Hospital, Heidelberg, Victoria, Australia.

Journal of Diabetes and Its Complications
|April 1, 1993
PubMed

Insights

Frequent intermittent microalbuminuria, especially in insulin-dependent diabetes mellitus (IDDM), predicts future persistent microalbuminuria. Serial albumin excretion rate (AER) measurements are recommended over single tests for diabetic patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Diabetology

Background:

  • Persistent microalbuminuria predicts nephropathy and cardiovascular mortality in diabetic patients.
  • The significance of intermittent microalbuminuria remains unclear.
  • Early detection of diabetic kidney disease is crucial.

Purpose of the Study:

  • To determine if intermittent microalbuminuria predicts the development of persistent microalbuminuria.
  • To assess the predictive value of frequent intermittent microalbuminuria in different diabetes types.
  • To evaluate the utility of serial albumin excretion rate (AER) measurements.

Main Methods:

  • Serial urinary albumin excretion (UAE) measurements every ~6 months in 139 diabetic patients without persistent microalbuminuria at baseline.
  • Comparison of UAE patterns between patients who developed persistent microalbuminuria and those who did not.
  • Calculation of relative risk for developing persistent microalbuminuria based on the proportion of elevated AER measurements.

Main Results:

  • Diabetic patients with >3/20 intermittent microalbuminuria measurements showed a significantly higher risk of developing persistent microalbuminuria.
  • Relative risk was 17.4 (95% CI, 3.92-77.2) for insulin-dependent diabetes mellitus (IDDM) and 2.78 (95% CI, 0.99-7.8) for non-insulin-dependent diabetes.
  • Frequent intermittent microalbuminuria is a strong predictor, particularly in IDDM.

Conclusions:

  • Frequent intermittent microalbuminuria predicts the future development of persistent microalbuminuria.
  • Serial AER assessment is more informative than single measurements for diabetic patients.
  • This highlights the importance of monitoring UAE patterns for early detection of diabetic kidney disease.

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