Back to Search
Start Over
Microalbuminuria and the Risk for Early Progressive Renal Function Decline in Type 1 Diabetes
- Source :
- Journal of the American Society of Nephrology. 18:1353-1361
- Publication Year :
- 2007
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2007.
-
Abstract
- This study aimed to establish the time of initiation and the determinants of renal function decline in type 1 diabetes. Until now, such decline has been assumed to be a late-occurring event associated with proteinuria. A total of 267 patients with normoalbuminuria and 301 patients with microalbuminuria were followed for 8 to 12 yr. Linear trends (slopes) in GFR were estimated by serial measurement of serum cystatin C. Cases of early renal function decline were defined by loss in cystatin C GFR that exceeded -3.3%/yr, a threshold that corresponds to the 2.5th percentile of the distribution of GFR slopes in an independent nondiabetic normotensive population. Cases of early renal function decline occurred in 9% (mean slope -4.4; range -5.9 to -3.3%/yr) of the normoalbuminuria group and 31% (mean slope -7.1; range -23.8 to -3.3%/yr) of the microalbuminuria group (P < 0.001). Risk for early renal function decline depended on whether microalbuminuria regressed, remained stable, or progressed, rising from 16 to 32 and 68%, respectively (P < 0.001). In multivariate analysis, risk for decline was higher after age 35 yr or when glycosylated hemoglobin exceeded 9% but did not vary with diabetes duration, smoking, BP, or angiotensin-converting enzyme inhibitor treatment. Contrary to the existing paradigm of diabetic nephropathy, progressive renal function decline in type 1 diabetes is an early event that occurs in a large proportion of patients with microalbuminuria. Together with testing for microalbuminuria, clinical protocols using cystatin C to diagnose early renal function decline and track response to therapeutic interventions should be developed.
- Subjects :
- Adult
Nephrology
medicine.medical_specialty
Adolescent
Population
Urology
Renal function
Kidney
urologic and male genital diseases
Internal medicine
medicine
Albuminuria
Humans
Diabetic Nephropathies
Cystatin C
Risk factor
education
Type 1 diabetes
education.field_of_study
Proteinuria
biology
business.industry
General Medicine
medicine.disease
Cystatins
female genital diseases and pregnancy complications
Diabetes Mellitus, Type 1
Endocrinology
biology.protein
Kidney Failure, Chronic
Female
Microalbuminuria
medicine.symptom
business
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 10466673
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....75a564d16e104373efb313b72c55b876