Interstitial lesions but not glomerular lesions were a significant predictor for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.

Background and Objective The influence of glycemic control on cardiovascular (CV) complications or survival is not clear in diabetic patients with end-stage renal disease (ESRD

Background Glycated albumin (GA), which is an alternative glycemic marker, is influenced by factors associated with albumin turnover, and it is not clear whether proteinuria influences GA values in diabetic patients with chronic kidney disease (CKD). Methods We enrolled 94 diabetic patients with CKD stages 3 to 5. GA, glycated hemoglobin, and urinary protein excretion (UP) levels were consecutively obtained in each patient. The correlations between GA and UP and those between changes in GA and UP were examined. Results There was a significant correlation between GA and UP in all cases (r=-0.46, p<0.0001), however no significant correlation was found in cases with UP of 0-3.49 g/day (r=0.01). GA values in cases with UP "3.5 g/day were significantly lower than those in cases with UP <3.5 g/day [UP "3.5 g/day and serum albumin (Alb) !3 g/dL; 12.0 ± 1.3%, UP "3.5 g/day and Alb >3 g/dL; 17.8 ± 4.3%, 0" UP <3.5 g/day; 21.2 ± 4.2%], while no significant difference in HbA1c or glucose levels was found. In cases with a minimum of UP "0.5 g/day, no significant correlation was found between the difference in GA and the difference in UP at the point of maximum UP and minimum UP (r=0.04). Conclusion Nephrotic-range proteinuria decreases GA values independent of the glycemic state, while nonnephrotic range proteinuria has no significant influence on GA values in diabetic CKD patients.

The influence of home blood pressure (HBP) control on renal and cardiovascular outcomes is not fully defined, and the optimal blood pressure (BP) target in elderly patients with chronic kidney disease (CKD) remains unknown. To clarify the influence of HBP on the progression of CKD and the occurrence of cardiovascular events in elderly CKD patients, we recruited 104 patients with stage 3 to 5 CKD, who were X70 years of age. The mean follow-up duration was 39±15 months. HBP was measured every morning and evening for 7 consecutive days. HBP data were obtained every 6 months for 79 of these patients. There were significant correlations observed between morning systolic BP (SBP), evening SBP and the change in estimated glomerular filtration rate (eGFR) during the follow-up period (baseline/follow-up; morning r¼À0.55/À0.51, evening r¼À0.48/À0.38, all Po0.0001, baseline: baseline values, follow-up: mean values obtained every 6 months during the follow-up period). Stepwise multivariate regression analysis identified morning SBP and urinary protein excretion as independent predictors of a change in eGFR during the follow-up period. Cox proportional hazards analysis showed that baseline morning SBP, baseline evening SBP and follow-up morning SBP were significantly associated with an increased risk of renal events (hazard ratios; 1.04 (95% CI, 1.01-1.07), 1.06 (1.02-1.09) and 1.10 (1.04-1.17), respectively). However, Cox proportional hazards analyses showed that there was no significant association between BP and the risk of cardiovascular events. In conclusion, even among elderly CKD patients, HBP is a significant predictor of decline in renal function and the development of end-stage renal disease. In addition, the optimal target BP for elderly CKD patients needs to be clarified.

Although arteriolar hyalinosis was associated with persistent haematuria, the clinical significance of microscopic haematuria was minor in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.