Microalbuminuria: An Early Marker of Renal Involvement in Diabetes

Mogensen, Carl Erik; Chachati, A.; Christensen, Cramer; Close, C. F.; Deckert, T.; Hommel, E.; Kastrup, Jens; Lefèbvre, Pierre; Mathiesen, E. R.; Feldt‐Rasmussen, Bo; Schmitz, A.; Viberti, Giancarlo

doi:10.3109/08860228509088195

Cited by 401 publications

(212 citation statements)

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“…Apart from the differences in mean HbA 1c levels mentioned above, it is possible that differences in the definition of progression of albuminuria may have influenced the results ( Table 2). Although persistent microalbuminuria has traditionally been classified according to a consensus definition of two out of three consecutive measurements exceeding 20 µg/min [70], more recent studies indicate that this definition may not ensure persistence of microalbuminuria in patients with type 1 diabetes on subsequent follow-up. When using the standard definition, spontaneous regression of microalbuminuria to normoalbuminuria has been reported to occur in 35% to 64% of patients [61].…”

Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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Glomerular filtration rate is commonly elevated in early diabetes and patients with this symptom are arbitrarily considered to have hyperfiltration. The prevalence of hyperfiltration in type 1 diabetes varies from less than 25% to more than 75%. The corresponding figures in type 2 diabetes are significantly lower, ranging between 0% and more than 40%. Several factors, methodological and biological, may contribute to the wide variation in estimates of hyperfiltration prevalence. Methodological differences in measurement and evaluation of GFR apply in particular to the handling of plasma disappearance curves of filtration markers. Biological factors that may influence GFR in the hyperfiltration range include glycaemic control, diabetes duration, BMI, sex, pubertal status in type 1 diabetes and age in type 2 diabetes. Hyperglycaemia may influence GFR and albuminuria, and may therefore confound the evaluation of hyperfiltration as an independent risk factor for diabetic nephropathy. Adequate assessment of the relationship between glycaemic control, GFR and AER therefore requires serial measurements of all three variables followed by multivariate analysis. A recent meta-analysis of ten type 1 diabetes studies concluded that the presence of hyperfiltration at baseline more than doubled the risk of developing micro-or macroalbuminuria at follow-up. However, not all studies allowed for confounding factors or regression dilution bias. Future studies will therefore need to address the independent role of hyperfiltration, not only in the evolution of albuminuria, but also in the subsequent decline of GFR.

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Section: Resolution Of Hyperfiltration In Clinical Trialsmentioning

confidence: 99%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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“…Urine albumin was measured by a radioimmunoassay [53]. Baseline UAE was expressed as the geometric mean of three overnight urine samples collected within a week [54]. To obtain fractionated urine collections patients were provided with three labelled urine collection bottles and collected urine in daytime, night-time, and daytime according to their sleeping pattern, giving a total of 24 h. Patients received verbal and written information about the procedures.…”

Section: -H Spectral Analysismentioning

confidence: 99%

Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in Type I diabetic patients with abnormal albuminuria

et al. 2002

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difference in heart rate between inspiration and expiration; LF, square root of power of the low frequency oscillation; LF power, power of the low frequency oscillation; Mean RR, mean of all normal RR intervals; Mean RR D-N, difference between awake and sleep time in mean RR; RSA, respiratory sinus arrhythmia; SDANN, standard deviation of the mean RR in all 5 min segments in a 24 h period; SDNN, standard deviation of all normal RR intervals; SDNN index, mean of SD's calculated on 5 min of RR intervals during a 24 h period; SE, standard error; sNN6%, number of successive RR interval differences > 6%, standardized to 24 h; sNN50, number of successive RR interval differences > 50 ms, standardized to 24 h; UAE, urine albumin excretion. AbstractAims/hypothesis. Diabetic nephropathy is associated with a high risk of cardiac mortality including sudden death. This is presumably related to an imbalance between sympathetic and parasympathetic tone resulting in a decreased heart rate variability (HRV). In nondiabetic patients a decreased HRV is known to be a strong predictor of cardiovascular death. Studies in non-diabetic patients have shown that β-blockers improve HRV parameters known to reflect parasympathetic function. The aim of our study was to investigate effects of additional β-blocker treatment on: cardiac autonomic function, blood pressure, and urine albumin excretion in ACE-inhibitor treated Type I (insulin-dependent) diabetes mellitus patients with abnormal albuminuria. Methods. We studied the effects of 6 weeks treatment with metoprolol (100 mg once daily, zero order kinetics formulation) in 20 patients participating in a randomised, placebo controlled, double blind, crossover trial. Patients were simultaneously monitored under ambulatory conditions with 24-h Holter-monitoring, Corresponding author: Dr. E. Ebbehøj, Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospitalet, DK-8000 Aarhus Denmark, E-mail: e.ebbehoj@dadlnet.dk Abbreviations: AMBP, Ambulatory blood pressure; CCVHF, coefficient of component variance for HF; CCVLF, coefficient of component variance for LF; HF, square root of power of the high frequency oscillation; HF power, power of the high frequency oscillation; HRV, heart rate variability; HRV index, geometric index of total variability in a 24 h period; I-E diff, Diabetologia (2002) 45:965-975 DOI 10.1007 Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in Type I diabetic patients with abnormal albuminuria 24-h ambulatory blood pressure recording, and 24-h fractionated urine collections. Heart rate variability was assessed by four different methods; ambulatory HRV analysis was carried out by spectral and time domain analysis, and on days of investigation short-term spectral analysis and bed-side tests were carried out. Results. Metoprolol treatment improved in vagal tone assessed by short-term spectral analysis. The 24-h ambulatory HRV analysis showed improvement in some parameters reflecting vagal function. A minor decrease in...

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“…With the availability of sensitive immunochemical assays, microalbuminuria was defined as urinary albumin excretion (UAE) rates of 30-300 mg day À1 for 24-h urine collections, 20-200 mg min À1 for timed urine collections or as albumin-to-creatinine ratios of 3.5-35 mg mmol À1 and/or 30-300 mg mg À1 (2.5-30 mg mmol À1 in men and 3.5-30 mg mmol À1 in women) for random or first morning spot urine collections. [1][2][3][4][5] There is substantial evidence to indicate that UAE in the microalbuminuria range is an independent risk factor for kidney and cardiovascular disease, and of mortality in type 1 and type 2 diabetes mellitus, [1][2][3][4][5][6] hypertensive subjects, non-diabetic subjects, as well as in the general population. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, recent studies conducted in type 2 diabetic patients revealed that even very low UAE rates, below those conventionally accepted as the lower limit to define microalbuminuria (o30 mg per 24 h), were also associated with increased mortality.…”

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confidence: 99%

“…[1][2][3][4][5] There is substantial evidence to indicate that UAE in the microalbuminuria range is an independent risk factor for kidney and cardiovascular disease, and of mortality in type 1 and type 2 diabetes mellitus, [1][2][3][4][5][6] hypertensive subjects, non-diabetic subjects, as well as in the general population. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, recent studies conducted in type 2 diabetic patients revealed that even very low UAE rates, below those conventionally accepted as the lower limit to define microalbuminuria (o30 mg per 24 h), were also associated with increased mortality. 15 Similarly, in non-diabetic subjects, albuminuria of o30 mg day À1 was found associated with older age, male gender, smoking, obesity, elevated blood pressure, left ventricular hypertrophy, dyslipidaemia, hyperinsulinaemia, salt sensitivity, lack of nocturnal BP dipping [15][16][17][18][19] and increased risk of coronary heart disease and death 10,15,[20][21][22][23][24][25] (Table 1).…”

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confidence: 99%