Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients

Parving, Hans‐Henrik; Gall, Mari-Anne; Skøtt, Peter; Jørgensen, Hans Ejsing; Løkkegaard, Hans; Jørgensen, F; Nielsen, Bent; Larsen, Svend

doi:10.1038/ki.1992.118

Cited by 404 publications

(286 citation statements)

References 16 publications

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“…Thus, it is important to define the clinical characteristics and laboratory features to correctly indicate the presence of NDRD and to selectively carry out renal biopsies in those patients. Studies based on renal biopsies in diabetic patients have shown that the incidence of NDRD in patients with type 2 diabetes mellitus was much higher than in patients with type 1 diabetes mellitus14, 21. The incidence of NDRD in the present study was 69.2%.…”

Section: Discussionmentioning

confidence: 98%

“…According to current guidelines, the presence of >3 RBCs/hpf is considered clinically significant microscopic hematuria26. There have been various criteria, for both scientific research and the clinical diagnoses of hematuria: >2 RBCs/hpf6, >3 RBCs/hpf14, 15, >5 RBCs/hpf27, >10 RBCs/hpf3, and >15 RBCs/hpf. As a result, the incidence of hematuria varied from 4.9 to 39.3%.…”

Section: Discussionmentioning

confidence: 99%

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Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Dong

Wang

Qiu

et al. 2015

J of Diabetes Invest

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Aims/IntroductionThere are sparse and limited studies on erythrocyte morphology in renal biopsy identifying nephropathic patients among type 2 diabetics. The present study sought to clarify the predictive value of dysmorphic erythrocytes in type 2 diabetics with non‐diabetic renal disease and influences on hematuria.Materials and MethodsWe examined 198 patients with type 2 diabetes who underwent kidney biopsies between 2012 and 2013. Hematuria was defined as >3 or >10 red blood cells per high‐power field (RBCs/hpf) in urine sediment. If >80% of the erythrocytes were dysmorphic, glomerular hematuria was diagnosed. Clinical findings and predictive value of dysmorphic erythrocytes were compared between patients with hematuria (n = 19) and those without (n = 61). The potential risk factors for hematuria among diabetic nephropathy patients were also screened.ResultsThere was a statistically significant difference between the diabetic nephropathy group and the non‐diabetic renal disease group (6.6 vs 16.8%; P = 0.04) when the demarcation point of hematuria was 10 RBCs/hpf. When the definition of hematuria was based on an examination of urinary erythrocyte morphology, a marked difference was seen (3.3 vs 24.8%; P < 0.001). Glomerular hematuria showed high specificity and a positive predictive value (0.97 and 0.94, respectively) in non‐diabetic renal disease. A multivariate analysis showed that nephrotic syndrome was significantly associated with hematuria (odds ratio 3.636; P = 0.034).ConclusionsDysmorphic erythrocytes were superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics. Nephrotic syndrome was an independent risk factor for hematuria.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Dong

Wang

Qiu

et al. 2015

J of Diabetes Invest

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“…Albuminuria is a marker of renal damage and a hallmark of progression to renal insufficiency [27][28][29]. It increases cardiovascular risk in type 2 diabetes mellitus [30,31], probably because it reflects widespread increased vascular permeability causing organ damage [28,31,32].…”

Section: Discussionmentioning

confidence: 99%

Diabetic nephropathy is associated with increased albumin and fibrinogen production in patients with type 2 diabetes

et al. 2006

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Aims/hypothesis: Hyperfibrinogenaemia and albuminuria are cardiovascular risk factors, often coexisting in diabetic and non-diabetic people. Albuminuria in turn is associated with a compensatory albumin overproduction in non-diabetic patients. It is not known whether the presence of albuminuria in patients with type 2 diabetes mellitus is associated with greater albumin and fibrinogen production rates than in normoalbuminuric patients. Subjects, materials, and methods: Using leucine isotope methods, we measured fractional and absolute synthesis rates (FSR, ASR) of albumin and fibrinogen in post-absorptive type 2 diabetic patients with either normal (n=11) or increased (n=10) urinary albumin excretion. Results: In albuminuric patients, albumin FSR (16.2± 1.5%/day) and ASR (20.5±1.9 g/day) were greater (p<0.02 and p<0.05, respectively) than in normoalbuminuric patients (FSR=11.5±1.1%/day; ASR=15.7±1.2 g/day). Fibrinogen FSR was similar between patients with normal and increased albumin excretion, but concentration, the circulating pool and ASR of fibrinogen were 40 to 50% greater (p<0.035) in patients with albuminuria. Albuminuria was positively correlated with albumin ASR, with fibrinogen concentration, the fibrinogen pool and ASR, whereas albumin synthesis was inversely correlated with calculated oncotic pressure. Conclusions/interpretation: Synthesis of albumin and fibrinogen is upregulated in type 2 diabetic patients with increased urinary albumin excretion. Albuminuria is associated with enhanced fibrinogen and albumin synthesis.

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“…However, there is greater heterogeneity of structural lesions and GFR in both microalbuminuric and proteinuric type 2 diabetic patients [4,8,12,13]. Some type 2 diabetic patients have a relatively well preserved GFR despite increased proteinuria and blood pressure; this may be related to the more pronounced glomerular enlargement that is seen in these patients [4].…”

Section: Introductionmentioning

confidence: 99%

Are glomerular volume differences between type 1 and type 2 diabetic patients pathologically significant?

2007

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The observation that patients with type 2 diabetes tend to have larger glomeruli than patients with type 1 diabetes was first made more than 10 years ago. It has also been noted that type 2 diabetic patients with nephropathy often have more heterogeneous renal function and structure than type 1 patients. However, whether these observations are linked or have any bearing on the progression of nephropathy in the two types of diabetes remains uncertain. Here we put forward several hypotheses as to why glomerular volume in type 1 differs from that in type 2 diabetes. We suggest that although type 1 and type 2 diabetic patients appear to progress through similar stages of diabetic nephropathy, the route they take may differ. Differences in the way in which the glomeruli respond to the diabetic milieu may enable some type 2 diabetic patients to preserve their filtration surface in the face of an expanding mesangium.

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Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients

Cited by 404 publications

References 16 publications

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Dysmorphic erythrocytes are superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics

Diabetic nephropathy is associated with increased albumin and fibrinogen production in patients with type 2 diabetes

Are glomerular volume differences between type 1 and type 2 diabetic patients pathologically significant?

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