Relationship between Urinary Albumin Excretion and Glomerular Filtration Rate in Normotensive, Nonproteinuric Patients with Type 2 Diabetes mellitus

Taniwaki, Hiromichi; Ishimura, Eiji; Emoto, Masanori; Kawagishi, Takahiko; Matsumoto, Naoki; Shoji, Tetsuo; Okamura, Terue; Inaba, Masaaki; Nishizawà, Yoshiki

doi:10.1159/000045710

Cited by 9 publications

(8 citation statements)

References 51 publications

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“…Similar changes have been demonstrated in white patients, with hyperfiltration present in 16% of 110 previously untreated type 2 diabetic patients [12]. Further cross-sectional studies measuring GFR isotopically have also demonstrated hyperfiltration in various racial groups [13][14][15][16][17].…”

Section: Introductionsupporting

confidence: 59%

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

et al. 2009

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Aims/hypothesis Glomerular hyperfiltration is a wellestablished phenomenon occurring early in some patients with type 1 diabetes. However, there is no consistent answer regarding whether hyperfiltration predicts later development of nephropathy. We performed a systematic review and meta-analysis of observational studies that compared the risk of developing diabetic nephropathy in patients with and without glomerular hyperfiltration and also explored the impact of baseline GFR. Methods A systematic review and meta-analysis was carried out. Cohort studies in type 1 diabetic participants were included if they contained data on the development of incipient or overt nephropathy with baseline measurement of GFR and presence or absence of hyperfiltration. Results We included ten cohort studies following 780 patients. After a study median follow-up of 11.2 years, 130 patients had developed nephropathy. Using a random effects model, the pooled odds of progression to a minimum of microalbuminuria in patients with hyperfiltration was 2.71 (95% CI 1.20-6.11) times that of patients with normofiltration. There was moderate heterogeneity (heterogeneity test p=0.05, measure of degree of inconsistency= 48%) and some evidence of funnel plot asymmetry, possibly due to publication bias. The pooled weighted mean difference in baseline GFR was 13.8 ml min −1 1.73 m −2 (95% CI 5.0-22.7) greater in the group progressing to nephropathy than in those not progressing (heterogeneity test p<0.01). Conclusions/interpretation In published studies, individuals with glomerular hyperfiltration were at increased risk of progression to diabetic nephropathy using study level data. Further larger studies are required to explore this relationship and the role of potential confounding variables.

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Section: Introductionsupporting

confidence: 59%

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

et al. 2009

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“…In diabetic patients, it has been proved that glomerular hyperfiltration plays a critical role in the initiation and progression of diabetic glomerulopathy. 13,15,16 In some cases, the increase of glomerular filtration can even precede MA. 16 With the disease progression, MA progresses to macroalbuminuria and GFR declines, so resolved glomerular hyperfiltration may not necessarily reflect a ''normalized'' GFR, but rather implicate a clinically important loss of filtration capacity in patients with MA.…”

Section: Discussionmentioning

confidence: 99%

“…13,15,16 In some cases, the increase of glomerular filtration can even precede MA. 16 With the disease progression, MA progresses to macroalbuminuria and GFR declines, so resolved glomerular hyperfiltration may not necessarily reflect a ''normalized'' GFR, but rather implicate a clinically important loss of filtration capacity in patients with MA. 12 Several methods of calculating GFR using endogenous creatinine, 23 Tc-pentectate 28 have been described in veterinary medicine.…”

Section: Discussionmentioning

confidence: 99%

“…Direct measurement of GFR is considered the gold standard test of renal function 10 and could be especially useful to evaluate proteinuric nonazotemic or border-line azotemic dogs. GFR in human beings with early stages of glomerular disease secondary to systemic lupus erythematous 11 or diabetes mellitus [12][13][14][15][16] is highly variable. Glomerular hyperfiltration exists in some of these patients, but in others a normal or low GFR occurs.…”

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confidence: 99%

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Glomerular Filtration Rate in Dogs with Leishmaniasis and Chronic Kidney Disease

Cortadellas

Palacio

Talavera

et al. 2008

Veterinary Internal Medicne

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Background: Glomerular filtration rate (GFR) measurement is an indicator of kidney function. However, its usefulness in dogs at early stages of spontaneous chronic kidney disease (CKD) of glomerular origin, where routine laboratory techniques are not sufficiently sensitive, remains unproved. Hypothesis: That GFR is reduced in proteinuric nonazotemic or mildly azotemic dogs with CKD secondary to leishmaniasis. Animals: Twenty‐six dogs with CKD secondary to leishmaniasis and 10 healthy dogs (control group). Methods: CBC, serum biochemistry, and urinalysis (microalbuminuria and urine protein/creatinine ratio [UPC]) were performed in all dogs. GFR was calculated by measuring exogenous creatinine clearance. Based on degree of proteinuria and serum creatinine concentration (SCr), dogs were classified as group A (control; n = 10): UPC < 0.2, SCr < 1.4 mg/dL; group B (n = 8): UPC, 0.2–0.5, SCr < 1.4 mg/dL; group C (n = 10): UPC > 0.5, SCr < 1.4 mg/dL; group D (n = 5): SCr, 1.4–2 mg/dL; group E (n = 3): SCr > 2 mg/dL. Results: GFR (mL/kg/min) was 3.9 ± 0.29, 4.4 ± 0.74, 4.5 ± 1.44, 2.8 ± 0.97, and 1.5 ± 0.43 for groups A, B, C, D, and E, respectively. Eleven dogs (1 from group B, 3 from group C, 4 from group D, and all 3 dogs from group E) had an abnormally low GFR. Four dogs from group B and 5 dogs from group C had a GFR above the upper reference range (>4.5 mL/min/kg). Conclusion and Clinical Relevance: Some proteinuric nonazotemic or mildly azotemic dogs with leishmaniasis have low GFR, but glomerular hyperfiltration occurs in other dogs.

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“…In the present study, we found that a characteristic feature of normotensive recipients with microalbuminuria was an increase in single kidney GFR for grafts after transplantation. The GFR of microalbuminuric patients with type 2 diabetes mellitus was significantly higher than non‐microalbuminuric and non‐diabetic patients 24 . Eberhard et al .…”

Section: Discussionmentioning

confidence: 96%

Clinical characteristics of normotensive renal transplant recipients with microalbuminuria and effects of angiotensin II type I receptor antagonist on urinary albumin excretion

et al. 2004

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Aim: Microalbuminuria is typically observed in renal transplant recipients with systemic hypertension. The effects of angiotensin II type 1 receptor antagonist (losartan) on the hypertensive recipients have been evaluated. However, the clinical background of normotensive recipients with microalbuminuria and the effect of losartan administration in those subjects have not been clarified. One of the two purposes for the present study was to investigate the clinical characteristics of normotensive recipients with microalbuminuria. The other was to evaluate the effect of losartan on urinary excretion of albumin in these patients. Methods:The clinical data and the change of the single kidney glomerular filtration rate (GFR) for the graft by radionuclide study were assessed in 13 normotensive recipients with microalbuminuria. These were compared with the data of 13 normotensive patients without microalbuminuria. The 13 recipients with microalbuminuria were treated with losartan for one year and urine excretion of albumin, N-acetyl-b-D-glucosaminidase (NAG) and serum creatinine (S-Cr) levels were measured. Results:The GFR of the grafts from donors to recipients significantly increased (30.9 to 55.2 mL/ min) in microalbuminuric recipients, but did not significantly increase in the non-microalbuminuric recipients. Decreases of the urinary excretion rate of albumin (351 ± 261 at baseline to 158 ± 14 mg/ gCr at 12 months), NAG (13 ± 5 to 10 ± 3 IU/gCr) and S-Cr (1.7 ± 0.6 to 1.5 ± 0.4 mg/dL) were observed in the microalbuminuric recipients with losartan administration. Conclusions:The present study suggests that an increased single kidney GFR of the graft from the donor in situ to the recipient might be a cause of microalbuminuria in normotensive recipients. The one-year effects of losartan were observed in terms of the decrease in urinary excretion of albumin, NAG and S-Cr levels.

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Relationship between Urinary Albumin Excretion and Glomerular Filtration Rate in Normotensive, Nonproteinuric Patients with Type 2 Diabetes mellitus

Cited by 9 publications

References 51 publications

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

Glomerular Filtration Rate in Dogs with Leishmaniasis and Chronic Kidney Disease

Clinical characteristics of normotensive renal transplant recipients with microalbuminuria and effects of angiotensin II type I receptor antagonist on urinary albumin excretion

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