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The Natural Course of Microalbuminuria in Insulin‐dependent Diabetes: A 10‐year Prospective Study
Author(s) -
Mathiesen E.R.,
Rønn B.,
Storm B.,
Foght H.,
Deckert T.
Publication year - 1995
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1995.tb00528.x
Subject(s) - microalbuminuria , medicine , nephropathy , diabetes mellitus , diabetic nephropathy , proteinuria , prospective cohort study , albuminuria , endocrinology , blood pressure , excretion , gastroenterology , urology , kidney
The purpose of this study was to describe the clinical course in patients followed right from the onset of microalbuminuria to the development of diabetic nephropathy. A 10‐year prospective follow‐up of 209 consecutive normotensive insulin‐dependent diabetic patients with normal urinary albumin excretion (UAE <30 mg 24 h −1 ), age 34 (18–50) years and duration of diabetes 17 (10–30) years was performed. Twenty‐four‐hour urinary albumin excretion was measured every 4 months, glycated haemoglobin and supine blood pressure was measured annually. Two‐hundred (96%) patients completed 10 (range 5–10) years follow‐up. Twenty‐nine (15%) patients developed persistent microalbuminuria (UAE 30–300 mg 24 h −1 ). Eight of these have progressed to nephropathy and one had died of diabetic nephropathy. Multiple stepwise logistic regression analysis demonstrated baseline urinary albumin excretion ( p = 0.0016) and glycated haemoglobin ( p = 0.0014) but not blood pressure as predictors of development of microalbuminuria within the following 10 years. The median annual increase in urinary albumin excretion was 27 (range 17–65)% in the 29 patients developing microalbuminuria. The median duration from onset of microalbuminuria to development of nephropathy was 7 years. The prevalence of patients receiving antihypertensive treatment (BP > 140/90 mmHg) increased from 10% at onset of microalbuminuria to 45% 4 years after onset of microalbuminuria. The prevalence of patients with proliferative retinopathy increased from 7% at onset of microalbuminuria to 28% 4 years after onset of microalbuminuria. The incidence of persistent microalbuminuria in normotensive insulin‐dependent diabetic patients is 2% per year, and development of persistent microalbuminuria is a strong predictor of overt nephropathy. Development of hypertension is frequent in the early course of microalbuminuria and treatment modalities for normotensive patients with microalbuminuria are urgently needed.