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The determinants of early nephropathy in insulin-dependent diabetes mellitus: a prospective study based on the urinary excretion of albumin.

Abstract

A four-year prospective study of the factors predicting albuminuria was carried out in 172 normotensive, insulin-dependent diabetic patients without overt nephropathy. Urinary albumin excretion was estimated as the urinary albumin:creatinine ratio (UA/UC) in an early morning sample. Multivariate analysis showed that UA/UC on the return visit was positively associated with the UA/UC (p less than 0.001) and glycosylated haemoglobin (HbA1; p less than 0.001) at initial examination; weaker associations were found with a history of hospital admission (p less than 0.05) and smoking (p less than 0.05), and with treatment of blood pressure (p less than 0.05). Neither initial blood pressure, heart rate, nor creatinine clearance were significant predictors of the UA/UC. Two patients died from coronary heart disease, both of whom had raised albumin excretion at initial examination. Eleven (6.8 per cent) of the 160 patients who were studied repeatedly developed macroalbuminuria (UA/UC greater than 45.5 mg/mmol): they had a significantly higher initial UA/UC (p less than 0.005), HbA1 (p less than 0.05) and a greater frequency of retinopathy (p less than 0.05) than patients matched for age, sex and duration of diabetes who did not develop macroalbuminuria. Simultaneous measurements of the UA/UC and HbA1 should be used when screening for microalbuminuria in diabetes mellitus: patients with a high UA/UC (e.g. greater than 3.5 mg/mmol) and HbA1 (e.g. greater than 13 per cent) should be closely monitored even when blood pressure is normal.

Authors+Show Affiliations

,

Department of Endocrinology and Chemical Pathology, St Thomas's Hospital Medical School, UMDS, London.

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Source

The Quarterly journal of medicine 79:288 1991 Apr pg 365-78

MeSH

Albuminuria
Case-Control Studies
Creatinine
Diabetes Mellitus, Type 1
Diabetic Nephropathies
Female
Follow-Up Studies
Glycated Hemoglobin A
Humans
Male
Prospective Studies

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

1852860

Citation

Watts, G F., et al. "The Determinants of Early Nephropathy in Insulin-dependent Diabetes Mellitus: a Prospective Study Based On the Urinary Excretion of Albumin." The Quarterly Journal of Medicine, vol. 79, no. 288, 1991, pp. 365-78.
Watts GF, Harris R, Shaw KM. The determinants of early nephropathy in insulin-dependent diabetes mellitus: a prospective study based on the urinary excretion of albumin. Q J Med. 1991;79(288):365-78.
Watts, G. F., Harris, R., & Shaw, K. M. (1991). The determinants of early nephropathy in insulin-dependent diabetes mellitus: a prospective study based on the urinary excretion of albumin. The Quarterly Journal of Medicine, 79(288), pp. 365-78.
Watts GF, Harris R, Shaw KM. The Determinants of Early Nephropathy in Insulin-dependent Diabetes Mellitus: a Prospective Study Based On the Urinary Excretion of Albumin. Q J Med. 1991;79(288):365-78. PubMed PMID: 1852860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The determinants of early nephropathy in insulin-dependent diabetes mellitus: a prospective study based on the urinary excretion of albumin. AU - Watts,G F, AU - Harris,R, AU - Shaw,K M, PY - 1991/4/1/pubmed PY - 1991/4/1/medline PY - 1991/4/1/entrez SP - 365 EP - 78 JF - The Quarterly journal of medicine JO - Q. J. Med. VL - 79 IS - 288 N2 - A four-year prospective study of the factors predicting albuminuria was carried out in 172 normotensive, insulin-dependent diabetic patients without overt nephropathy. Urinary albumin excretion was estimated as the urinary albumin:creatinine ratio (UA/UC) in an early morning sample. Multivariate analysis showed that UA/UC on the return visit was positively associated with the UA/UC (p less than 0.001) and glycosylated haemoglobin (HbA1; p less than 0.001) at initial examination; weaker associations were found with a history of hospital admission (p less than 0.05) and smoking (p less than 0.05), and with treatment of blood pressure (p less than 0.05). Neither initial blood pressure, heart rate, nor creatinine clearance were significant predictors of the UA/UC. Two patients died from coronary heart disease, both of whom had raised albumin excretion at initial examination. Eleven (6.8 per cent) of the 160 patients who were studied repeatedly developed macroalbuminuria (UA/UC greater than 45.5 mg/mmol): they had a significantly higher initial UA/UC (p less than 0.005), HbA1 (p less than 0.05) and a greater frequency of retinopathy (p less than 0.05) than patients matched for age, sex and duration of diabetes who did not develop macroalbuminuria. Simultaneous measurements of the UA/UC and HbA1 should be used when screening for microalbuminuria in diabetes mellitus: patients with a high UA/UC (e.g. greater than 3.5 mg/mmol) and HbA1 (e.g. greater than 13 per cent) should be closely monitored even when blood pressure is normal. SN - 0033-5622 UR - https://www.unboundmedicine.com/medline/citation/1852860/The_determinants_of_early_nephropathy_in_insulin_dependent_diabetes_mellitus:_a_prospective_study_based_on_the_urinary_excretion_of_albumin_ L2 - http://www.diseaseinfosearch.org/result/2236 DB - PRIME DP - Unbound Medicine ER -