Microalbuminuria as Identified by a Spot Morning Urine Specimen in Non‐insulin‐treated Diabetes: an Eight‐year Follow‐up Study

Abstract

This study followed up a cohort of patients with microalbuminuria identified on a spot morning urine sample 8 years earlier and aimed to determine if a spot morning urinary albumin concentration was able to identify patients with non-insulin treated diabetes at increased risk of mortality and progression to nephropathy. In 1984, 47 of 216 patients chosen by random selection from our teaching hospital-based diabetes clinic were identified as having microalbuminuria (urinary albumin concentration 35-300 micrograms ml-1). Subjects were compared with an age-matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, 22 of 47 (46.8%) patients with microalbuminuria had died compared to 10 of 47 (21.3%) patients without albuminuria (p < 0.05). The majority of deaths were from cardiovascular disease (53.1%). Logistic regression showed microalbuminuria to be an independent predictor of mortality, not influenced by age, duration of diabetes, blood pressure, glycosylated haemoglobin or creatinine at the initial examination. Eight years later, in the group with initial microalbuminuria, eight still had microalbuminuria and five patients had developed nephropathy. In the group without albuminuria in 1984, only one patient had progressed to microalbuminuria and no patients to nephropathy. In conclusion, a spot urinary albumin concentration is of value in identifying patients with an increased risk of mortality or progression to nephropathy, and is simple to obtain at a clinic.

Proteinuria and metabolic syndrome as predictors of cardiovascular death in non-diabetic and type 2 diabetic men and women

“…Our finding that proteinuria alone predicted CVD is also in accord with findings from other studies [1][2][3][4][5][6][7][8][9][10][11][12]. Microalbuminuria has been shown to be related to insulin resistance and hyperinsulinaemia [35][36][37][38][39], and other components of metabolic syndrome, including blood pressure [40,41], high levels of triglycerides and apolipoprotein B [42,43] and obesity [44].…”

“…Microalbuminuria and proteinuria predict cardiovascular disease (CVD) events, not only in diabetic [1][2][3][4][5][6][7], but also in non-diabetic individuals [5,[8][9][10][11][12]. Microalbuminuria was included in the WHO definition of the metabolic syndrome in 1998 [13], but since then there has been debate about microalbuminuria as a component of the metabolic syndrome [14].…”

Prediction of cardiovascular events, diabetic nephropathy, and mortality by albumin concentration in a spot urine sample in patients with type 2 diabetes

“…However, these events were similarly predicted by UAC and 24-h UAE. Two case-controlled studies evaluated UAC measured in a random sample (Beatty et al, 1994;Beatty et al, 1995) and a positive association of high UAC values with DN was demonstrated. However, these studies did not evaluate the relationship of UAC with GFR, as performed in the present cohort.…”

“…UAC in a random urine specimen may be an alternative for the diagnosis of microalbuminuria in diabetic patients, especially considering its low cost and accuracy (Incerti, Camargo JL, Gross, & Azevedo, 2005). Data on the predictive role of albuminuria were based mainly on 24-h urine collections or non-random samples (Heerspink et al, 2008;Heerspink et al, 2010;Hillege et al, 2002;Hovid et al, 2004;Mogensen, 1984;Mogensen & Christensen, 1984;Parving, Oxenboll, Svendsen, Christiansen, & Andersen, 1982;Steinke, Sikaiko, & Kramer, 2005;Viberti, Hill, Jarrett, Argyropoulos, Mahmud, & Keen, 1982;Zandbergen et al, 2007) and few studies assessed in patients with diabetes the role of spot urine collections (Beatty, Ritchie, Bell, Hadden, Kennedy, & Atkinson, 1995;Beatty, Ritchie, Hadden, Kennedy, Bell, & Atkinson, 1994;Incerti et al, 2005).…”

Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study

“…Urinary albumin concentration was measured at Århus University Hospital by a polyethylene glycol radioimmunoassay. Spot urinary albumin concentration is of value in predicting both progression of renal involvement and increased mortality, as is albumin excretion rate [26]. …”