Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus

Abstract

Urinary albumin excretion has been consistently found to be normal in a significant number of subjects with early stages of diabetic kidney disease. This study was aimed to estimate the prevalence and characteristics of non-albuminuric chronic kidney disease associated with type 2 diabetes mellitus among subjects who reach advanced stages of renal failure. Study population was composed of incident patients with advanced chronic kidney disease (glomerular filtration rate 530 mL/min) related to type 2 diabetes in a tertiary hospital from Gran Canaria (Spain) during a period of 2 years. Subjects were classified as normoalbuminuric (urinary albumin-to-creatine ratio [UACR] 530 mg/g), microalbuminuric (UACR !30 and 5300 mg/g), or proteinuric (UACR !300 mg/g). Of 78 eligible patients, 21.8% had normoalbuminuria, 20.5% had microalbuminuria, and 57.7% had proteinuria. Individuals with normoalbuminuria were mostly women and had a lower prevalence of smoking and polyneuropathy than subjects with microalbuminuria or proteinuria. They also presented greater measures of body mass index and waist circumference, higher values of total and LDL cholesterol, and lower values of HbA 1c and serum creatinine than subjects with microalbuminuria or proteinuria. Multivariate analysis demonstrated that female sex (positively) and HbA 1c and polyneuropathy (negatively) were independently associated with absence of albuminuria. In conclusion, around 20% of subjects with diabetes-related advanced chronic kidney disease, characteristically women, have normal urinary albumin excretion. HbA 1c and polyneuropathy are inversely related to this non-albuminuric form of nephropathy.

Relationship between Anemia and Serum Concentrations of Calcium and Phosphorus in Advanced Non-Dialysis-Dependent Chronic Kidney Disease

“…In the present study, only 2 subjects were excluded as they showed missing values for blood hemoglobin levels; subsequently, the final sample size consisted of 382 participants. Detailed information of this survey has been described elsewhere [21,22] .…”

Normoalbuminuric diabetic kidney disease: a distinct entity?

“…Mesangial matrix proliferation, increased glomerular fibrosis, thickening of basement membrane, and increased type IV collagen in the interstitium and glomeruli are some pathological changes that were demonstrated in NADKD rats and patients [12]. Moreover, a faster eGFR decline in albuminuric DM patients was observed as compared with patients with NADKD [13]. Urinary NGAL and FABP are the important indicators of tubular injury in the kidney [14] that may be helpful in the diagnosis of NADKD.…”

Características clínicas de una población de diabéticos tipo 2 con alteración en la función renal no macroalbuminúricos

“…En cambio, la etiología de la ERD-NA en diabéticos tipo 2 podría ser más variable. Desafortunadamente, aunque la ERD-NA en diabéticos tipo 2 ha sido descrita en una gran variedad de estudios, en ellos se hace diferenciación respecto a características clínicas y hábitos entre su condición normoalbuminúrica vs. microalbuminuria o macroalbuminuria, sin recurrir a la biopsia renal para obtener un diagnostico definitivo [2][3][4][5][6][7] .…”

“…La prevalencia de esta enfermedad [2][3][4] varía entre 25 % a 50 % de los pacientes que exhiben TFG menor a 60 ml/min/1,73mt2. Los pacientes con ERD-NA presentan características diferentes a la población albuminúrica, tales como: mayor proporción de sexo femenino, edad mayor, menor TFG, buen control de la presión arterial, raza blanca no hispanos, menor prevalencia de tabaquismo y mayor prevalencia de polineuropatía [5][6][7] .…”