Risk Factors for Microalbuminuria and Macroalbuminuria in Type 2 Diabetic Patients

Murussi, Marcia; Baglio, Pierangelo Tadeu; Gross, Jorge Luiz; Silveiro, Sandra Pinho

doi:10.2337/diacare.25.6.1101

Cited by 43 publications

(48 citation statements)

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“…In our study, odds of incident albuminuria is elevated even in people with baseline UACR lower than traditional cutoff value (UACR<30 mg/g), which is consistent with findings from other studies [12][13][14] . Participants with UACR of 10-30 mg/g had 2.7-fold odds of developing albuminuria compared with those with UACR<5 mg/g.…”

Section: Discussionsupporting

confidence: 81%

“…Age, male sex, cholesterol concentration, and plasma triglycerides have been reported as risk factors for incident albuminuria in some studies 10,12,14 but not in others 11,13 . The different results could be due to different definitions for albuminuria, sample size, and statistical models (logistic regression vs. Cox proportional hazards models).…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria has been associated with increased risk of all-cause and cardiovascular disease (CVD) mortality in individuals with either type 1 or type 2 diabetes [2][3][4][5] , in hypertensive adults 6,7 , and in the general population 8,9 . Previous cross-sectional and cohort studies have shown that higher systolic blood pressure and cholesterol, worse glycemic control, and higher baseline albumin excretion rate predict albuminuria in type 2 diabetes [10][11][12][13][14] . To our knowledge no studies have employed data acquired at more than two time points or used methods of longitudinal data analysis to identify risk factors for albuminuria over time more effectively.…”

Section: Introductionmentioning

confidence: 99%

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A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Lee

Devereux

et al. 2008

American Journal of Kidney Diseases

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Lee

Devereux

et al. 2008

American Journal of Kidney Diseases

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“…However, clinicians need a precise reference value to adequately guide patients' treatment. UAER Ͼ10 g/ min has been associated with micro-and macroalbuminuria on Cox regression analysis in type 1 and type 2 diabetic patients (8,9). Our data indicate that patients with even lower levels of UAER are at risk.…”

Section: Leitã O and Associatesmentioning

confidence: 99%

Urinary Albumin Excretion Rate Is Associated With Increased Ambulatory Blood Pressure in Normoalbuminuric Type 2 Diabetic Patients

et al. 2005

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OBJECTIVE -To evaluate the 24-h blood pressure profile in normoalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in 90 type 2 diabetic patients with a urinary albumin excretion rate (UAER) Ͻ20 g/min on two occasions, 6 months apart (immunoturbidimetry). Patients underwent clinical and laboratory evaluations. Ambulatory blood pressure monitoring and echocardiograms were also performed.RESULTS -UAER was found to correlate positively with systolic doctor's office blood pressure measurements (r ϭ 0.243, P ϭ 0.021) and ambulatory blood pressure (24 h: r ϭ 0.280, P ϭ 0.008) and left ventricular posterior wall thickness (r ϭ 0.359, P ϭ 0.010). Patients were divided into four groups according to UAER (Ͻ5, Ն5-10, Ն10 -15, and Ն15-20 g/min). Systolic blood pressure parameters for the 1st, 2nd, 3rd, and 4th groups, respectively, were 123.0 Ϯ 10.6, 132.5 Ϯ 15.0, 139.0 Ϯ 23.4, and 130.7 Ϯ 8.0 mmHg for 24-h blood pressure (ANOVA P ϭ 0.004) and 48.4 Ϯ 6.0, 54.5 Ϯ 11.2, 58.8 Ϯ 15.6, and 57.6 Ϯ 8.0 mmHg for 24-h pulse pressure (ANOVA P ϭ 0.003). A progressive increase in the prevalence of diabetic retinopathy was observed from the 1st to the 4th UAER group: 27.3, 43.8, 45.5, and 66.7% (P ϭ 0.029 for trend).CONCLUSIONS -In type 2 diabetic patients, UAER in the normoalbuminuric range is positively associated with systolic ambulatory blood pressure indexes, left ventricular posterior wall thickness, and diabetic retinopathy, suggesting that intensive blood pressure treatment may prevent diabetes complications in these patients. Diabetes Care 28:1724 -1729, 2005M icroalbuminuria is a known risk factor for the development of clinical nephropathy in type 1 and type 2 diabetes (1-4), and it is also an independent risk factor for cardiovascular disease (4). The cutoff value used to define microalbuminuria (urinary albumin excretion rate [UAER] Ͼ20 g/min or Ͼ30 mg/24 h) (5) was defined by consensus, based on studies performed in patients with type 1 and type 2 diabetes in the 1980s (1-4). However, there is emerging evidence that patients with diabetes in the high-normal range of UAER are already at high risk for progressing to microalbuminuria or even more advanced stages of renal disease (6 -9).Arterial hypertension follows the establishment of microalbuminuria in patients with type 1 diabetes (10). In type 2 diabetes, this relationship is not that clear because hypertension is a common feature in these patients, regardless of renal status (11). Ambulatory 24-h blood pressure monitoring has a better correlation with target organ damage than doctor's office blood pressure measurements (12) and allows the evaluation of blood pressure parameters, such as circadian blood pressure rhythm and blood pressure loads. Nondiabetic healthy subjects in the high-normal range of UAER (15-20 mg/24 h) have higher blood pressure levels than nondiabetic individuals in the lower ranges of UAER (13). The same seems to be true for patients with type 1 diabetes and UAER above the median (4.2 g/min) (14), s...

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“…No entanto, estudos prospectivos de longa duração não conseguiram estabelecer um papel do aumento da taxa de filtração glomerular como fator de risco, quer seja para a microalbuminúria como para a nefropatia diabética (8).…”

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Microalbuminúria e a síndrome metabólica

Gross

2003

Arq Bras Endocrinol Metab

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A NEFROPATIA DIABÉTICA é uma complicação importante do diabetes pois acomete cerca de 30 a 40% dos pacientes, está associada a um aumento da mortalidade e evolui inexoravelmente para a perda progressiva de função renal, necessitando o uso de medidas de reposição da função renal (1).Diversos fatores de risco tem sido descritos para a nefropatia diabética, entre eles, o grau de hiperglicemia, a duração do diabetes, a presença de hipertensão arterial, o fumo e fatores genéticos (1). Marcadores de nefropatia diabética estão sendo enfaticamente procurados e a presença de microalbuminúria, isto é, um aumento da excreção urinária de albumina acima de 20 µg/min e menor do que 200 µg/min (2), é um dos fatores predisponentes mais estudados. Além disto é também um fator de risco para a doença cardiovascular (3), a principal causa de morte em pacientes com diabetes do tipo 2 (4). A presença de microalbuminúria está associada aos mesmos fatores de risco da nefropatia diabética e também à resistência insulínica e síndrome metabólica (5).A Organização Mundial da Saúde considera a presença de microalbuminúria como um dos componentes necessários para definir a presença de Síndrome Metabólica (6). Especula-se que a resistência insulínica determine disfunção endotelial e, por conseguinte, cause um aumento da permeabilidade da membrana glomerular. De fato, níveis séricos de endotelina-1, um marcador da função endotelial, estão mais elevados em pacientes com diabetes do tipo 2 e dislipidêmicos do que em pacientes apenas dislipidêmicos ou indivíduos normais. Os principais determinantes da elevação da endotelina são os níveis mais elevados de excreção urinária de albumina e o índice HOMA de resistência insulínica (7).Outro possível marcador precoce de nefropatia diabética é a hiperfiltração glomerular, que antecederia ainda o aparecimento da microalbuminúria. No entanto, estudos prospectivos de longa duração não conseguiram estabelecer um papel do aumento da taxa de filtração glomerular como fator de risco, quer seja para a microalbuminúria como para a nefropatia diabética (8).Neste número dos ABE&M, Cruz e colaboradores (9) testaram a hipótese de que alterações precoces da função renal -hiperfiltração glomerular e microalbuminúria -poderiam estar presentes em estágios iniciais da alteração da homeostase glicêmica, como a tolerância a glicose diminuída. Observaram que pacientes com tolerância a glicose diminuída apresentavam um índice de massa corporal maior, maior proporção de indivíduos com relação cintura quadril alterada, e níveis tensionais mais elevados. Alem disto, os índices de resistência insulínica também eram mais elevados neste grupo. Embora a prevalência de microalbuminúria nos pacientes com tolerância a glicose diminuída (21,1%) tenha sido maior do que no grupo controle (3,3%), esta diferença não atingiu a significância estatística convencional (9).Entretanto, estes resultados poderiam ser analisados de uma outra forma, sem que os pacientes fossem separados em dois grupos distintos.

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Risk Factors for Microalbuminuria and Macroalbuminuria in Type 2 Diabetic Patients

Abstract: Serum uric acid is a strong predictor of stroke in patients with noninsulin-dependent diabetes mellitus.

Cited by 43 publications

References 10 publications

A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Urinary Albumin Excretion Rate Is Associated With Increased Ambulatory Blood Pressure in Normoalbuminuric Type 2 Diabetic Patients

Microalbuminúria e a síndrome metabólica

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