Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long‐term follow‐up study of childhood onset type‐1 diabetic patients

Dahlquist, Gisela; Stattin, Eva‐Lena; Rudberg, Susanne

doi:10.1093/ndt/16.7.1382

Cited by 90 publications

(63 citation statements)

References 21 publications

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“…Glomerular hyperfiltration has been associated with various diseases including diabetes mellitus, polycystic kidney disease, secondary focal segmental glomerulosclerosis, obesity, sleep apnea, cancer and blood disorders [37]. In patients with diabetes, hyperfiltration was reported to be a significant risk factor for developing macro-or microalbuminuria [38]. In patients with pre-hypertension, subpopulations with hyperfiltration were supposed to be at increased risk for subsequent kidney damage [39].…”

Section: Discussionmentioning

confidence: 99%

Renal function in children and adolescents with Duchenne muscular dystrophy

Braat

Hoste

Waele

et al. 2015

Neuromuscular Disorders

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Improved life expectancy and the need for robust tools to monitor renal safety of emerging new therapies have fueled the interest in renal function in Duchenne muscular dystrophy (DMD) patients. We aimed to establish a methodology to accurately assess their renal function. Twenty DMD patients (5-22 years) were included in this prospective study. After obtaining medical history, all patients underwent a clinical examination, 24-hour ambulatory blood pressure monitoring, ultrasound of the kidneys, direct GFR measurement ( 51 Cr-EDTA, mGFR), complete blood and urine analysis. Seventeen of 20 patients were treated with corticosteroids and 5/20 with angiotensin converting enzyme inhibitor (lisinopril). No patient suffered from urinary tract infections or other renal diseases. Hypertension (systolic or diastolic blood pressure >P95) was found in 9/20 patients (8/9 patients were on steroid treatment) and a non-dipping blood pressure profile in 13/20 subjects (10/13 patients were on steroid treatment). Urinary protein to creatinine ratio was elevated in 17/18 patients, whereas 24-hour urine protein excretion was normal in all subjects. Median interquartile range (IQR) mGFR was 130.4 (29.1) mL/min/1.73 m 2 . Hyperfiltration (mGFR >150 mL/min/1.73 m 2 ) was found in 5/20 patients. Inverse correlation between mGFR and age was observed (R 2 = 0.45, p = 0.001). Serum creatinine based estimated GFR (eGFR) equations overestimated mGFR up to 300%. eGFR based on cystatin C Filler equation was closest to the mGFR (median eGFR (IQR) of 129.5 (39.7) mL/min/1.73 m 2 ). Our study demonstrates a high prevalence of hyperfiltration and hypertension in children and adolescents with DMD. Because the majority of hypertensive patients were under corticosteroid treatment, the iatrogenic cause of hypertension cannot be excluded. Serum or urine creatinine measurements are of no value to evaluate renal function in DMD patients due to the reduced skeletal muscle mass.

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Section: Discussionmentioning

confidence: 99%

Renal function in children and adolescents with Duchenne muscular dystrophy

Braat

Hoste

Waele

et al. 2015

Neuromuscular Disorders

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“…The decrease was observed in the cohort with onset of diabetes between 1979 and 1984, that is, 10 to 15 years later than in our study. A Swedish population study completed in 1999 reported a cumulative incidence of macroalbuminuria of 12% after an average diabetes duration of 29 years [21].…”

Section: Discussionmentioning

confidence: 99%

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Nordwall

Bojestig²,

Arnqvist³

et al. 2004

Diabetologia

187

122

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Aims/hypothesis. In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to10 years later in the same population. Methods. We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninetyone percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes.Results. The cumulative proportion of severe retinopathy had declined (p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years, it was 32% (20-44) and 11% (2-20) for the oldest cohorts (p<0.0001). Conclusions/interpretation. In an unselected population with Type 1 diabetes diagnosed in childhood, modern diabetes care markedly reduced the incidence of severe retinopathy and nephropathy.

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“…In type 1 diabetes, the reported prevalence of hyperfiltration usually ranges from 40% to 60% [2,9,15]. However, the prevalence of hyperfiltration in other studies in type 1 diabetes has varied from as low as 13% [16] to as high as 67% [17].…”

Section: Prevalence Of Hyperfiltration In Type 1 Diabetesmentioning

confidence: 98%

“…However, hyperfiltration has been traditionally defined as GFR >2 standard deviations above the mean GFR in control participants. The threshold for hyperfiltration has ranged from 125 to 140 ml min −1 1.73 m −2 in various studies [9,11,12].…”

Section: Measurement Of Gfrmentioning

confidence: 99%

“…In particular, it examines the evidence linking hyperfiltration to the onset of microalbuminuria and seeks to rationalise apparently divergent results obtained in several studies [7,8]. Initial hyperfiltration has also been associated with an increased rate of decline of GFR in some studies, and the onset and duration of this decline are also reviewed [9,10].…”

Section: Introductionmentioning

confidence: 99%

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The clinical significance of hyperfiltration in diabetes

et al. 2010

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Glomerular filtration rate is commonly elevated in early diabetes and patients with this symptom are arbitrarily considered to have hyperfiltration. The prevalence of hyperfiltration in type 1 diabetes varies from less than 25% to more than 75%. The corresponding figures in type 2 diabetes are significantly lower, ranging between 0% and more than 40%. Several factors, methodological and biological, may contribute to the wide variation in estimates of hyperfiltration prevalence. Methodological differences in measurement and evaluation of GFR apply in particular to the handling of plasma disappearance curves of filtration markers. Biological factors that may influence GFR in the hyperfiltration range include glycaemic control, diabetes duration, BMI, sex, pubertal status in type 1 diabetes and age in type 2 diabetes. Hyperglycaemia may influence GFR and albuminuria, and may therefore confound the evaluation of hyperfiltration as an independent risk factor for diabetic nephropathy. Adequate assessment of the relationship between glycaemic control, GFR and AER therefore requires serial measurements of all three variables followed by multivariate analysis. A recent meta-analysis of ten type 1 diabetes studies concluded that the presence of hyperfiltration at baseline more than doubled the risk of developing micro-or macroalbuminuria at follow-up. However, not all studies allowed for confounding factors or regression dilution bias. Future studies will therefore need to address the independent role of hyperfiltration, not only in the evolution of albuminuria, but also in the subsequent decline of GFR.

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Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long‐term follow‐up study of childhood onset type‐1 diabetic patients

Cited by 90 publications

References 21 publications

Renal function in children and adolescents with Duchenne muscular dystrophy

Renal function in children and adolescents with Duchenne muscular dystrophy

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

The clinical significance of hyperfiltration in diabetes

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