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      Relationship between Urinary Albumin Excretion and Glomerular Filtration Rate in Normotensive, Nonproteinuric Patients with Type 2 Diabetes mellitus

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          Background/Aim: In patients with type 2 diabetes mellitus, the relationship between glomerular filtration rate (GFR) and urinary albumin excretion remains an unresolved issue. In order to investigate the early renal function abnormalities, GFR and urinary albumin excretion were assessed, and their relationship was examined in normotensive patients with type 2 diabetes mellitus. Methods: In a cross-sectional study of 85 nonhypertensive Japanese patients with type 2 diabetes mellitus not showing overt proteinuria, the GFR was measured using <sup>99m</sup>Tc-diethylenetriamine pentaacetate renography. Fifty-one diabetic patients lacked microalbuminuria (albumin excretion <30 mg/day), while 34 patients showed microalbuminuria (between 30 and 300 mg/day). Fifteen healthy subjects served as controls. Results: The three groups were well matched with regard to gender, age, and body mass index. The GFR in microalbuminuric patients (134 ± 23 ml/min/1.48 m<sup>2</sup>) was significantly higher than in patients without microalbuminuria (108 ± 21 ml/min/1.48 m<sup>2</sup>) and in controls (109 ± 18 ml/min/1.48 m<sup>2</sup>; p < 0.0001). In type 2 diabetic patients, the GFR positively correlated with the logarithmically transformed urinary albumin excretion. Multiple regression analysis showed that the urinary albumin excretion was significantly and independently affected by GFR (β = 0.548), duration of diabetes (β = 0.297), and systolic blood pressure (β = 0.232; R<sup>2</sup> = 0.409; p < 0.0001). Conclusion: It is suggested that one of the mechanisms underlying increased urinary albumin excretion in early nephropathy in normotensive type 2 diabetes is glomerular hyperfiltration.

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          The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies.

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            Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus.

            The risk of microalbuminuria in patients with insulin-dependent diabetes mellitus (IDDM) is thought to depend on the degree of hyperglycemia, but the relation between the degree of hyperglycemia and urinary albumin excretion has not been defined. We measured urinary albumin excretion in three random urine samples obtained at least one month apart from 1613 patients with IDDM. Microalbuminuria or overt albuminuria was considered to be present if the ratio of albumin (in micrograms) to creatinine (in milligrams) was 17 to 299 or > or = 300, respectively, for men and 25 to 299 or > or = 300, respectively, for women. Measurements of glycosylated hemoglobin (hemoglobin A1) obtained up to four years before the urine testing were used as an index of hyperglycemia. Twelve percent of the patients had overt albuminuria and were excluded from subsequent analyses. The prevalence of microalbuminuria was 18 percent in patients with IDDM. It increased with increasing postpubertal duration of diabetes and, within each six-year interval of disease duration, it increased nonlinearly with the hemoglobin A1 value. For hemoglobin A1 values below 10.1 percent, the slope of the relation was almost flat, whereas for values above 10.1 percent, the prevalence of microalbuminuria rose steeply (P < 0.001). For example, as the hemoglobin A1 value increased from 8.1 to 10.1 percent, the odds of microalbuminuria increased by a factor of 1.3, but as the value increased from 10.1 to 12.1 percent, the odds were increased by a factor of 2.4. The risk of microalbuminuria in patients with IDDM increases abruptly above a hemoglobin A1 value of 10.1 percent (equivalent to a hemoglobin A1c value of 8.1 percent), suggesting that efforts to reduce the frequency of diabetic nephropathy should be focused on reducing hemoglobin A1 values that are above this threshold.
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              Estimation of in vivo capillary or venous blood glucose concentration from analysis on stored venous blood or its plasma and use in quality control of near-patient glucose tests


                Author and article information

                S. Karger AG
                September 2000
                30 August 2000
                : 86
                : 1
                : 36-43
                aSecond Department of Internal Medicine, and bDepartment of Radiology, Osaka City University Medical School, Osaka, Japan
                45710 Nephron 2000;86:36–43
                © 2000 S. Karger AG, Basel

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                Figures: 2, Tables: 3, References: 57, Pages: 8
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