Diabetes & Metabolism Journal

Original Articles

Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults: Mervat M. El-Eshmawy, Hala A. Abd El-Hafez, Walaa Othman El Shabrawy, Ibrahim A. Abdel Aal; Diabetes Metab J. 2013;37(6):450-457. Published online December 12, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.6.450

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Background

Recent evidence has suggested an association between subclinical hypothyroidism (SCH) and microalbuminuria in patients with type 2 diabetes. However, whether SCH is related to microalbuminuria among subjects with prediabetes has not been studied. Thus, we evaluated the association between SCH and microalbuminuria in a cohort of prediabetic Egyptian adults.

Methods

A total of 147 prediabetic subjects and 150 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR), thyroid stimulating hormone (TSH), free thyroxine, triiodothyronine levels, and urinary albumin-creatinine ratio (UACR) were assessed.

Results

The prevalence of SCH and microalbuminuria in the prediabetic subjects was higher than that in the healthy controls (16.3% vs. 4%, P<0.001; and 12.9% vs. 5.3%, P=0.02, respectively). Prediabetic subjects with SCH were characterized by significantly higher HOMA-IR, TSH levels, UACR, and prevalence of microalbuminuria than those with euthyroidism. TSH level was associated with total cholesterol (P=0.05), fasting insulin (P=0.01), HOMA-IR (P=0.01), and UACR (P=0.005). UACR was associated with waist circumference (P=0.01), fasting insulin (P=0.05), and HOMA-IR (P=0.02). With multiple logistic regression analysis, SCH was associated with microalbuminuria independent of confounding variables (β=2.59; P=0.01).

Conclusion

Our findings suggest that prediabetic subjects with SCH demonstrate higher prevalence of microalbuminuria than their non-SCH counterparts. SCH is also independently associated with microalbuminuria in prediabetic subjects. Screening and treatment for SCH may be warranted in those patients.

Citations

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The prevalence of subclinical hypothyroidism in a pre-diabetes population and an analysis of related factors
Xingyu Chang, Yaqi Wang, Yi Liu, Yanyu Shen, Jiaqing Feng, Qianqian Liu, Chenjun Jiang, Jing Yu, Xulei Tang, Gaojing Jing, Qianglong Niu, Songbo Fu
Annals of Medicine.2023; 55(1): 643. CrossRef
High Thyroid-Stimulating Hormone and Low Free Triiodothyronine Levels Are Associated with Chronic Kidney Disease in Three Population-Based Studies from Germany
Till Ittermann, Sabrina von Rheinbaben, Marcello R. P. Markus, Marcus Dörr, Antje Steveling, Matthias Nauck, Alexander Teumer, Maik Gollasch, Dominik Spira, Maximilian König, Ilja Demuth, Elisabeth Steinhagen-Thiessen, Henry Völzke, Sylvia Stracke
Journal of Clinical Medicine.2023; 12(17): 5763. CrossRef
Free triiodothyronine predicts the risk of developing diabetic kidney disease
Weihong Li, Zhi Yang, Shengjian Li, Shanshan Jiang, Wan Hu, Zhenying Wan, Ping Tu, Peng Duan
BMC Nephrology.2023;[Epub] CrossRef
The Correlation between Thyroid Hormone Levels and the Kidney Disease Progression Risk in Patients with Type 2 Diabetes
Zhi Yang, Peng Duan, Weihong Li, Ronghui Nie, Xiaoyang Lou, Lina Wang, Kexia Wu, Jiang Liu, Ping Tu, Xiaoyang Lai
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 59. CrossRef
Thyroid hormone status in patients with impaired kidney function
Juliane Peters, Stefanos Roumeliotis, Peter R. Mertens, Vassilios Liakopoulos
International Urology and Nephrology.2021; 53(11): 2349. CrossRef
Subclinical hypothyroidism is associated with albuminuria in Japanese nondiabetic subjects
Akiko Toda, Shigeko Hara, Hiroshi Tsuji, Yasuji Arase
Endocrine.2020; 68(3): 592. CrossRef
Hypothyroidism and Kidney Function: A Mendelian Randomization Study
Christina Ellervik, Samia Mora, Paul M. Ridker, Daniel I. Chasman
Thyroid.2020; 30(3): 365. CrossRef
Relationship between serum thyrotropin and urine albumin excretion in euthyroid subjects with diabetes
Gautam Das, Peter N Taylor, Hussam Abusahmin, Amer Ali, Brian P Tennant, John Geen, Onyebuchi Okosieme
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine.2019; 56(1): 155. CrossRef
The longitudinal effect of subclinical hypothyroidism on urine microalbumin-to-urine creatinine ratio in patients with type 2 diabetes mellitus
Juan Xie, Xiaoqing Wang, Yiyuan Zhang, Hailun Li, Yong Xu, Donghui Zheng
BMC Endocrine Disorders.2019;[Epub] CrossRef
The effect of l-thyroxine substitution on oxidative stress in early-stage diabetic nephropathy patients with subclinical hypothyroidism: a randomized double-blind and placebo-controlled study
Yong Chen, Ganlin Wu, Meirong Xu
International Urology and Nephrology.2018; 50(1): 97. CrossRef
Association between subclinical hypothyroidism and diabetic nephropathy in type 2 diabetes
Ayman Abd-Elrahman Mohamed Nsr-Allah, Azza H. Abd-El Fatah, Mahmoud Azab, Maggie M. Fawzi
The Egyptian Journal of Internal Medicine.2018; 30(3): 160. CrossRef
Role of Microalbuminuria in Predicting Cardiovascular Mortality in Individuals With Subclinical Hypothyroidism
Tushar A. Tuliani, Maithili Shenoy, Kevin Belgrave, Abhishek Deshmukh, Sadip Pant, Anthony Hilliard, Luis Afonso
The American Journal of the Medical Sciences.2017; 354(3): 285. CrossRef
Inositol(s) in thyroid function, growth and autoimmunity
Salvatore Benvenga, Alessandro Antonelli
Reviews in Endocrine and Metabolic Disorders.2016; 17(4): 471. CrossRef
Hypothyroïdie infra-clinique et risque d’évènements cardiovasculaires chez la femme diabétique de type 2
M. Gourine, K. Bentadj, S. Mostefa-Kara, A. Cherrak, S. Halimi, M. Belhadj
Médecine des Maladies Métaboliques.2016; 10(5): 466. CrossRef
Can levothyroxine treatment reduce urinary albumin excretion rate in patients with early type 2 diabetic nephropathy and subclinical hypothyroidism? A randomized double-blind and placebo-controlled study
Peng Liu, Ruidong Liu, Xia Chen, Yingying Chen, Debao Wang, Fengmei Zhang, Yangang Wang
Current Medical Research and Opinion.2015; 31(12): 2233. CrossRef
Free Triiodothyronine Levels Are Associated with Diabetic Nephropathy in Euthyroid Patients with Type 2 Diabetes
Jingcheng Wu, Xiaohua Li, Yang Tao, Yufei Wang, Yongde Peng
International Journal of Endocrinology.2015; 2015: 1. CrossRef
Letter: Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults (Diabetes Metab J2013;37:450-7)
In-Kyung Jeong
Diabetes & Metabolism Journal.2014; 38(1): 83. CrossRef
Free Triiodothyronine Concentrations Are Inversely Associated with Microalbuminuria
Yulin Zhou, Lei Ye, Tiange Wang, Jie Hong, Yufang Bi, Jie Zhang, Baihui Xu, Jichao Sun, Xiaolin Huang, Min Xu
International Journal of Endocrinology.2014; 2014: 1. CrossRef
Thyroid hormone and heart failure: from myocardial protection to systemic regulation
Laura Sabatino, Giorgio Iervasi, Alessandro Pingitore
Expert Review of Cardiovascular Therapy.2014; 12(10): 1227. CrossRef

Homocysteine as a Risk Factor for Development of Microalbuminuria in Type 2 Diabetes: Eun-Hee Cho, Eun Hee Kim, Won Gu Kim, Eun Hui Jeong, Eun Hee Koh, Woo-Je Lee, Min-Seon Kim, Joong-Yeol Park, Ki-Up Lee; Korean Diabetes J. 2010;34(3):200-206. Published online June 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.3.200

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Abstract PDF PubReader

Background

Kidney function is critical in homocysteine clearance, and plasma homocysteine level is frequently increased in patients with renal failure. On the other hand, recent studies in animals have shown that hyperhomocysteinemia induces renal injury. In this study, we determined whether hyperhomocysteinemia can be a risk factor for the development of microalbuminuria in patients with type 2 diabetes.

Methods

A nested case-control study. Of 887 patients with type 2 diabetes who did not have microalbuminuria at baseline, 76 developed microalbuminuria during follow-up (mean, 36.0 ± 11.7 months; range, 18 to 76 months). The control group consisted of 152 age- and sex-matched subjects who did not develop microalbuminuria. Baseline plasma homocysteine concentrations were measured in stored samples.

Results

Baseline plasma homocysteine concentrations and mean HbA1C levels during follow-up were significantly higher in patients who developed microalbuminuria than in those who remained normoalbuminuric. Multivariate logistic regression analysis showed that baseline plasma homocysteine level and mean HbA1C were independent predictors of microalbuminuria in type 2 diabetes.

Conclusion

Hyperhomocysteinemia was associated with increased risk of microalbuminuria in patients with type 2 diabetes supporting the concept that hyperhomocysteinemia has an etiologic role in the pathogenesis of diabetic nephropathy.

Citations

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Homocysteine and diabetes: Role in macrovascular and microvascular complications
Emir Muzurović, Ivana Kraljević, Mirsala Solak, Siniša Dragnić, Dimitri P. Mikhailidis
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Associations of Homocysteine with B Vitamins and Zinc in Serum Levels of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
Sadako MATSUI, Chika HIRAISHI, Ryo SATO, Takai KOJIMA, Kiyotaka ANDO, Kei FUJIMOTO, Hiroshi YOSHIDA
Journal of Nutritional Science and Vitaminology.2021; 67(6): 417. CrossRef
A risk scoring system for the decreased glomerular filtration rate in Chinese general population
Yan Gu, Min Chen, Bei Zhu, Xiaohua Pei, Zhenzhu Yong, Xiaona Li, Qun Zhang, Weihong Zhao
Journal of Clinical Laboratory Analysis.2020;[Epub] CrossRef
Relationship between plasma total homocysteine and the severity of renal function in Chinese patients with type 2 diabetes mellitus aged ≥75 years
Ning Ma, Ning Xu, Dong Yin, Weiwei Liu, Mengping Wu, Xingbo Cheng
Medicine.2020; 99(27): e20737. CrossRef
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Yifang Zhong, Feng Yan, Weixia Jie, Ying Zhou, Fang Fang
Pteridines.2019; 30(1): 114. CrossRef
The role of molecular genetic alterations in genes involved in folate and homocysteine metabolism in multifactorial diseases pathogenesis
A. M. Burdennyy, V. I. Loginov, T. M. Zavarykina, E. A. Braga, A. A. Kubatiev
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МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИЕ НАРУШЕНИЯ ГЕНОВ ФОЛАТНОГО И ГОМОЦИСТЕИНОВОГО ОБМЕНА В ПАТОГЕНЕЗЕ РЯДА МНОГОФАКТОРНЫХ ЗАБОЛЕВАНИЙ, "Генетика"
А. М. Бурдённый, В.И. Логинов, Т.М. Заварыкина, Э.А. Брага, А.А. Кубатиев
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NMDA Receptors as Potential Therapeutic Targets in Diabetic Nephropathy: Increased Renal NMDA Receptor Subunit Expression in Akita Mice and Reduced Nephropathy Following Sustained Treatment With Memantine or MK-801
Hila Roshanravan, Eun Young Kim, Stuart E. Dryer
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Association between homocysteine status and the risk of nephropathy in type 2 diabetes mellitus
Song Mao, Wei Xiang, Songming Huang, Aihua Zhang
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Prevalence and Determinants of Diabetic Nephropathy in Korea: Korea National Health and Nutrition Examination Survey
Jae Hee Ahn, Ji Hee Yu, Seung-Hyun Ko, Hyuk-Sang Kwon, Dae Jung Kim, Jae Hyeon Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Kyungdo Han, Bong-Yun Cha, Nan Hee Kim
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Plasma Homocysteine level and its clinical correlation with type 2 diabetes mellitus and its complications
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Is C677T Polymorphism in Methylenetetrahydrofolate Reductase Gene a Risk Factor for Diabetic Nephropathy or Diabetes Mellitus in a Chinese Population?
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Clinical Significance of Decreased Glomerular Filtration Rate (GFR) without Albuminuria among Type 2 Diabetics.: Ji Eun Lee, Kyu Chang Won, Hyoung Woo Lee, Ji Sung Yoon; Korean Diabetes J. 2008;32(3):252-258. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.252

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Abstract PDF

BACKGROUND
Microalbuminuria in type 2 diabetes is a predictor of development of clinical nephropathy and cardiovascular disease. But, it has been reported that reduced glomerular filtration rate (GFR) may occur in some normoalbuminuric diabetic patients. The aim of this study was to identify whether decreased GFR without microalbuminuria is to predict diabetic vascular complications. METHODS: Between January 1998 and February 2001, 73 patients with type 2 diabetes who visited Yeungnam university medical center were divided into 5 groups according to initial GFR ranges: group 1 (GFR < 30 mL/min), group 2 (30 < or = GFR < 60 mL/min), group 3 (60 < or = GFR < 90 mL/min), group 4 (90 < or = GFR < 125 mL/min), group 5 (125 mL/min < or = GFR). They were examined for microvascular and macrovascular complications initially and after 4 years. RESULTS: Decreased GFR had a negative correlation with age (r = -0.472, P = 0.001). Decreased GFR without microalbuminuria had a significant correlation with development of diabetic nephropathy (P = 0.016) after 4 years. There were no significant correlation with the prevalence of diabetic retinopathy, peripheral neuropathy, and macrovacular disease. But, our study showed that coronary artery disease had an increasing tendency with decreased GFR without statistical significance (P = 0.085). CONCLUSIONS: Our data suggest that reduced GFR, independent of albuminuria, may be an important predictor of diabetic nephropathy and coronary artery disease to some extent. So we recommend that not only the microalbuminuria, but also the decrease in GFR should be evaluated at the follow-up of patients with type 2 diabetes.

Citations

Citations to this article as recorded by

Screening and Management of Diabetic Nephropathy
Ji Sung Yoon
The Journal of Korean Diabetes.2013; 14(1): 19. CrossRef

Review

The Role of Glomerular Podocytes in Diabetic Nephropathy.: Eun Young Lee, Choon Hee Chung; Korean Diabetes J. 2007;31(6):451-454. Published online November 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.6.451

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Abstract PDF

Diabetic nephropathy is the most common cause of end-stage renal disease and accounts for significant morbidity and mortality among individuals with diabetes mellitus. Therefore, the clarification of the pathogenesis of diabetic nephropathy is an urgent issue. Podocytes cover the outer layer of the glomerulus and maintain its integrity so that fluid and toxins exit in urine, but cells and important proteins are kept in the blood stream. Diabetes mellitus alters this structure, it becomes scarred and then the ability of the kidney to clear toxins is lost. Recent evidence shows that early in diabetes the podocyte number is reduced, areas of the glomerular basement membrane are denuded, and podocyte number predicts long-term urinary albumin excretion in the patients with diabetes and microalbuminuria. These results suggest that podocytes play a critical role in the early stage of diabetic nephropathy. It is the purpose of this article to review the pathogenetic role of podocytes in diabetic nephropathy.

Citations

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Inhibition of dipeptidyl peptidase-4 (DPP4), antioxidant, antiglycation and anti-inflammatory effect of Ferulic acid against streptozotocin toxicity mediate nephropathy in diabetic rats
Maryam A. AL-Ghamdi, Said S. Moselhy
Environmental Science and Pollution Research.2022; 30(12): 33942. CrossRef
Study of Antiglycation, Hypoglycemic, and Nephroprotective Activities of the Green Dwarf Variety Coconut Water (Cocos nucifera L.) in Alloxan-Induced Diabetic Rats
Isabella F.D. Pinto, Railmara P. Silva, Adriano de B. Chaves Filho, Lucas S. Dantas, Vanderson S. Bispo, Isaac A. Matos, Felipe A.M. Otsuka, Aline C. Santos, Humberto Reis Matos
Journal of Medicinal Food.2015; 18(7): 802. CrossRef
Effects of ferulic acid on diabetic nephropathy in a rat model of type 2 diabetes
Ran Choi, Bo Hwan Kim, Jarinyaporn Naowaboot, Mi Young Lee, Mi Ri Hyun, Eun Ju Cho, Eun Soo Lee, Eun Young Lee, Young Chul Yang, Choon Hee Chung
Experimental and Molecular Medicine.2011; 43(12): 676. CrossRef

Original Articles

Plasminogen Activator Inhibitor-1 (PAI-1)/tissue Plasminogen Activator (t-PA) Levels and PAI-1 4G/5G Promoter Polymorphism in Type 2 Diabetes with Microalbuminuria.: Seong Hee Kwon, Young Joo Park, In Kyong Jeong, Jae Joon Koh, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee; Korean Diabetes J. 2003;27(3):186-198. Published online June 1, 2003

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Abstract PDF: BACKGROUND
Persistent microalbuminuria in diabetic patients is a risk factor of cardiovascular mortality. Increased plasma plasminogen activator inhibitor type-1 (PAI-1) levels have been observed in diabetic patients with overt nephropathy. However, there have been few studies on diabetic patients with microalbuminuria. The expression of PAI-1 may be influenced by the polymorphism of the PAI-1 genotype promoter. The aim of this study was to investigate the relationship between the plasma PAI-1/t-PA levels, polymorphism of the PAI-1 4G/5G promoter and microalbuminuria in type 2 diabetes. METHODS: The plasma PAI-1/t-PA levels and polymorphisms of the PAI-1 promoter were measured in type 2 diabetic patients without nephropathy (n=30), and with microalbuminuria (n=30) and overt proteinuria (n=20). The correlation between the amount of urinary albumin excretion and plasma PAI-1/t-PA levels were investigated using Pearson's correlation analyses. RESULTS: The plasma PAI-1/t-PA levels and polymorphisms of the PAI-1 promoter showed no significant difference between the three groups in relation to the urinary albumin excretion. There were no differences in the plasma PAI-1/t-PA levels between the genotypes of the polymorphism of the PAI-1 promoter. No association was found between the amount of urinary albumin excretion and the plasma PAI-1/t-PA levels and genotypes of the polymorphism of the PAI-1 promoter. CONCLUSION: These results show that there was no decrease in the fibrinolytic state in type 2 diabetics with microalbuminuria, compared to normoalbuminuria, which also suggest that polymorphisms of the PAI-1 4G/5G promoter do not affect the plasma PAI-1/t-PA levels in type 2 diabetic patients with microalbuminuria.

Left Ventricular Mass Index Increases in Proportion to the Urinary Microalbumin Excretion Rate in Type 2 Diabetes.: Seung Ha Park, Won Young Lee, Sun Woo Kim; Korean Diabetes J. 2002;26(6):500-508. Published online December 1, 2002

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Abstract PDF: BACKGROUND
In type 2 diabetes, microalbuminuria is an early marker of the atherosclerotic process and of endothelial dysfunction. It has also been shown to be related with the prevalence and morbidity of renal and cardiovascular diseases, and is associated with other risk factors of vascular damage. Left ventricular hypertrophy (LVH) has long been established as a major independent marker of future cardiovascular morbidity and mortality, depending on the body mass and blood pressure load. In order to clarify any association between the urinary microalbumin excretion rate (UAER) and the left ventricular mass index (LVMI), which may explain the observed poor prognosis in these patients, we analysed the clinical characteristics and laboratory findings data of type 2 diabetes. METHODS: We conducted a cross-sectional study of 48 patients with type 2 diabetes, who had been echocardiographically assessed and their 24-h urine collection analyzed for UAER, and the patients with clinical evidence of heart and renal diseases were excluded. The patients were divided into two groups according to their mean LVMI value (Low LVMI group: LVMI <97 g/m2, n=26; High LVMI group: LVMI >or=97 g/m2, n=22). RESULTS: The UAER, and systolic and diastolic blood pressures, were higher in the High LVMI group, but age, sex, body mass index (BMI) and duration of diabetes were similar in both group. The correlation of UAER and systolic blood pressure with LVMI remained significant, even after a multiple regression analysis (p=0.042, p=0.01 respectively). CONCLUSION: The significant relationship between the UAER and LVMI was independent of blood pressure, age, sex, BMI, duration of diabetes and other cardiovascular risk factors in type 2 diabetes. Therefore, an increased UAER may play an important role in the development of LVH.

Lack of Effectiveness of Glomerular Hyperfiltration on Development of Microalbuminuria in Type 2 Diabetic Patients: five Year Follow-up Study.: Eun Sook Kim, Sang Wook Kim, Jin Yub Kim, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1999;23(2):155-161. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Glomerular hyperfiltration (GHF) is found in 30-40% of patients with type 1 diabetes at the onset of the disease. Several lines of evidence suggest that this might be responsible for the development of diabetic nephropathy. However, it is still controversial whether GHF is a risk factor in patients with type 2 diabetes. This led us to perform a five-year-prospective study in normoalbuminuric type 2 diabetic patients. METHODS: A total of 68 patients with type 2 diabetes were studied prospectively, They were all normoalbuminuric initially. Glomerular filtration rate was determined by the 51Cr-EDTA single injection method and urinary albumin excretion rate by the radioimtnunoassay method. RESULTS: GHF was present in 19 out of 68 patients. At follow-up, l7 out of 49 patients of the normofiltration group and 3 out of 19 patients of GHF group progressed to microalbuminuria (p>0.05). Multiple logistic regression analysis revealed that the known duration of diabetes, systolic hypertension, and the presence of retinopathy were independently associated with the development of microalbuminuria. CONCLUSION: Our study suggests that GHF does not predict the subsequent development of diabetic nephropathy as indicated by the elevation of the urinary albumin excretion rate during the five year interval.

Microalbuminuria in Diabetic and Non-diabetic Subjects: A population Based Study.: Young Il Kim, Yun Ey Chung, Jin Yup Kim, Sang Wook Kim, Eun Sook Kim, Moo Song Lee, Joong Yeoul Park, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1999;23(1):79-86. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Microalbuminuria is associated with increased cardiovascular mortality in type 2 diabetic patients and non-diabetic subjects. This study was undertaken to determine the prevalence ot microalbuminuria among diabetic and non-diabetic subjects in Korea and to determine the factors associated with microalbuminuria. METHOD: A sample of 1,791 subjects aged > 40 years living in Jungup district were selected from the 28,380 inhabitants using a random cluster sampling method. Among these subjects, 1,006 of them (56.1%) underwent the 75 g oral glucose tolerance test that was also part of the timed overnight urine collection. 46 subjects were excluded because they had signs of urinary tract infection (n=41) or overt proteinuria (n=5). Microalbuminuria was defined as urinary albumin excretion rate (UAER) between 20 and 200 pg/min. RESULTS: Subjects with microalbuminuria had a higher weight and body mass index (BMI), abdominal circumference, systolic and diastolic blood pressure (BP), fasting and 2hr plasma glucose, fasting semm insulin and proinsulin concentrations than subjects without microalbuminuria. The prevalence of micro- albuminuria increased as the glucose tolerance worsened[6.0% in normal glucose tolerance, 11.8% in impaired glucose tolerance (IGT) and 21.8% in diabetes, respectively; x trend=25.9, p<0.(0001]. Mean UAER of subjects with hypertension was greater than that of subjects without hypertension (7.8+0.9ug/min vs. 9.6+0.7ug/min, p<0.001). Univariate analysis revealed that the UAER was significantly (p<0.05) correlated with weight and BMI, abdominal circumference, systolic and diastolic BP, fasting and 2hr plasma glucose, fasting serum insulin and proinsulin after sex-adjustment. Multiple regression analysis revealed that weight or BMI, diastolic BP, 2hr plasma glucose and fasting serum insulin were independently associated with UAER in non-diabetic subjects. CONCLUSION: The present study demonstrates that the prevalence of microalburninuria is higher in patients with glucose intolerance. The association of the UAER with BMI, diastolic BP, 2hr plasma glucose and fasting serum insulin suggest that microalbuminuria is a feature of the insulin resistance syndrome.

Changes of Glomerular Filtration Rate and Urinary Albumin Excretion Rate in NIDDM patients with Microalbuminuria.: Hyo Jung Kim, Jung Min Koh, Eun Sug Shin, Yun Ey Chung, Young Il Kim, Chul Hee Kim, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1997;21(4):414-424. Published online January 1, 2001

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Abstract PDF: BACKGROUND
We previously suggested that micro-albuminuria in the presence of retinopathy may represent a state of real incipient diabetic nephropathy with declining glomerular filtration rate(GFR), while the meaning of microalbuminuria in the absence of retinopathy may be more heterogeneous. This study was performed to further test this hypothesis. METHODS: We prospectively followed up the changes in GFR and urinary albumin excretinn rate (UAE) in microalbuminuric NIDDM patients with or without diabetic retinopathy for 3.1 years. RESULTS: 1) Among 45 patients who completed the followup, 27 had retinopathy from the baseline(group A), while 18 patients did not have retinopathy throughout the study(group B). 2) UAE at baseline was not statistically different between the group A and group B. During follow-up, VAE remained stable in the group B patients(40.0 [20.5 ~ 158.0) to 60.0[20.2 ~ 231.0] ug/min, NS). On the other hand, UAE significantly increased in the group A patients(47.9[20.0~186.0] to 140.0[24.5~2862.0] ug/min, P <0.001). 3) Thirty percent of the group A patients(8/27) progressed to overt proteinuria, while 11%(2/18) of the group B patients developed overt proteinuria(NS). 4) GFR significantly decreased both in the group A (113.0+21.2 to 89.1+24.0 mL/min/1.73 m, P < 0,001) and in the group B patients(134.1+27.2 to 121.5+27.3 mL/min/1.73 m, P<0.01). However, the magnitude of change in GFR was significantly higher in the group A than in the group B patients(7.7+7.6 vs 3.9+4.2 mL/min/1.73 m /year, P <0.05), 5) Multiple logistic regression analysis revealed that the presence of retinopathy was a independent risk factor for faster decline in GFR. CONCLUSION: It appears that clinical course is different in NIDDM patients with microalbuminuria, according to the presence or absence of diabetic retinopathy. Microalbuminuria in the presence of retinopathy predicts aggravation of albuminuria and decline in GFR. In contrast, the renal function in microalbuminuric NIDDM patients in the absence of retinopathy may remain stable for years.

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